Older people with mental health needs and dementia often face difficulties with daily living and community participation, requiring the intervention of social care services. However, cognitive and emotional needs often mean that mainstream support is not appropriate. In England, mental health support workers may attempt to address these concerns, to prevent mounting care needs and the potential for institutional care. Yet, their work has not been researched to identify good practices and to understand the mechanisms through which they engage older people. A new qualitative study used semi-structured interviews and focus groups with specialist support workers (n = 22), managers (n = 7), homecare staff (n = 4) and service users and carers (n = 6). The latter group were interviewed by co-authors with lived experiences of dementia and care. Participants were recruited from mental health services, home care organisations and third-sector agencies across the North of England in 2020–2021. The study identified three themes that described support worker activities. First, ‘building trusting relationships’ identified steps to establish the foundations of later interventions. Paradoxically, these may involve misleading clients if this was necessary to overcome initial reluctance, such as by feigning a previous meeting. Second, ‘re-framing care’ referred to how the provision of care was positioned within a narrative that made support easier to engage with. Care framed as reciprocal, as led by clients, and having a positive, non-threatening description would more likely be accepted. Third, ‘building supportive networks’ described how older people were enabled to draw upon other community resources and services. This required careful staging of support, joint visits alongside workers in other services, and recognition of social stigma. The study was limited by constrained samples and covid context requiring online data collection. The study recommends that support workers have more opportunity for sharing good practice across team boundaries, and improved access to specialist training.

中文翻译：

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最大限度地让有心理健康需求和痴呆症的老年人参与社会护理

有心理健康需求和痴呆症的老年人在日常生活和社区参与方面经常面临困难，需要社会护理服务的介入。然而，认知和情感需求往往意味着主流支持并不合适。在英格兰，心理健康支持工作者可能会尝试解决这些问题，以防止不断增加的护理需求和机构护理的可能性。然而，尚未对他们的工作进行研究，以确定良好做法并了解他们与老年人互动的机制。一项新的定性研究使用半结构化访谈和焦点小组，对象包括专家支持人员 ( n  = 22)、管理人员 ( n  = 7)、家庭护理人员 ( n  = 4) 以及服务使用者和护理人员 ( n = 6). 后一组接受了共同作者的采访，他们有痴呆症和护理的生活经历。参与者是在 2020-2021 年间从英格兰北部的心理健康服务机构、家庭护理组织和第三部门机构招募的。该研究确定了描述支持人员活动的三个主题。首先，“建立信任关系”确定了为以后干预奠定基础的步骤。矛盾的是，如果这是克服最初不情愿所必需的，这些可能会误导客户，例如假装之前会面。其次，“重新构建护理”指的是如何将护理的提供置于叙述中，使支持更容易参与。护理被定义为互惠的，由来访者主导，并且具有积极的、无威胁的描述更有可能被接受。第三，“建立支持网络”描述了老年人如何能够利用其他社区资源和服务。这需要谨慎地提供支持，与其他服务部门的工作人员一起进行联合访问，并承认社会耻辱感。该研究受到受限样本和需要在线数据收集的 covid 上下文的限制。该研究建议支持人员有更多机会跨团队分享良好实践，并改善获得专家培训的机会。