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Specialist Mental Health Services for Older People - Acute Inpatient Unit

What it is

SMHSOP acute inpatient services provide specialist psychiatric care for people who present with acute, severe symptoms of mental illness.

How it works

Acute SMHSOP inpatient units may be discrete facilities or sub-units within acute mental health facilities or acute hospitals. The units provide multidisciplinary assessment of a person’s mental and behavioural status, including with physical health and psycho-social issues and short term clinical treatment (voluntary or involuntary) for the acute phase of an illness which cannot be managed in the community. Service options of acute inpatient treatment depend upon population size, catchment, infrastructure, workforce and resources. SMHSOP acute inpatient units have linkages with adult mental health teams and units, acute geriatric medical inpatient services, Emergency Department staff and aged care teams.  In 2009-10, SMHSOP acute admission units provided just over 2,000 episodes of care.

The SMHSOP Acute Inpatient Unit Model of Care Project Report was developed as a guide to support consistency and best practice for these units.


Units require a multidisciplinary team approach, and staff require extensive skills and knowledge and the capacity to work in collaboration with a range of key stakeholders. Staff require specialist training to manage older consumers with mental illness and problems associated with cognitive impairment, restricted mobility, physical illness and sensory impairment. Staffing numbers will vary on the acuity, dependency and presenting problems of the older consumers admitted (with higher staff ratios required for older consumers with severe agitation or BPSD).

Success factors

  • A range of factors for a good practice model of care are outlined in the SMHSOP Acute Inpatient Unit Model of Care Project Report, including:
  • Person-centred, recovery-focused biopsychosocial philosophy of care
  • Primary target population of older people with acute, severe clinical symptoms of mental illness, preferably with capacity to manage BPSD
  • Appropriate physical health care
  • Effective functional relationships with a range of other services, particularly SMHSOP community teams, aged health and aged care services, and adult mental health services, and other operational arrangements (such as access to ECT facilities and geriatric inpatient units) that support integrated service provision across inpatient, community and residential settings.
  • Key processes, including entry procedures to support most appropriate admission, assessment and care planning, and multidisciplinary case review
  • Recovery focused clinical interventions
  • Minimising use of seclusion and restraint
  • Appropriate and therapeutic facility design
  • Multidisciplinary staffing
  • Performance frameworks.
  • The ability to manage BPSD depends upon a workforce who is trained and oriented towards managing BPSD, programs which are suitable for people with BPSD, and facility design which allows some form of segregation of consumers with severe agitation or aggression.

Models in operation

  • SMHSOP Acute Inpatient Units – various locations across NSW (Sydney, South West Sydney, North Sydney, Hunter New England, Southern, South Eastern Sydney, St Vincent’s, Western Sydney, Illawarra Shoalhaven, Central Coast LHDs)