Mental health toolkit
The Mental Health Toolkit may be used by any primary care professional or general practice in the UK. It is designed to collate resources which inform and support delivery of high quality mental health care in the primary care setting. It is arranged by clinical topic, and there are also sections collating important national and international guidelines and key documents for those involved in service design and commissioning. Patients, carers, and GPs concerned about their own mental health, may also find the toolkit useful.
Older adults
Guidelines
Care Homes NICE Quality Standard [QS50] - Mental wellbeing of older people in care homes (2013) - This quality standard covers the mental wellbeing of older people (aged 65 and over) receiving care in care homes. It focuses on support for people to improve their mental wellbeing so that they can stay as well and independent as possible.
Delirium SIGN Guideline 157 - Risk reduction and management of delirium (2019) - This guideline provides recommendations based on current evidence for best practice in the detection, assessment, treatment and follow up of adults with delirium, as well as reducing the risk of delirium. The guideline applies to all settings: home, long-term care, hospital, and hospice.
Delirium NICE Guideline [NG103] – Delirium: prevention, diagnosis and management (updated 2019) - This guideline covers diagnosing and treating delirium in people aged 18 and over in hospital and in long-term residential care or a nursing home. It also covers identifying people at risk of developing delirium in these settings and preventing onset. It aims to improve diagnosis of delirium and reduce hospital stays and complications.
Delirium NICE Quality Standard [QS63] – Delirium in adults (2014) - This quality standard covers the prevention, diagnosis and management of delirium in adults (aged 18 and over) in hospital or long-term care settings.
Dementia NICE Quality Standard [184] – Dementia (2019) - This quality standard covers preventing dementia, and assessment, management and health and social care support for people with dementia
Dementia NICE Guideline [NG97] - Dementia: assessment, management and support for people living with dementia and their carers (2018) - This guideline covers diagnosing and managing dementia (including Alzheimer’s disease).
Dementia NICE Technology Appraisal [TA217] - Donepezil, galantamine, rivastigmine and memantine for the treatment of Alzheimer's disease (updated 2018) - This discusses assessment of dementia and the use of donepezil, galantamine, rivastigmine and memantine for treating Alzheimer's disease in adults.
Dementia NICE Guideline [NG16] - Dementia, disability and frailty in later life – mid-life approaches to delay or prevent onset (2015) - This guideline covers mid-life approaches to delay or prevent the onset of dementia, disability and frailty in later life. The guideline aims to increase the amount of time that people can be independent, healthy and active in later life.
Useful resources
Addenbrookes Cognitive Examination III (ACE-III) - A detailed memory assessment, enabling a breakdown of scores into attention, memory, fluency, language and visuospatial skills.
Alzheimer’s Society - Optimising treatment and care for people with behavioural and psychological symptoms of dementia - A best practice guide for health and social care professionals (2016) - This guide aims to provide evidence-based support, advice and resources to professionals caring for people with dementia who have behavioural and psychological symptoms. It has been designed to be a practical, informative tool, with an emphasis on alternatives to drug treatment, although these are also considered (page 22).
Devon Partnership NHS Trust - Pharmacological Management of
Severe Behavioural & Psychological Symptoms of Dementia (BPSD) (2019) - These guidelines by Devon Partnership NHS Trust have some very useful evidence-based advice on interventions for BPSD.
Hub of Hope - A directory of local services for support with a wide variety of mental health and related issues.
GPCOG - The Dementia Collaborative Research Centres have produced the General Practitioner assessment of Cognition (GPCOG) is a screening tool for cognitive impairment. It has been designed for primary care practitioners. It comprises a patient interview and an informant interview. This link is to the online version, but it is also available in printable format in several languages.
Mini Mental State Examination (MMSE) - This is the more detailed 30-point screening tool, commonly used in secondary care memory services.
Montreal Cognitive Assessment (MoCA) - A 10 minute, 30 point test which includes executive functioning and attention tasks, as well as language, memory and visuo-spatial skills designed for those scoring 24-30 on MMSE. It is free to use, but registration is needed. If you do not wish to do the online training in its administration then you can still use it but have to sign a disclaimer to say you are untrained.
Top Tips: Diagnosis and management of common mental health problems in older people. - A brief guide to the diagmosis and management of mental illness in older people – a summary of the content of the ‘Practice Primer’ but NHS England and NHS Improvement (see below).
Top Tips: Management of Depression in Older People: Why this is Important in Primary Care - The primary care management of depression in older adults is summarised in this document.
6-item Cognitive Impairment Test (6-CIT) - Developed by The Kingshill Research Centre, Swindon, this is a brief screening tool in primary care, although the scoring is more complicated than some other tools. It has high sensitivity and specificity rates and takes 3-4 minutes to complete.
Patient and carer information
Age UK - Age UK offer friendship services, both face to face and via telephone, to combat loneliness in older people. There is a wealth of information on dementia and depression/anxiety in later life. Practical advice and support is also available on a variety of life issues such as finding and arranging care, and support for carers.
Alzheimer’s Society - A list of resources for patients and carers with dementia is available here.
Carers Trust - This site helps carers find help, information and support local to them. It includes specific information about mental health caring.
Independent Age - This site helps people live well, keep active, addresses lonliness and discusses relationships in later life.
Men’s Sheds - These are community spaces for men to connect, converse and create. The activities are often similar to those of garden sheds, but for groups of men to enjoy together. They help reduce loneliness and isolation.
Mental Health Foundation - Information on changes in later life and how they may affect mental health. It includes a guide on how to look after your mental health in later life.
Mind - There is a legal line (0300 466 6463) for free advice on mental health related law, including mental capacity, community care and discrimination.
Princess Royal Trust for Carers - This organisation helps people make plans in advance about what would happen to the person they care for should they unexpectedly become unwell themselves and not able to fulfil their caring role.
Public Health England – A Guide to Healthy Caring - This guide offers advice to carers on keeping well, recognising the strain that being a carer can bring.
Rethink Mental Illness – Carers Hub - This section of the website has all that carers need to know about looking after their dependent.
Royal College of Psychiatrists - Information for patients, carers, family and friends relating to mental health problems and disorders.
The Silver Line - This is a confidential help and advice line, available 24/7/365, and it also offers telephone friendship calls and facilitated groups.
10 Today - 10 Today is an exercise programme led by older people, for older people. It provides a series of easy and accessible 10-minute broadcasts, which can be done almost anywhere and at any time, in a group or alone, standing up or sitting down, and which can be adapted to different fitness levels. 10 Today aims to increase mental wellbeing and social interaction through group classes, whilst also improving physical activity.
Further information and reading
Alzheimer’s Society – Resources for professionals - This includes a link to refer people to Dementia Connect for tailored support from Alzheimer’s society. There are also educational materials on the site.
British Association for Psychopharmacology – Dementia (2017) - This consensus statement looks at the changes to classification of cognitive impairment and a detailed review of drugs for dementia.
Troya, M., Babtunde, O., Polidano, K. et al. Self-harm in older adults: systematic review. British Journal of Psychiatry, 214(4), 186-200 - This paper looks at the latest evidence and characteristics around self-harm in older people. It is discussed further in a podcast with Dr Elizabeth England and Professor Carolyn Chew-Graham.
NHS England, RCGP, Age UK Webinar: Detection and Treatment of Depression in Older People - This webinar explores how to improve the identification of mental illness in older adults. It discusses tips and issues around OPMH in primary care.
NHS England – Dementia diagnosis and management (2015) - This is a brief, pragmatic resource for GPs, and this version has summary notes and highlights to make it easy to use. It includes justification and support for making the diagnosis of dementia in primary care.
NHS England and NHS Improvement - Mental Health in Older People
A Practice Primer - To support GPs’ and primary healthcare professionals’ diagnosis and management of common mental health problems in older people, a comprehensive guide has been published by NHS England and NHS Improvement.
NICE - Antipsychotics in people living with dementia (2019) - This document summarises the evidence base on antipsychotics in people living with dementia. It is a key therapeutic topic that has been identified to support medicines optimisation rather than formal NICE guidance.
RCGP eLearning Module – Alzheimer’s dementia - This course updates learners on how Alzheimer’s disease is diagnosed and managed. The emphasis is on the GP’s role in prescribing and dealing with difficult symptoms such as loss of appetite, poor sleep, agitation and aggression.
RCGP/RCPsych Joint webinar: a collaborative case discussion with GPs and old age psychiatrists - The aim of the webinar was to offer the opportunity for participants from primary care and psychiatry to learn together. The panellists worked through a case (based on experiences of the webinar presenters) to illustrate the complexity of managing an older person with mental-physical comorbidity.