Title: The FIRESIDE Study: Optimising Fire and Rescue Service “Safe & Well” visits to support detection and sign-posting for mental health problems in older adults
Funder: Department of Health and Social Care

Abstract: RESEARCH QUESTION Can current &ldquo;Safe & Well&rdquo; (S&W) visits delivered by the Fire and Rescue Service be extended to support detection and sign-posting for mental health problems among older people living in the community? BACKGROUND Mental ill-health is a leading cause of disability worldwide. One-in-four older adults experience symptoms of mental ill-health. Anxiety and depression in later life are associated with distressing life events, such as bereavement, loss of meaningful roles, physical function or decline in cognitive capacity. Loneliness and social isolation, experienced by up to 50% of older adults, are associated with depression and suicide. However, fewer than one-in-six older adults consult a healthcare professional about symptoms of a mental health problem. Attitudes and beliefs about mental health prevent older people from seeking and accessing appropriate healthcare, such as: a lack of mental health awareness, perceived stigma, prioritising physical over mental health, and reluctance to add additional burden on NHS resources. Early detection of mental health problems remains a key NHS priority. Thus, &ldquo;non-traditional&rdquo; providers of healthcare may provide innovation solutions to support detection and help-seeking among this population. AIMS AND OBJECTIVES The proposed research aims to examine whether and how Fire and Rescue Service S&W visits can be optimized to include detection and sign-posting for mental health problems (anxiety and depression) in older people. Key objectives are set to explore delivery of existing S&W visits, examine acceptability among mixed stakeholder about extending S&W visits to include a mental health component, refine an intervention programme theory, and agree adaptations to S&W visits and new resources. METHODS Multi-method qualitative study designed in two sequential work packages (WPs). WP1 includes: non-participant observation of S&W visits (as currently designed) to better understand delivery processes, interactions and receptiveness among the public; focus groups with Fire and Rescue Service officers to explore acceptability and identify training needs, and; interviews with older people and health and social care stakeholders to establish in-depth contextual understanding of barriers and facilitators to inform design and implementation. WP2 includes a consensus workshop with a diverse range of stakeholders; findings from WP1 will be used to facilitate and inform workshop discussion to agree core components of the extended S&W visit. TIMELINES FOR DELIVERY This is an ambitious 12-month project. WP1 will be completed during months 1-10; WP2 will be completed during months 8-12. At 12 months we will have refined the intervention programme theory for the extended S&W visits, designed a delivery model and protocol for home visits, and developed new training materials. ANTICIPATED IMPACT AND DISSEMINATION A variety of research outputs will be generated to engage a range of different audiences including conference and meeting papers, peer-reviewed publications in high-impact journals and social media content. To maximise reach, we will engage members of our existing networks: National Fire Chiefs Council, Age UK, Primary Care Networks, Public Health England, Royal Colleges of General Practitioners and Psychiatrists, and the Society for Academic Primary Care. Outputs are intended to inform, generate interest in the next stage of testing and promote future scalability.

Lay abstract: AIM OF OUR RESEARCH The FIRESIDE study will examine whether an existing Fire and Rescue Service programme could be used to improve detection of mental health problems among older people, and support them to seek help. WHAT WE KNOW ALREADY Mental health problems such as stress, anxiety and depression are experienced by one-in-four people in the UK. Older people commonly experience things that put a strain on their mental health, including: physical health problems (arthritis, pain, diabetes), loss of mobility, and distressing life events (death of loved ones). Research tells us older people often delay seeking help for mental health problems. They may not recognize early signs, feel ashamed about what they are experiencing, or have limited access to services. Untreated mental health problems can worsen over time. This may lead other health conditions to worsen and put strain on personal relationships. It is important to find new ways to detect mental health problems early and provide support to older adults. NHS England are keen for public services (such as police and fire services) to support them in delivering healthcare. In some English regions the Fire and Rescue Service has provided health advice about falls prevention and administered flu vaccinations to the public. The Fire and Rescue Service provide &ldquo;Safe & Well&rdquo; home visits, across England, to potentially vulnerable people at risk of fire. Presently, &ldquo;Safe & Well&rdquo; home visits focus on fire prevention but could be expanded to cover mental health. WHAT WE PLAN TO DO We want to find out whether &ldquo;Safe & Well&rdquo; home visits could be extended to include mental health checks and advice for older people. These checks will look to detect early signs of mental health problems (depression and anxiety). Advice will include information, encouragement and support to access appropriate NHS and voluntary sector services. During the proposed research, we will talk with Fire and Rescue Service staff, healthcare providers, and the public to hear their views on proposed changes to &ldquo;Safe & Well&rdquo; visits. We will use this information to develop a new plan for &ldquo;Safe & Well&rdquo; visits to include mental health checks and information sharing. We will produce new training for Fire and Rescue Service staff to help them put these changes into practice. We will also collect information to understand how this new approach could work in the real world. PATIENT AND PUBLIC INVOLVEMENT (PPI) PPI supported the development of this research proposal. A PPI group will inform research decisions throughout including the approach to dissemination. DISSEMINATION We will share findings in several ways (published reports, presentations, visual animations, and lay summaries) to reach a broad audience from members of the public to national figures in health and social care.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES;7.1 INDIVIDUAL CARE NEEDS
Health categories: MENTAL HEALTH