mental health triage service procedure...3.9 referral to child and adolescent mental health team...

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Effective: 3 September 2014

WACHS KIMBERLEY Kimberley Mental Health and Drug Service

TITLE: MENTAL HEALTH TRIAGE SERVICE PROCEDURE

1. BACKGROUND

1.1 The Kimberley Mental Health and Drug Service (KMHDS) is a specialist servicethat provides ambulatory and inpatient care to people with mental health conditions and alcohol and or drug problems in the Kimberley region.

1.2 KMHDS Community Mental Health Service (CMHS) clinics are located in Broome, Derby, Fitzroy Crossing, Halls Creek and Kununurra. Mental Health (MH) Triage service is based at each site except Halls Creek. Services are provided to the community, hospitals and Emergency Departments (ED) and Remote Area Clinics.

1.3 KMHDS promotes easy and timely access to appropriate health services for patients experiencing mental health problems.

2. GUIDING PRINCIPLES

2.1 Clients are partners in the management of all aspects of their treatment, care andrecovery planning.

2.2 KMHDS implements and maintains ongoing engagement with carers as partners in the delivery of care as soon as possible in all episodes of care.

2.3 The Consultant Psychiatrist provides clinical oversight and leadership for MH Triage, assisted by Medical Officers (MO) and /or Psychiatric Registrars.

2.4 The MH Triage service is the first point of contact for all referrals to KMHDS and provides triage to all age groups.

2.5 Triage is preferably conducted face to face between the client and the Triage clinician but may be performed by telephone or by video conference (VC).

2.6 Where indicated and possible, the same gender Aboriginal Mental Health Worker is involved in the Triage assessment process.

2.7 KMHDS aim to minimise the need for multiple client assessments. 2.8 The Triage service coordinates consultation /liaison to hospitals and Emergency

Departments (ED). As part of this service Triage provides support to enhance staff confidence and competence in providing equitable and high quality care to patients with a mental health condition or alcohol and or drug problems.

Title: Mental Health Triage Service Procedure Contact: Community Mental Health Nurse; AMHP, Senior Project Officer (M.Vandale)

Directorate: Mental Health TRIM Record Number: ED-CO-14-56035 Version: 1.00

Date of Last Review: First Issue Date Published: 4 Sept 2014

Date Next Review: June 2016

This information is available in alternative formats upon request


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2.9 The Mental Health Triage team role is to: 3.2.1. prioritise care based on clinical need /risk 3.2.2. assist clients to access effective and appropriate support from either the

specialist mental health service or another service provider 3.2.3. consider the safety of clients, family and /or carer and the public at all

times in relation to the Triage process 3.2.4. triage all police notifications 3.2.5. provide a respectful and appropriate service to people who are

• of Aboriginal1 origin • from other culturally and linguistically diverse backgrounds

3.2.6. provide specialist advice and assistance regarding the care of patients with complex or acute presentations

3.2.7. use a standardised approach to assessment of urgency which includes: • obtaining relevant information from the client and others • performing a mental state examination • conducting a risk assessment

3.2.8. triage officers provide a provisional diagnosis as part of assessment formulation

3.2.9. facilitate a further in depth psychiatric assessment if the initial assessment is not adequate to determine the intervention required. This may be conducted with or by the Psychiatrist, Psychiatric Registrar or Psychiatry Resident Medical Officer

3.2.10. Broome site only – Share responsibility with the Mabu Liyan /BMHU Bed Manager to ensure handover is conducted weekday afternoons regarding pending admissions to the inpatient unit

Further information: 3.2.11. KMHDS Ambulatory Service – Documentation Standards for Referrals

Site Instruction 3.2.12. KMHDS Case Management (under development) 3.2.13. KMHDS Multidisciplinary Team Meeting Terms of Reference.

3. PROCEDURE 3.1 Referral to Mental Health Triage Service

3.1.1. People, family and or carers may present directly (without referral) while referrals are accepted from health professionals and other relevant agencies.

1 Within Western Australia, the term Aboriginal is used in preference to Aboriginal and Torres Strait Islander, in recognition that Aboriginal people are the original inhabitants of Western Australia. No disrespect is intended to our Torres Strait Islander colleagues and community.


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3.1.2. The KMHDS Referral and Resource Pack includes referral information to referrers and is distributed to external services and agencies. This pack is updated as required by KMHDS.

3.1.3. Where other services or agencies refer a person to MH Triage Service the necessary documentation should accompany the referral. This includes a:

• completed KMHDS referral form MR52A • completed Brief Risk Assessment MRK 119

Other documentation may include: • current management plan • metabolic screening • psychiatric assessment • recent blood results • recovery Management Plan • paediatrician review report (Child and Adolescent Mental Health

Service (CAMHS) 3.1.4. Detected Incident Reports

• Police notification referrals are received for all incidents of self-harm or threatened self-harm by fax via reception

• Following triage a Detected Incident Report (MKR14) is completed and

o scanned and emailed to Police o copy sent for Deliberate Self Harm register o original is filed in the client health record.

3.2 Mental Health Triage Clinician responsibilities

3.2.1. The MH Triage clinician is the first point of contact for incoming referrals and is responsible for:

• taking referral and complete, as required, on the PSOLIS Triage form

• conducting a Psychiatric Services On Line Information System (PSOLIS) search

• entering client referral information on the Triage Referral register • determining the level of intervention required and document this on

the PSOLIS Triage form • identifying the referral pathway for the client • where the client does not meet the referral criteria and depending

on his /her presentation, possibly referring: o back to the referrer o to GP o to counselling service o other mental health service provider o other drug and alcohol service provider.

http://wachs.hdwa.health.wa.gov.au/index.php?id=5286




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• Where the client meets the referral criteria and depending on his / her presentation, the Triage clinician may: o consult with and or conduct further assessment with or without

the Consultant Psychiatrist or Psychiatric Registrar o complete a Brief Risk Assessment form MRK 119 o collate client history o conduct a mental health assessment using and documenting

on the Mental Health Assessment form (SMHMR902) o provide a provisional diagnosis o provide client with rights and responsibilities pamphlet /

discussed o complete consent form (MRK30A) o where indicated and possible, develop client initial

management plan with client /carer o where client is referred from Mabu Liyan /Broome Mental

Health Unit (BMHU), on discharge from the unit, follow up contact must be made with the client as soon as practicable but within seven days. This can occur face-to-face or by telephone.

3.3 Assessment

3.3.1. MH assessments can take place at CMHS, in ED, on hospital general ward, in the community, on a home visit or at a Western Australia Police station.

3.3.2. MH assessments are to be conducted in conjunction with an Aboriginal Mental Health Worker (AMHW) where indicated and possible.

3.4 Case Managed Clients

3.4.1. Where the Case Manager (CM) is unavailable to respond to a case-managed client who contacts or presents to the clinic, Triage staff are, where possible, to contact the CM or another CM regarding the client to gain relevant information. Triage or other available staff are to provide service to the client as required.

3.5 Pending Clients

3.5.1. The Triage Pending Review form MRK55A is used to review all pending clients.

3.5.2. The Triage Pending Review form is signed by the overseeing psychiatrist.

3.6 Short Term Management 3.6.1. Where initial assessment indicates that brief intervention is required:

• Triage may provide these services for up to 12 weeks • the client may remain on the Triage case load where a client has

been referred for a time limited specialist service, e.g. psychological counselling, monitoring and stabilising of psychotropic medication

• the client may remain on the Triage pending referrals caseload, while awaiting treatment, for up to three months.


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3.7 Referral to Case Management Team 3.7.1. Clients can be referred to the Case Management Team following triage

assessment and or short term treatment. (See KMHDS Case Management procedure (currently under development)).

3.7.2. Criteria for referral to Case Management • Client has long term and persistent symptoms of mental illness

with ‘complex needs’ • Client requires individualised coordinated care • Client is likely to reside in the catchment area for an extended

period of time (e.g. greater than three months) Completion of: • comprehensive MH assessment MRK111A • Brief Risk assessment (BRA) MRK119) • psychiatric examination • PSOLIS – Health Of The Nation Outcome Scales (HONOS).

3.8 Referral to Community Drug Service Team (CDST)

3.7.1. Clients presenting with drug and or alcohol problems are to be referred to CDST unless assessed with an acute condition

3.7.2. Clients can also be referred to CDST following triage or short term treatment according to the CDST referral pathway.

3.7.3. Department of Corrective Services • Clients referred from the Department of Corrective Services may

present to Broome clinic every Wednesday 1.00 – 3.00pm. During this time clients are to have, where possible, a joint interview with CDST Counsellor and Triage staff

3.7.4. Indigenous Diversion Program (IDP) and Cannabis Infringement • A photocopy of IDP and Cannabis Infringement referrals are

provided to Triage by the KCDST staff for Triage documentation processing

3.7.5. Completed referrals must be placed in the CDST referral tray KCDST Referral Pathway

3.9 Referral to Child and Adolescent Mental Health Team (CAMHS)

3.9.1. Clients can be referred to CAMHS following triage according to the CAMHS referral process

3.9.2. Child and Adolescent Mental Health Service Access Criteria 3.9.3. 0.2 FTE Child and Adolescent Mental Health Professional is based in

Broome Triage to assist triaging of Broome CAMHS referrals.

3.10 Referral to Mabu Liyan /Broome Mental Health Unit (BMHU) 3.10.1. Clients can be referred to Mabu Liyan /BMHU following triage according

to the Mabu Liyan /BMHU referral process. 3.10.2. Mabu Liyan /Broome Mental Health Unit Patient Bed Flow Procedure



https://healthpoint.hdwa.health.wa.gov.au/policies/Policies/WACHS/Child%20and%20Adolescent%20Mental%20Health%20Services%20Access%20Criteria%20-%20Policy.pdf

https://healthpoint.hdwa.health.wa.gov.au/policies/Policies/WACHS/Patient%20Bed%20Flow%20Procedure%20-%20Broome%20Mental%20Health%20Unit%20(Mabu%20Liyan).pdf


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3.11 Referral to other Services 3.11.1. Where the client does not meet referral criteria or require CMH

services, Triage provides information and contact details of other key support agencies e.g. Centrelink, Department of Housing.

3.11.2. For referrals where there is no evidence that specialist mental health care is required but where risk is an issue e.g. assault, family violence, the Triage makes immediate contact with the relevant statutory agency i.e. Police, Department of Child Protection. It is a legal requirement for doctors and nurses to report all reasonable beliefs of child sexual abuse to the Department for Child Protection. For referrals where mental health conditions e.g. depression, anxiety are of a mild to moderate severity or related distress from adverse life events, Triage may refer the client to a General Practitioner or Boab Health Services Mental Health Counselling service. This must include appropriate referral information i.e. GP template or Boab Health service referral form.

3.12 My Care Plan

3.12.1. My Care Plan MRK24 is used where the client is triaged and referred to CMHS, KCDST or an external service provide. A signed copy of My Care Plan is given to the client/carer and a copy is filed in the client health record

3.12.2. My Care Plan

3.13 Additional services to hospitals 3.13.1. Consultation and liaison services to local general hospital regarding

patients admitted for mental health reasons. 3.13.2. Patients placed under the WA Mental Health Act 1996. 3.13.3. Where a patient has been placed on Form 1 (MHA) and is awaiting

transfer to either Mabu Liyan / BMHU, or an authorised metropolitan facility, Triage is able to provide recommendations regarding treatment and care to support hospital staff to safely manage the patient whilst awaiting transfer.

3.14 Services to West Kimberley Regional Prison

3.14.1. KMHDS Psychiatric services are provided on an as needs basis to West Kimberley Regional Prisons pending agreement with Corrective Services.

3.14.2. Requests for psychiatric services is to be initiated by the prison MH clinician and /or MO.

3.15 Services to Broome Regional Aboriginal Medical Service

3.15.1. Mental health clinics are held at BRAMS every second Wednesday from 0830hr to 1200hr. Two clinics run concurrently which are the BRAMS Mental Health Wellbeing Clinic (BMHWBC) and the Physical Health Clinic (see Case Management procedure – currently under development). Clinics are attended by the Consultant Psychiatrist and Aboriginal Mental Health Worker (AMHW).


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3.15.2. A designated Triage clinician acts as primary Case Manager for clients and supports the AMHW who is the secondary Case Manager

3.15.3. BRAMS Mental Health Wellbeing Clinic • KMHDS AMHW receives all new referral information from BRAMS

i.e. completed referral form (MRK52A) and BRA. • New MH referrals and pending referrals are seen by the

Consultant Psychiatrist and the AMHW where possible. • Where possible, same gender AMHW is to be available for

interview • KMHDS AMHW maintains the BRAMS Pending Referral folder. All

new referrals and client health records are held in this folder. • When a new referral is received the AMHW enters client details in

the Triage Intake Register. • All clients are reviewed through Triage clinical review meetings. • The Consultant Psychiatrist documents all client assessments on

MMEX and a copy is made available to the AMHW for the KMHDS client health record.

3.16 Documentation

3.16.1. Staff are to complete required documentation in the client health record. 3.16.2. Staff enter required data on PSOLIS.

3.17 Consultant Psychiatrist service hours

Mabu Liyan /BMHU and CMHS Consultant Psychiatrists are available. 3.17.1. Business hours

Mon – Thurs 0800 – 1630hr 3.17.2. After hours (includes public holidays)

The on call Psychiatrist is available via Broome Hospital switchboard: Mon – Thurs 1630 – 0800hr and Fri 1630hr to Mon 0800hr

3.18 Psychiatric Registrar and Psychiatry Resident Medical Officer service hours

3.18.1. Mon – Fri 0800 – 1630hr

3.19 Triage Business Meeting Regional Triage Business Meeting is held every eight weeks.

3.20 Triage Multidisciplinary Team Meetings

3.20.1. Standing items for meetings are to include: • new referrals • new client assessments • clients in local hospitals, Graylands or other hospitals • active clients three monthly review • challenging clinical issues • determination of ongoing need for service and discharge planning • discharged clients.


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3.21 Triage Multidisciplinary Team Meetings – all sites except Broome 3.21.1. Clinical Intake meetings for new referrals and pending referrals are

multidisciplinary and are held: • Derby: once weekly • Fitzroy Crossing: once weekly • Kununurra /Wyndham/Kalumburu: once weekly • Halls Creek: once every two weeks • Balgo: once every two weeks

3.21.2. Mabu Liyan /BMHU ward rounds for inpatients are held as indicated via telephone or VC.

3.22 Triage Multidisciplinary Team Meetings – Broome site

• Daily Triage meeting includes Triage staff, KCDST, CAMHS and medical • Triage staff attend the following meetings once weekly:

o Mabu Liyan /BMHU ward round for inpatients

• Triage, Community Drug Service Team and medical staff attend the following meetings

o Pending and activated clients once weekly • Triage and Mabu Liyan/BMHU Bed Manager meet for the purpose of

handover regarding pending /potential client admission in the afternoon on weekdays. Meeting can occur face to face or by phone.

• Triage staff attend daily Case Management coordination meetings as required.

3.23 Broome Mental Health Triage Service

3.23.1. MH Triage Service hours: • Mon – Fri 0800 to 1830hr and • Weekends and public holidays 0800 – 1630hr

3.23.2. After hours MH Triage • After hours Triage dedicated mobile telephone number is

0467 764 949 • Staff are based in Mabu Liyan /BMHU, CMHS or ED. • Staff are available to provide senior level consultation and support

to Mabu Liyan staff. • Telephone MH consultation is available to all hospitals and

Remote Area Clinics in the Kimberley and Pilbara regions. • As required Triage staff consult with BH duty DMO and the on call

Psychiatrist if the case is complex.

3.24 RuralLink 3.2.1. Outside of MH Triage hours, RuralLink (p: 1800 552 002) is the first

point of contact for referrers across the region. RuralLink have access to PSOLIS and is able to provide specialist MH advice, consultation and background information on known clients.


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4. DEFINITIONS 4.1 Mental Health Triage

4.4.1. Triage is the process of initial assessment to determine the need for service and the nature and urgency of the care required.

4.2 RuralLink

4.2.1. RuralLink is a specialist after hours mental health telephone service for the rural and remote communities of Western Australia.

4.3 Psychiatric Services On Line Information System (PSOLIS)

4.3.1. PSOLIS is the Mental Health Clinical Information system and is designed to collect demographic information and treatment related history from clients of public MH services in order to support the provision of optimum care and treatment.

4.3.2. PSOLIS – Health of the Nations Outcome Score (HONOS) is a scale to measure the health and social functioning of people with severe mental illness.

4.4 Complex Needs

4.4.1. All clients who are case managed have ‘complex needs’. 4.4.2. All case managed clients are reviewed using the PSOLIS HONOS

score. The score determines the ‘complex’ client’s level of severity. Currently there is no range within the HONOS score to differentiate a client's level of complexity.

4.4.3. Complexity is likely derived from: o Multiple diagnoses on Axis 1 and 2 o Drug and /or Alcohol disorder o Intellectual or physical impairment o Lack of psychological supports o Potential for non-adherence to treatment.

4.4.4. Clients with ‘complex needs’ may have other unmet needs e.g. homelessness, financial difficulties.

5. ROLES AND RESPONSIBILITIES 5.1 Clinical Director

The Clinical Director has overall responsibility for ensuring that services are delivered in accordance with this procedure.

5.2 Consultant Psychiatrist

The Consultant Psychiatrist is responsible for the medical management of clients in accordance with this procedure.

5.3 Regional Manager Mental Health

The Regional Manager Mental Health is responsible for the implementation of this procedure.


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5.4 Triage Clinicians In the event of after-hours staff sick leave, Triage staff are responsible to attempt to contact colleagues or the Mabu Liyan Shift Coordinator regarding overtime requirements.

5.5 All Staff

All relevant staff are responsible for adhering to this procedure.

6. COMPLIANCE It is a requirement of the WA Health Code of Conduct that employees “comply with all state government policies, standards and Australian laws and understand and comply with all WA Health business, administration and operational directives and policies”. Failure to comply may constitute suspected misconduct under the WA Health Misconduct and Discipline Policy.

7. EVALUATION 7.1 Clinical documentation is audited six monthly as part of the clinical

documentation audit schedule. 7.2 This procedure is to be reviewed following the implementation / proclamation of

the WA Mental Health Act 2012.

8. REFERENCES 8.1 National Standards for Mental Health 2010: 1.3; 2.10; 2.11; 4.1; 6.7; 7.2; 9.3;

10.3.4; 10.4.2; 10.5.5; 10.5.6 8.2 National Safety and Quality Standards:1.8; 1.18.1;4.6; 4.7; 4.8; 4.13.1; 4.14.1;

9.4.1; 8.3 EQuIP Standards: 11.2.2; 12.2; 12.3; 12.4; 12.8; 12.9; 8.4 National Practice Standards for the Mental Health Workforce 2013: 1.1; 2.7; 3.2;

5.3; 5.7; 5.8; 6.3; 7.3; 7.16 8.5 Government Response to the Stokes Report 2012: 1.2; 2.5; 2.6; 2.8; 2.9; 2.12;

3.2; 4.3; 4.7; 7.1; 7.3; 7.5; 7.10.4; 7.10.5; 7.10.8; 7.10.14; 7.11.1; 7.11.2; 7.11.3; 7.11.4;

8.6 A National Framework for Recovery-Oriented Mental Health Services 2013 8.7 WACHS Goldfields Mental Health Triage Procedure 8.8 Children and Community Services Act 2004.

9. APPENDIX

Appendix 1: KMHDS Triage Service Flowchart Appendix 2: MRK24 KMHDS My Care Plan

http://www.health.wa.gov.au/CircularsNew/circular.cfm?Circ_ID=12788

Effective:

MH TRIAGE CLINICIAN is the first point of contact for client referrals

Does client meet referral criteria?

MH Triage clinician is responsible to: • Receive referral and complete PSOLIS Triage form, PSOLIS check; enter client referral

information on Triage Intake register • Allocate triage category • Identify referral pathway for client

KMHDS TRIAGE SERVICE FLOWCHART Broome (Mon – Fri 0800 to 1830hr P: 9194 2640; Weekends and Public Holidays 0800 to 1630hr P: 0467 764 949; – F: 9192 3489)

Mon – Fri: Derby (P: 9193 3605 – F: 9193 3607) Fitzroy Crossing (P: 9194 2867 – F: 9191 5111) Kununurra and East Kimberley (P: 9166 4350 – F: 9166 4363)

MH Triage clinician is responsible to • Collate client history • Conduct MH assessment with or without Consultant Psychiatrist or Psychiatric Registrar as required • Consult with hospital DMO, Psychiatrist or on call Psychiatrist as required • Complete Brief Risk Assessment (BRA) MRK119 • Provide client with Rights and Responsibilities information • Complete consent form MRK30A • Where indicated and possible, develop client initial management plan with client /carer

Mabu Liyan /BMHU MH Triage clinician is responsible to • Contact Mabu Liyan /BMHU Bed Manager

regarding referral • If patient is accepted for admission

facilitate admission to Mabu Liyan /BMHU • Provide required documentation

Referral pathways

Case Management Team MH Triage clinician is responsible to • Facilitate the allocation of Case Manager

(CM) via intake meeting • Provide required documentation • CM creates PSOLIS Management Plan

NO Refer back to referrer or other service provider/agency and provide client information to other agencies as required

YES

Authorised Facility Perth MH Triage clinician is responsible to • Provide recommendations

regarding treatment and care to support hospital staff to safely manage patient whilst awaiting transfer

KCDST and CAMHS MH Triage clinician is responsible to • Refer client as per referral

process • Provide required

documentation

Short Term Management Client may remain on MH Triage case load when: • Brief intervention is required • Pending referral awaiting treatment • Client is awaiting specialist service

BRAMS REFERRALS

New referrals are seen by the Consultant Psychiatrist and where possible, the AMHW. The AMHW is responsible to: • Coordinate BRAMS MH Wellbeing Clinic as the

secondary Case Manager • Receive new referral information from BRAMS • Enter new BRAMS referral information on

Triage Intake register • Maintain BRAMS new referrals and pending

client folder which is held in Triage

My Care Plan MRK24 is completed where client is triaged and referred on and a signed copy is given to client/carer

Please use ID label or block print

WA COUNTRY HEALTH SERVICE - KIMBERLEY Kimberley Mental Health and Drug Service

SURNAME

URN

GIVEN NAMES

My Care Plan DOB SEX

DISCHARGE ADDRESS AND PHONE NO

MRK2

4 K

MHDS

MY

CARE

PLA

N

I, _______________________________________have been seen at / discharged from ___________ ____________________________________________________________on ____/____/____ by __ ________________________________________________________ I have agreed to the following recommendations:

I will contact my own Doctor (name)_____________________________________ and I agree to the KMHDS Triage Service providing them with information regarding my care

Referral to my local Community Mental Health Clinic

Referral to Kimberley Community Drug Service Team (KMHDS phone numbers below)

Referral to another agency:

___________________________________________________________________________ I have an appointment with (service) __________________________ to see (name) ____________________ on (date) ____________ at (time) ___________ OR

I will make my own arrangements for support and follow up

I have been given □ Medication □ Medicine information □ Prescription After Hours Crisis Numbers: RuralLink: freecall 1800 552 002 (after hours mental health telephone service) Suicide Call Back Service 1300 659 467 Alcohol and Drug Information Service: 1800 198 024 Crisis Care: 9233 1111 Lifeline: 131 114; Samaritans: 1800 198 313; Salvo Care: 9227 8655; Men’s Line: 1300 789 978 Kids Help Line 1800 551 800

I am aware that if I am in crisis, that during business hours I can contact my doctor or clinic or one of the agencies listed above. After hours I can contact one of the crisis numbers listed above or present to the local Hospital Emergency Department. ________________________________________________________________________________________ Signed Patient: ________________________________________________ Date __________________ Signed Carer ________________________________________________ Date __________________ Staff sign: ________________________________________________ Date __________________

Broome Hospital: 9194 2222 KMHDS: 9194 2640

Derby Hospital: 9193 3333 KMHDS: 9193 3605

Fitzroy Crossing Hospital: 9166 1777 KMHDS: 9194 2867

Halls Creek Hospital: 9168 2222 KMHDS: 9166 4350

Kununurra Hospital: 9166 4222 KMHDS: 9166 4350

Wyndham Hospital: 9161 0222 KMHDS: 9166 4350

Copy in Patient Notes

Author: KMHDS; authorised by: KMHDS Clinical Governance Committee Version5 (March 2014) Review date: March 2015

mental health triage service procedure...3.9 referral to child and adolescent mental health team...

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