Overview Mira Vucevic Overview of the literature review aims What can be learnt from domestic amp international teletriage models to assist NHS 111 London in the development of best practice for mental health callers in crisis ID: 426216
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Slide1
Mental Health Tele-Triage Literature Review Overview
Mira Vucevic Slide2
Overview of the literature review aims What can be learnt from domestic & international tele-triage models to assist NHS 111 London in the development of best practice for mental health callers in crisis
Domestic: Generic telephone healthcare and advice service
NHS Direct - Mental Health Service
International: Specialist
mental
health telephone services
Medibank Health Solutions
(
formerly
McKession Asia Pacific)
- Specialist
Mental Health Service Models
International: Mental Health
Triage
Scales and Training
Victorian State-wide Mental
H
ealth Triage Scale (Telephone Triage)
Australian Mental Health Triage Scale (ATS) (Emergency Dept. Triage) Slide3
Domestic Service : NHS Direct
A specific aim of NHS Direct :
“
To enable integrated access to
out-of-hours
general practice, social services and
mental
health service
”
It is estimated that mental health related calls are a small (1-4%) but significant proportion of the NHS Direct workload. Research has shown that mental health calls are on average 23 minutes long. A study by Payne et al (2003) reported one call lasting 193 minutes.
Mental Health Project – The only “specialist role “ established in an otherwise generalist service. Each site
has a dedicated mental health
professional /lead that :
Establishes links and referrals with local mental health, non statutory and voluntary service providers.
Provides on-going training, education, support and clinical supervision to nurse advisors – mental health training based on SCAN principles and techniques.
Assists the development of mental health algorithms
Assists the development of protocols between NHS Direct and local mental health services
National (Service Wide) Policies and Guidance for Mental Health :
National
Policy for Referral Of Callers with a Mental Health Crisis to Local Specialist Statutory
Provision (NP003)
National
Guidance on the Management of Suicidal
Callers (NP041)
National
Guidance on the Management of Callers who
Self Harm (NP042) Slide4
Medibank Health Solutions (formerly McKesson Asia-Pacific)
Service Model
Greater Murray Access Line
South West 24
Geographical
Coverage
Greater Murray Area Health (New South Wales)
South West Western AustraliaLocationSydney, AustraliaN/A Urban and RuralRuralApprox. population250,000140,000Model TypeCentralised / Call CentreCentralised / Call CentreServices the entire population in catchment areaServices the entire population in catchment areaOperating Hours27/427/4StaffingMental health cliniciansMental health cliniciansDedicated triage teamDedicated triage teamServices providedTele-TriageTele-TriageAssessmentAssessment Referral ReferralAdviceCase Management & SupportInformationSelf ManagementCrisis Management Counselling Case management support (staff leave & standing orders) (Includes sexual assault and drug and alcohol calls) Operational Guidelines and ProcessesPolicies and guidelines, electronic triage instrument, clinical management guidelines, automated suicide assessmentClinical management guidelines ProtocolAutomated alert (further assessment)Electronic records InfrastructureCall centre telecommunications & IT systemsCall centre telecommunications & IT SystemsCase management softwareDedicated office spaceDedicated office space
Department of Human Services Victoria
, Evaluation
of the Southern Health Psychiatric Triage Service
(2008) Slide5
Emergency Department Research - Mental Health Triage Scales & Training: Implications and Outcomes
R
esearch investigating emergency
mental health triage
has reported prior to the implementation of a mental health triage scale and mental
h
ealth training:
Generalist triage nurses did not feel confident in assessing patients with mental health complaintsReported to be insufficiently prepared to prove care to patients with mental health problems Lack of mental health knowledge Incorrect triage of patients After implementation and training: Significantly improved knowledge Significantly increased confidenceA positive change in attitudes More patients triaged correctly and consistently Broadbent et al (2002), Happell et al (2002) Slide6
Mental Health Triage Scales/Tools (Australian Models)
What can we learn from:
Victorian State-wide Mental Health Triage Scale Guidelines & Training Methodologies
Comprehensive guidelines and training methodologies for the triage of mental health callers. Implemented across the state of Victoria, Australia for all area mental health services
(July 2010).
A telephone
t
riage scale: The mental health triage scale maps mental triage assessments to seven categories (Codes A to G), reflecting different levels of need, risk and urgency. Designed for use by area mental health services and experienced mental health clinicians. Australian Mental Health Triage Scale Guide and Training Toolkit Most widely used emergency department triage scale in Australia Designed for use by non-mental health specialist Combined physical and mental health triage scaleNICE (2004) recommended for the triage of self-harm in emergency settings. Slide7
ReferencesBroadbent, M. (2002). Improving competence in emergency mental health triage. Accident and Emergency Nursing, 10, 155-162
.
Department of Human Services Victoria , Evaluation of the Southern Health Psychiatric Triage Service (2008)
Happell, B., Summers, M., & Pinikahana, J
. (2002).
Measuring the effectiveness of
the national
Mental Health Triage Scale in an emergency department. International Journal of Mental Health Nursing, 12 (4), 288-292National institute of clinical excellence (2004). Self-harm: The short-term physical and psychological management of secondary prevention of self-harm in primary and secondary care. London. NICETurner,V.F., Bentley,P.J., Hodgson, S.A., Collard, P.J. et al (2002). Telephone triage in Western Australia. Medical Journal of Australia, 176:100-103.Victorian Government Department of Health: Statewide Mental Health Triage Scale Guidelines: (2010) Wilson, A & Cullen, M. (2002) The Greater Murray Accessline. Australasian Psychiatry : 9( 4)