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Mental Health Tele-Triage Literature Review Overview

Mental Health Tele-Triage Literature Review Overview . Mira Vucevic . 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

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Mental Health Tele-Triage Literature Review Overview

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  1. Mental Health Tele-Triage Literature Review Overview Mira Vucevic

  2. 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 Health Triage Scale (Telephone Triage) • Australian Mental Health Triage Scale (ATS) (Emergency Dept. Triage)

  3. 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)

  4. Medibank Health Solutions (formerly McKesson Asia-Pacific) Department of Human Services Victoria , Evaluation of the Southern Health Psychiatric Triage Service (2008)

  5. Emergency 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 complaints • Reported 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 confidence • A positive change in attitudes • More patients triaged correctly and consistently • Broadbent et al (2002), Happell et al (2002)

  6. 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 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 Toolkit • Most widely used emergency department triage scale in Australia • Designed for use by non-mental health specialist • Combined physical and mental health triage scale • NICE (2004) recommended for the triage of self-harm in emergency settings.

  7. References • Broadbent, 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), 288-292 • 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. NICE • Turner,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)

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