Older people with mental disorders can potentially benefit from crisis and home treatment services in managing their frequently complex mental and physical health needs. If the principles of equity and the recent anti-age discrimination policies in the UK (Department of Health, 2004, 2005) are to be upheld, such services developed for people of working age should be made available to older adults with mental health disorders on the basis of need. This is not, however, currently the case in the UK. For older people with physical health problems, there has been considerable development in intermediate care services providing intensive multidisciplinary input to allow people who would otherwise be at risk of unnecessarily long stays to live more independently, typically in their own homes (British Geriatrics Society, 2004). However, those who also have comorbid mental health problems face barriers in accessing these services (Morris et al., 2006). In this chapter, we first consider the challenges in developing crisis services for older people. We then examine the current extent and nature of crisis and home treatment services for older people, and review the three potential models of service provision: intermediate care, general adult crisis resolution teams (CRTs) and specialist teams.

Challenges in setting up mental health teams for older people

The configuration of specialist mental health services for older people in the UK varies substantially, with some based on the model usual in services for adults of working age (multidisciplinary community teams allied to inpatient units), while others are based on more traditional medical models of ‘doctor led’ assessment (Challis et al., 2002).