Spotlight on our intensive dementia service

Our intensive dementia service (IDS) was set up in 2017 as an urgent assessment and treatment service for people with a diagnosis of dementia, undiagnosed/suspected dementia, and increased confusion, who exhibit significant challenging behaviours that increase the risks to themselves or others

These behaviours often include both verbal and physical aggression towards others and/or property, increased levels of agitation, restless or driven behaviours, and non-engagement with their usual care and treatment, which in turn causes significant carer strain, burn out, and the risk of a placement breaking down.

The service, which aims to prevent admissions into our mental health in patient beds at Pyrland ward, as well as to support discharge, operates across Somerset.

The East team is based at Magnolia House, on the Summerlands Hospital site in Yeovil, and the West team is based on the upper floor of Pyrland Ward, on the Wellsprings Hospital site in Taunton.

Each team is made up of registered nurses, mental health practitioners, assistant practitioners, community support workers, a team manager and a team administrator, with a consultant psychiatrist working across both teams. All colleagues in the team have extensive knowledge of dementia and its management.

The teams provide a service seven days a week, between the hours of 8am and 8pm, enabling colleagues to support individuals intensively.

Emma Norton, the service manager, explains: “We know that an admission to hospital can cause increased distress, further disorientation and confusion to individuals who have dementia and impaired cognition, which is why assessment, treatment and risk management within the community is so important.”

The number of people referred into our intensive dementia service has grown year on year.

“Referral numbers have increased by more than 550 over the last three years, with the current average monthly referral rate running at 149,” Emma continues. “As awareness of the service has grown, so have the number of people referred into us.

“Before our service was set up in 2017, there was a clear gap in community service provision for patients with dementia.

“We had our older persons’ mental health inpatient beds for those who needed admission, and our older adults' community mental health teams, but they only worked Monday to Friday, 9am to 5pm.

“Outside of these hours, there was no specialist service that could provide urgent assessment, treatment and support during evenings and weekends. The development of our service meant that we could fill this gap enhancing community services.”

The service has established links with nursing and residential homes throughout Somerset and these settings are the biggest referrer into the service.

It also provides assessment and support to individuals within our trust’s intermediate care pathway beds.

Sue Stephens, home manager at Immacolata House care home, says: “Almost three years ago we opened the older people’s mental health plus unit at Immacolata House. The individuals we admitted had the most complex needs, and all required constant assessment and reassessment often with urgent medication changes required.

“From the start, colleagues in the intensive dementia service were there at the end of the phone, offering advice and attending the home in times of crisis, as well as helping with medication and other behavioural management strategies.

“This meant we could quickly optimise the mental health of those we look after, enabling them to move on to care in the communities they chose to live in. The whole team are approachable, supportive and willing to engage with us to enable the best outcome for our residents.”

How to make a referral into the service

Emma explains that the team has made the referral process into the intensive dementia service as easy as possible.

She says: “As we’re a crisis service, a simple referral pathway is key, so we ask people who refer into us, whether they are patient family members/carers or our fellow NHS or social care colleagues, to simply pick up the phone and call the team to discuss the referral.

“We run through some triage questions to gather information about the nature, duration and frequency of the behaviours that are increasing the persons risks, as well as establishing what solutions have been tried, and the referrer’s expectations from the referral.

“The duty worker then reviews the patient record to gain a fuller picture of their health needs, and from that we identify next steps, whether that be our team undertaking a face-to-face initial assessment, or providing some advice and ongoing referrals to other more appropriate services.”

IDS East: 01935 443602, email: IntensiveDementiaServiceEast@somersetft.nhs.uk

IDS West: 01823 426240, email:IntensiveDementiaServiceWest@somersetft.nhs.uk

Who can refer into our intensive dementia service?

Our intensive dementia service accepts referrals from a variety of different routes, including healthcare professionals from within the trust, as well as external health and social care providers, care home colleagues, patients carers and families.

If a person has been recently discharged from the service, carers can still make contact if further advice and support is required due to a deterioration in the person’s mental health.

What does the intensive dementia service offer?

Following assessment, the team offers a range of treatment, including medication reviews, prescribing and de-prescribing.

It also has a significant focus on non-pharmacological interventions, using the Newcastle model to identify triggers and patterns to behaviours to develop personalised safety plans to help manage this. The team can provide observational and monitoring visits.

Our colleagues can work alongside carers to role model and demonstrate an effective approach and communication to reduce levels of distress. They also provide support to carers via onward referral to carer support services and dementia advisors.