Understanding how “non-traditional” providers can support early detection of mental health problems among older adults: a realist synthesis

Problem

Help-seeking for mental health problems among older adults can be delayed due to a lack of awareness, stigma, and limited access to acceptable services. Mental health problems within this population can affect quality of life, the management of physical comorbidities and relationships with others – often detection of mental health problems occurs at a late stage or crisis point. NHS recommendations suggest that wider public services should support the delivery of healthcare interventions to support prevention, early intervention and to reduce the burden of crisis care. Evidence for interventions delivered by Fire & Rescue Services – in the context of falls prevention, smoking cessation and flu vaccination – and Police Forces – in the context of mental health crisis and dementia – suggest such interventions are effective and acceptable. Utilising existing points of contact between public service workforce and potentially vulnerable older adults could therefore support early identification of mental health problems and engagement with support services. However, we need to better understand how, when and in what contexts interventions delivered by non-traditional for older adults, work.

Approach

A realist synthesis to identify interventions that support detection of, and sign-posting for, mental health problems in older adults. We focus on interventions delivered by services that would not traditionally be involved in healthcare, such as fire and rescue, police, and library services. A PPIE group supported our initial evidence search strategy and definition of key terms. The review is registered with PROSPERO.

Findings

Systematic evidence searches were conducted; these revealed a dearth of relevant and rigorous evidence reporting mental health interventions delivered by non-traditional providers. These searches informed an adjustment of the scope of our review. The review has been narrowed at a provider-level (fire and rescue services, police only) and broadened at a condition-level to include evidence for falls prevention and dementia interventions; findings will be transposed to mental health contexts. We are currently coding evidence to establish context-mechanism-outcome configurations to inform programme theories and make sense of interventions from multiple levels. The synthesis is due to be completed prior to the conference.

Consequences

By synthesising existing evidence from a realist perspective, new knowledge will be generated to better understand key mechanisms in mental health interventions delivered by non-traditional providers to older adults. Findings will provide the theoretical basis for a future study to support early identification and management of mental health problems among older adults.Abstract dedicated to Katie Tempest.