title: The impact of the organisation of mental health services on the quality of assessment provided to older patients with depression.
abstract: OBJECTIVE
  The objective of this study was to examine the impact of the organisation of mental health services on the quality of medical and psychiatric assessment provided to patients with depression over 50 years of age.
  
  
  METHODS
  A retrospective clinical audit of 99 patients with primary depressive disorders who were over 50 years of age was used. These patients were assessed initially by specialised psychogeriatric outpatient and community services (44%), community-based adult mental health services (35%) or an inpatient service (21%). At 2-3 years follow up, clinical outcomes were rated by treating physicians and included current depression status, cognitive and medical status, course of illness since initial assessment and current living circumstances.
  
  
  RESULTS
  Patients who were assessed by the community-based adult mental health service received the least comprehensive assessment. Although these patients were more likely to be living independently, they tended to have the poorest depression outcome. Patients who were assessed by the specialised or inpatient services received more comprehensive initial assessment and better coordinated long-term care. Although these patients had more medical and cognitive comorbidity they had better overall depression outcomes.
  
  
  CONCLUSIONS
  Within a service system that determines access according to an arbitrary age of onset, patients with depression receive the best assessment from specialised psychogeriatric services. However, patients with an early age of onset, more chronic disorders and poor outcomes are treated largely within community-based adult services. Psychiatric services need to ensure that all older patients with depression receive appropriate biomedical and psychosocial assessment, as well as continuity of medical and psychological treatment.
authors.affiliation: The University of New South Wales, Sydney, Australia. i.hickie@unsw.edu.au
authors.forename: I
authors.initials: I
authors.lastname: Hickie
authors.forename: D
authors.initials: D
authors.lastname: Burke
authors.forename: M
authors.initials: M
authors.lastname: Tobin
authors.forename: C
authors.initials: C
authors.lastname: Mutch
mesh_terms: D000367:Age Factors; D000368:Aged; D002391:Catchment Area, Health / Q000706:statistics & numerical data; D003863:Depression / Q000175:diagnosis* / Q000628:therapy*; D005260:Female; D005852:Geriatric Psychiatry / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000458:organization & administration / Q000706:statistics & numerical data; D006299:Health Services for the Aged / Q000458:organization & administration*; D006801:Humans; D008297:Male; D008485:Medical Audit; D008605:Mental Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies