School of Medicine, Keele University, Staffordshire, UK.
Research and Innovation Department, Midlands Partnership NHS Foundation Trust, Stafford, UK.
Health Expect. 2022 Dec;25(6):2658-2679. doi: 10.1111/hex.13594. Epub 2022 Sep 6.
Mental health problems experienced by older adults (60+ years of age) may remain hidden due to individual and system-level barriers. Opportunities to support early identification and management are therefore crucial. The National Health Service recommends wider public services that are embedded within local communities, but are not traditionally part of the healthcare landscape (i.e., 'nontraditional'), could facilitate engagement with healthcare by members of the public. Evidence for interventions involving Fire and Rescue, Police, Library services and postal workers, as nontraditional providers of mental health services, has not been synthesized previously. This review aims to understand how, why and in what contexts mental health interventions delivered by these nontraditional providers, to older adults, work.
A realist review of interventions to identify and/or manage mental health problems (depression with or without anxiety) experienced by older adults. Systematic, cluster and iterative literature searches were conducted. Intervention evidence was appraised for rigour and explanatory relevance and then coded to inform context-mechanism-outcome configurations (CMOCs). A public advisory group supported our initial evidence search strategy and definition of key terms. This review is registered with PROSPERO (CRD42020212498).
Systematic searches revealed a dearth of evidence reporting mental health interventions delivered by nontraditional providers. Our scope was adjusted to consider interventions delivered by Fire and Police services only and for wider health and wellbeing concerns (e.g., dementia, falls prevention, mental health crises). Forty-three pieces of evidence were synthesized. Key themes included: legitimizing expanded roles, focusing on risk, intervention flexibility and organization integration; further subthemes are described. Themes map onto CMOCs and inform a preliminary programme theory. Findings were transposed to mental health contexts.
Findings highlight challenges and opportunities for Fire and Police services, as nontraditional providers, to deliver interventions that identify and/or manage mental health problems among older adults. Our programme theory explains what could work, how, for whom and also by whom (i.e., which public services). Further empirical evidence is needed to test interventions, understand acceptability and inform implementation.
A public advisory group comprising older adults with lived experience of mental health problems and informal caregivers contributed to the original application, reviewed the scope and informed the approach to dissemination.
老年人（60 岁及以上）经历的心理健康问题可能由于个人和系统层面的障碍而被隐藏。因此，支持早期识别和管理的机会至关重要。国民保健制度建议更广泛的公共服务嵌入当地社区，但这些服务并非传统意义上的医疗保健服务（即“非传统服务”），可以促进公众与医疗保健的接触。此前，尚无证据表明消防、警察、图书馆服务和邮政工作人员等非传统的心理健康服务提供者参与的干预措施是有效的。本综述旨在了解这些非传统服务提供者为老年人提供的心理健康干预措施是如何、为何以及在何种情况下发挥作用的。
通过对干预措施的系统评价，确定和/或管理老年人经历的心理健康问题（伴有或不伴有焦虑的抑郁症）。进行了系统、聚类和迭代文献检索。对干预措施的证据进行了严格性和解释相关性评估，然后进行编码，以提供情境-机制-结果配置（CMOC）。一个公共咨询小组支持了我们最初的证据检索策略和关键术语的定义。本综述已在 PROSPERO（CRD42020212498）上注册。
系统搜索发现，很少有证据报告非传统服务提供者提供的心理健康干预措施。我们的范围进行了调整，仅考虑消防和警察服务提供的干预措施，以及更广泛的健康和福利问题（例如，痴呆症、预防跌倒、心理健康危机）。综合了 43 条证据。关键主题包括：使扩展角色合法化、关注风险、干预措施的灵活性和组织整合；进一步描述了子主题。主题映射到 CMOC，并为初步方案理论提供信息。研究结果被转换到心理健康背景下。
研究结果强调了消防和警察服务作为非传统服务提供者在为老年人提供识别和/或管理心理健康问题的干预措施方面所面临的挑战和机遇。我们的方案理论解释了什么是可行的、如何实现、针对谁以及由谁实现（即哪些公共服务）。需要进一步的实证证据来测试干预措施、了解可接受性并为实施提供信息。
一个由有心理健康问题经历的老年人和非正式照顾者组成的公众咨询小组参与了最初的申请，审查了范围，并为传播方法提供了信息。
