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Specialist Mental Health Services for Older People (SMHSOP) Community Team

What it is

SMHSOP community teams are central to the provision of coordinated services to older people with mental health problems. These teams have three major functions: specialist mental health assessment and treatment, care planning and case management.

How it works

Provides specialist mental health assessment and treatment, community team care planning and case management for older people with severe mental health problems. The model provides consultation / liaison and conducts capacity building with other key services as well as activities with a prevention and early intervention focus. SMHSOP community teams may be involved in hospital admission and discharge processes, and work in partnership with other services such as aged health, aged care and GPs. There are SMHSOP community teams in each Local Health District, and consumers are referred to the service via the Mental Health Line (1800 011 511) or directly to the local SMHSOP service. Wherever possible, community care is provided in the person’s normal place of residence (home, supported accommodation or residential aged care). A mid-term evaluation of the NSW Service Plan for SMHSOP found that in 2009-10, there were more than 141,000 contacts provided by community SMHSOP teams to close to 11,000 individuals.  The contacts provided by these teams have increased by more than 200% since 2004-05, and they have increased as a proportion of total services provided to the target group (i.e. with services also provided to this group by adult mental health teams).


Multidisciplinary teams comprising clinicians specialising in older people’s mental health such as nurses, psychologists, social workers, occupational therapists and old age psychiatrists.

Success factors

  • Clear point/s of entry and access arrangements
  • Multidisciplinary team with specialist mental health and aged care knowledge
  • Specialist geriatric/psychogeriatric assessment
  • Case management functions
  • Strong partnerships and collaboration with key partner services from mental health and aged care, and GPs
  • Capacity building with families, carers and other service providers
  • Provision of integrated bio-psychosocial care
  • Strong clinical governance
  • Involvement in benchmarking
  • Integration of SMHSOP clinical service stream within the broader mental health service
  • Support from adult mental health services, especially for acute responses
  • Use of financial incentives to encourage less expensive, community-based care.

Models in operation

  • SMHSOP Community Teams / SMHSOP Community Services (each Local Health District)