[A version of this item appears in: Dementia: the Latest Evidence Newsletter (RWHT), Volume 2 Issue 9, April 2012].
This document has been written by Ruth Eley and the JCP-MH editorial team. It is based broadly on the Dementia Commissioning Pack produced by the Department of Health in 2011. Section headings cover:
- What are dementia services?
- Why are dementia services important to commissioners?
- What do we know about current dementia services?
- What would a good dementia service look like?
- Supporting the delivery of the mental health strategy and national dementia strategy.
This guide covers a comprehensive dementia commissioning programme, which includes:
- The public health component, dealing with prevention, early identification of people with dementia, concentration on high-risk groups such as people who fall, and on people with a family history of dementia or vascular risk factors.
- Assessment and early diagnosis services for people with memory problems. Treatment with anti-Alzheimer’s medication (acetylcholinesterase inhibitors). Identification of people with mild cognitive impairment (MCI) and follow-up for risk of progression to dementia.
- Dementia support services based in the community, possibly involving a dementia advisor or a designated member of the health / social care team to act as the care manager for people with more complex needs. Community support might include telecare, housing adaptations, carer support and day opportunities.
- Specialist mental health care services for patients with dementia and behavioural problems (BPSD), patients with dementia complicated by comorbid functional mental health problems and people with complex diagnoses. Such services have a community focus, but may involve a limited number of inpatient beds. Some patients may need to be detained under the Mental Health Act or the Deprivation of Liberty Safeguards.
- Mental health liaison services based in acute general hospitals with specialist expertise in dementia and delirium. These may have links with physical health services for the elderly and older people’s community mental health teams.
This guide also discusses dementia care standards for memory services; the prescription of anti-dementia medication; inappropriate use of antipsychotic medication; and dementia care standards for acute general hospitals. The latter includes the 2012 dementia care CQUIN to improve awareness and diagnosis of dementia, with risk assessments, in acute hospital settings.
The entire patient care pathway is considered, with joint commissioning of services to enable people to live well with dementia at all stages:
- Public information / awareness campaigns.
- Memory services.
- Information for people with dementia and carers.
- Continuity of support for people with dementia and carers.
- Peer support for people with dementia and carers.
- Improved community personal support.
- Implementing carers’ strategy for people with dementia.
- Improved care in general hospitals.
- Improved intermediate care for dementia.
- Housing including telecare.
- Improved care home care.
- Improved end of life care.
Eley, R. [and] Joint Commissioning Panel for Mental Health (2012). Guidance for commissioners of dementia services. Volume Two: Practical mental health commissioning. London: Royal College of Psychiatrists’ Joint Commissioning Panel for Mental Health, February 2012.