Presentation on theme: "Mental Health Tele-Triage Literature Review Overview"— Presentation transcript:
1Mental Health Tele-Triage Literature Review Overview Mira Vucevic
2Overview 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 crisisDomestic: Generic telephone healthcare and advice serviceNHS Direct - Mental Health ServiceInternational: Specialist mental health telephone servicesMedibank Health Solutions (formerly McKession Asia Pacific) - Specialist Mental Health Service ModelsInternational: Mental Health Triage Scales and TrainingVictorian State-wide Mental Health Triage Scale (Telephone Triage)Australian Mental Health Triage Scale (ATS) (Emergency Dept. Triage)
3Domestic 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 algorithmsAssists the development of protocols between NHS Direct and local mental health servicesNational (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)
4Medibank Health Solutions (formerly McKesson Asia-Pacific) Service ModelGreater Murray Access LineSouth West 24Geographical CoverageGreater Murray Area Health (New South Wales)South West Western AustraliaLocationSydney, AustraliaN/AUrban and RuralRuralApprox. population250,000140,000Model TypeCentralised / Call CentreServices the entire population in catchment areaOperating Hours27/4StaffingMental health cliniciansDedicated triage teamServices providedTele-TriageAssessmentReferralAdviceCase Management & SupportInformationSelf ManagementCrisis ManagementCounsellingCase 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 guidelinesProtocolAutomated alert (further assessment)Electronic recordsInfrastructureCall centre telecommunications & IT systemsCall centre telecommunications & IT SystemsCase management softwareDedicated office spaceDepartment of Human Services Victoria , Evaluation of the Southern Health Psychiatric Triage Service (2008)
5Emergency Department Research - Mental Health Triage Scales & Training: Implications and Outcomes Research investigating emergency mental health triage has reported prior to the implementation of a mental health triage scale and mental health 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 problemsLack of mental health knowledgeIncorrect triage of patientsAfter implementation and training:Significantly improved knowledgeSignificantly increased confidenceA positive change in attitudesMore patients triaged correctly and consistentlyBroadbent et al (2002), Happell et al (2002)
6Mental Health Triage Scales/Tools (Australian Models) What can we learn from:Victorian State-wide Mental Health Triage Scale Guidelines & Training MethodologiesComprehensive 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 triage 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 ToolkitMost widely used emergency department triage scale in AustraliaDesigned for use by non-mental health specialistCombined physical and mental health triage scaleNICE (2004) recommended for the triage of self-harm in emergency settings.
7ReferencesBroadbent, M. (2002). Improving competence in emergency mental health triage. Accident and Emergency Nursing, 10,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),National 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: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)