The Pathways to Community Living Initiative (PCLI) for older adults: implementation and outcomes.

OBJECTIVE: To describe implementation of the Pathways to Community Living Initiative (PCLI) within an Older People's Mental Health (OPMH) service. METHOD: A retrospective observational study was conducted. Implementation comprised partnership with a specialist Residential Aged Care Facility (RACF). Data were obtained from Clinical Advisory Committee (CAC) discussion and minutes, the PCLI database, and consumer medical records. RESULTS: Eighteen consumers were accepted onto the program between April 2019 and March 2023. Their PCLI and rating scale outcomes alongside interventions facilitating placements are described. Interventions included OPMH case management, wide-reaching liaison, and inservices. Challenges included communication, confusion regarding roles, and differing views on capacity to accommodate complex consumers. Solutions included streamlining communication, including clinical updates in the CAC, facility appointment of a lead PCLI-nurse, and targeted RACF education. CONCLUSIONS: Considered interventions strengthened the OPMH and specialist RACF partnership over time. Clarification of professional roles and intersection with other services was crucial. Successful placement for PCLI consumers required consideration of personalised needs and existing resident mix, liaison with stakeholders, and targeted staff training. These strategies may apply to other health services implementing similar initiatives supporting community placements for OPMH consumers with complex needs.

Pathways to community living in practice: Local development and adaptation within an older peoples mental health service.

OBJECTIVE: To describe the local adaptation of the Pathways to Community Living (PCLI) program in an Older Peoples Mental Health (OPMH) service to guide other services. METHOD: A retrospective observational study was conducted. Data were obtained from service planning meetings and newly developed documents, Clinical Advisory Committee meetings, and OPMH PCLI database. RESULTS: The PCLI program was adapted for the local OPMH service through development of an assessment template, creating a Memorandum of Understanding with a partner Residential Aged Care Facility (RACF) and establishing processes for collaboration and regular review. Between 2019 and March 2023, 20 mental health consumers were referred to the OPMH PCLI program. Their demographic and clinical characteristics are described. CONCLUSIONS: Adaptation of the PCLI program for OPMH consumers required consideration of specific older adult needs to develop a bespoke plan for assessment and partnership with the PCLI-funded RACF. The development phase and ongoing processes for review facilitated engagement of key stakeholders across health and RACF sectors, highlighting issues with consumer engagement. Similar models could be used by other health services to implement the PCLI in their local context.

Homicide and Dementia: A Systematic Review.

BACKGROUND: Homicide by older offenders is rare and devastating. It likely occurs due to a complex interaction of personal, social, and environmental factors. Dementia is a progressive neurological condition which may amplify behavioural disturbances such as aggression. This systematic review aims to evaluate the factors associated with homicide committed by people with dementia in order to inform clinical practice. SUMMARY: MEDLINE, PsychINFO, Embase, and PubMed databases were searched in accordance with PRISMA guidelines for empirical studies examining the characteristics and circumstances of people with dementia who committed homicides. Data on factors associated with the homicide were extracted and the quality of each study rated using standardized criteria. A total of 499 papers were screened and thirteen studies met the inclusion criteria. Study design included case reports (seven studies), case series (four studies), and two retrospective cohort studies, indicative of low levels of evidence. Sample sizes were 1-70. Study findings were predominantly descriptive. Quality ratings ranged from 50 to 100%. Factors associated with disinhibition such as dysexecutive syndrome, alcohol use, and delirium may predispose to severe impulsive aggression. Psychosis and personality pathology appeared to influence targeted assaults resulting in homicide by people with dementia. Victim vulnerability was also a key element. KEY MESSAGES: The current evidence examining risk factors for homicide committed by people with dementia is limited. However, there are common characteristics reported in these descriptive studies including psychiatric factors and cognitive states causing disinhibition. Recommendations for clinical practice include early assessment of older people with dementia and changed behaviours to allow management of comorbidities and reversible risk factors, alongside education, and advice to carers (who may be targets of aggression). Specialized geriatric forensic psychiatry services and care settings should be developed.

Prevalence and characteristics of mental disorders in jails and prisons.

PURPOSE OF REVIEW: The published literature from 2004 on mental disorders in jails and prisons was reviewed. RECENT FINDINGS: A number of important studies on prisoner suicide, older prisoners, prison medical services and inmate mental health are highlighted, which provide useful potential interventions to improve the care of mentally ill prisoners. Relevant pieces on ethical issues are also discussed. SUMMARY: Despite increasing prison populations worldwide and robust evidence that serious mental disorders are common in inmates in Western countries, many key issues in the treatment of mentally disordered prisoners remain unanswered. In addition, the evidence base on the nature and prevalence of mental disorders in prisoners in non-Western countries remains small.