Collaborative practices with older people living at home with mental health problems: A person-centred approach

Mental health services in Norway are in a period of rapid development seeking to expand non-institutional mental health care. White papers focus on the adult population below retirement age and do not take adequate account of the needs of older people living with mental health problems. The Coordination Reform argues that service users needs for coordinated services are not taken care of in a satisfactory way. A more central role for the municipality was also stated, as well as strengthening service user´s participation in service development. Older people living at home with mental health problems and their families face a variety of illnesses and challenging situations and are in need of coordinated services provided in a context-specific and personcentred way. We derived our research focus and research aims by identifying key issues that impact on the transformation processes implicit in the Coordination Reform. The study is being carried out with an appreciative action research methodology, with an integrated qualitative evaluation of the implementation of a model of collaborative personcentred practice. The results will contribute to knowledge about how older people living at home with mental health problems and their families understand collaborative person-centred practice and how mental health and wellbeing can be promoted in a person-centred way. In the first stage of the research, an in-depth ethnographic study of services to older people in the municipality was undertaken. This involved 12-months of in-depth fieldwork (observations, interviews and document analysis) with the mental health and the home care teams. Naturalistic interviews with staff were undertaken during observation periods and 1: 1 interviews with service users and family members were also carried out. Focus groups were held with key stakeholders in the municipality. The analysis of this data resulted in the development of preliminary proposed 'model' of person-centred home-based mental health care for older people being developed. The key concept underpinning this model is 'a regime of generosity', implying that the key issue for older people is not that of structural organisation of services, but rather the need for services to be more integrated, fluid and flexible to meet their needs. The findings and preliminary model were presented and discussed using a variety of creative media with 50+ key stakeholders (predominantly service users and their representatives) at a 'kick-off' event. At this event, volunteers were identified to join 'action groups' to work with the findings and the model in order to develop implementation action plans. Working in these action groups and their evaluation formed stage 2 of the project. The data from this stage shows how older people and their families experience being members of a dialogue group, how social and health care professionals experience their work-life and the challenges they face in delivering person-centred care, what outcomes arose as a result of the implementation of a model of collaborative person-centred practice, and to what extent the model is transferable to other health care contexts. The key findings have implications for collaboration between general and specialist services and for the way in which services are planned by Municipalities.Key achievements include: Awareness of a more healthy and resource-oriented approach to service provision for older people in the municipality - Development and distribution of an information brochure about various assistance programs, activities and places for older people in the municipality - Setting up benches in city parks and gathering places - Cafe for seniors - Changing the focus and content of an activity center - The creation of the position of leader of the activity center - Reallocation of positions to the activity center

Mental health services in Norway are in a period of rapid development seeking to expand non-institutional mental health care. White papers focus on the adult population below retirement age and do not take adequate account of the needs of older people liv ing with mental health problems. The Coordination Reform argues that service users needs for coordinated services are not taken care of in a satisfactory way. A more central role for the municipality was also stated, as well as strengthening service user´ s participation in service development. Older people living at home with mental health problems, and their families, faces a variety of illnesses and challenging situations, and are in need of coordinated services provided in a context-specific and person centred way. We derived our research focus and research aims by identifying key issues that impact on the transformation processes implicit in the Coordination Reform. The study will be carried out with an appreciative action research methodology, combini ng qualitative components in developing, and a quantitative evaluation of implementation, of a model of collaborative personcentred practice. The results will contribute with knowledge about how older people living at home with mental health problems and their families understand collaborative personcentred practice and how mental health and wellbeing can be promoted, how social and health care professionals experience challenges and opportunities for promoting personcentred practice, the description of a nd key elements of a composite model of collaborative personcentred practice, how older people and their families experience being members of an appreciative action research group, how social and health care professionals experience being members of an ap preciative action research group, what outcomes arise as a result of the implementation of a model of collaborative personcentred practice, and to what extent the model is transferable to other health care contexts