Crisis Assessment and Treatment Team - health.act.gov.au · Web viewTo provide Triage/CATT staff with a Procedure to outline processes specific to the area of mental health triage

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Canberra Hospital and Health ServicesOperational ProcedureCrisis Assessment and Treatment Team – Mental Health Services Triage

Contents

Contents...................................................................................................................................1

Purpose.................................................................................................................................... 2

Scope........................................................................................................................................2

Section 1 – Underlying Philosophy “No wrong door”...............................................................2

Section 2 – Contacting Triage...................................................................................................3

Section 3 – CISCO Phone Software...........................................................................................4

Section 4 – Triage Staffing........................................................................................................4

Section 5 – Roles and responsibilities of Triage........................................................................4

Section 6 – Core Components of Initial Triage Assessment......................................................5

Section 7 – Triage Response Categories...................................................................................6

Section 8 – Referral Types........................................................................................................7

Section 9 – Clinical Escalation and Resolution Process...........................................................10

Section 10 – Training..............................................................................................................11

Evaluation...............................................................................................................................11

Related Legislation, Policies and Standards............................................................................12

Attachments...........................................................................................................................13

Doc Number Version Issued Review Date Area Responsible PageCHHS14/037 1.0 June 2014 Dec 2017 MHJHADS 1 of 23

Do not refer to a paper based copy of this policy document. The most current version can be found on the ACT Health Policy Register

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Purpose

To provide Triage/CATT staff with a Procedure to outline processes specific to the area of mental health triage in order to promote greater consistency in response to consumers and referrers seeking assistance from mental health services; and ensuring service responses are appropriate to the consumer’s level of acuity and risk.

Triage performs a preliminary assessment of current mental health issues, current situational issues and risk assessment of all new referrals and self presentations by: Providing mental health screening Determining the nature and urgency of the response required. Providing referral to mental health services within ACT (and interstate where

appropriate) Providing appropriate referral options to other services internal and external to

MHJHADS

Scope

This procedure pertains to all staff members who are working in the Crisis Assessment and Treatment Team (CATT). MHJHADS operates a 24 hour/7day Mental Health phone intake and referral line. The main purpose of this triage line is to determine whether or not an individual requires further assessment by MHJHADS and/or other services; and the nature and urgency of the response required

Section 1 – Underlying Philosophy “No wrong door”

The Open Door (or ‘no wrong door’) philosophy supports the National Standards for Mental Health Services and underpins the endorsed service expectation to support all persons who make contact with triage to either receive a direct response or to be linked to the appropriate service.

To meet this expectation practically, any contact needs to be responded to as an opportunity to assist by either providing the response directly, or by referring to another service deemed more suitable to the persons needs. Providing an ‘Open Door’ aims to reduce risks associated with being disengaged from services while figuring out “correct” point of entry.

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Section 2 – Contacting Triage

62051065 or 1800 629 354 (free call); 6244 2380 (TCH internal phone for The Canberra Hospital, Calvary Hospital and

Australian Federal Police, ACTAS & CATT Clinicians use only). Note when working on Triage this line (62442380) should remain open and be answered

as quickly as possible to take calls from emergency services and CATT/other MHJHADS workers (although it is accepted that this phone may not be answered if there Triage worker/s are required to manage an at risk consumer on the main triage line). This number should also be forwarded to the “62051065” number overnight by the CATT Night worker when working in TCH ED, and then returned to normal function by Morning Triage worker;

Fax 61747175 (typically used by General Practitioner’s and other Interstate Mental Health Services to refer consumers)- also see Section below titled Faxed Referrals;

MHCATT @act.gov.au – email is available to receive collateral information from other agencies or care partners (ie GP/AFP/ACTAS). The MHCATT email is not to be provided to consumers or their families and is not a method of referral to MHJHADS. The CATT generic email should only be used in line with the associated procedure - which can be located at http://inhealth/SearchCenter/Pages/PPRsearchresults.aspx?k=CATT%20email

Mhagic via e-message function NOTE: Messages requesting Triage or CATT follow-up by other Community Mental Health Teams (CMHTs) using Mhagic should be sent to both “CATT” and “Triage”, not just “CATT” in order for consumers to be registered on “CATT Whiteboard” to ensure follow-up occurs in a timely manner. Additionally, where significant risks are identified by the CMHT, it is preferable that this request is made via phone contact with Triage also.

As part of the Mental Health Community Policing Initiative (MHCPI) there is a CATT clinician based at AFP operations who is available to provide consultation advice to AFP/ACTAS patrols in order to assist them in managing and supporting people with mental health issues.

The role is covered on a shift basis seven days per week (8 hours per day) Mon – Wed 10:30 – 19:00Thur – Sat 14:30 – 23:00Sunday’s 12:30 – 20:30

NOTE: Any ACTP/ACTAS officers/staff who contact mental health Triage during these times should be re-directed to contact the MHCPI Clinician instead

The MHCPI Clinicians can be contacted through ACTPOPS (131 444) or mental health clinicians can contact them by using the MHCPI Clinician mobile (0408 486 781). The MHCPI number is not for release to the public. Please review the clinician in police operations procedure for further information on the role and MHCP http://inhealth/SearchCenter/Pages/PPRsearchresults.aspx?k=CATT%20clinician%20in%20operations



http://inhealth/SearchCenter/Pages/PPRsearchresults.aspx?k=CATT%20clinician%20in%20operations

http://inhealth/SearchCenter/Pages/PPRsearchresults.aspx?k=CATT%20clinician%20in%20operations

http://inhealth/SearchCenter/Pages/PPRsearchresults.aspx?k=CATT%20email

http://inhealth/SearchCenter/Pages/PPRsearchresults.aspx?k=CATT%20email

mailto:[email protected]

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Section 3 – CISCO Phone Software

When using CISCO Computer Software for Triage always ensure Display window under Preferences menu (button with picture of paper and pencil), the window behaviour is set to “Always on top” so can easily check if phone is set to “Ready”

Additionally, the Report window ‘Real Time Display Contact Service Queue Statistics’ should also be kept open as this alerts to calls waiting even if CISCO has reverted to not ready.

Note: When both phones/or only phone in use are set to “Not ready” no calls can be received by Triage.

When logged out of both phones on CISCO, all calls will automatically diverted to the “Night Mobile- 0418 658 227”, but always recommend “test” call to demonstrate transfer has occurred.


Section 4 – Triage Staffing

Triage is covered 24hrs per day/7 day per week; Triage personnel are Mental Health workers from a range of disciplines including

nursing, psychology, and social work; Only staff at a HP2/ RN2 level and above will be rostered to perform triage duties. 2 workers from 07.15am - 2300pm 7 days a week Overnight the CATT Night Worker performs the triple role of Triage, CATT and 2nd Mental

Health Assessment Unit (MHAU) worker, hence triaging functions may be limited and should be prioritised according to most urgent need. However, there is the facility to call in a second CATT worker when the need dictates same.


Section 5 – Roles and responsibilities of Triage

Mental health screening and referral to other mental health services within ACT (and interstate where appropriate), providing a preliminary assessment of whether a person is likely to have a mental illness or experiencing acute distress, and then determine the nature and urgency of the response required;

Referring to other areas of MHJHADS and helping people who don’t require specialist mental health services to access more appropriate services;



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Brief crisis resolution (due to resource limitations of Triage, consumers who may require ongoing supportive telephone counselling should also be given number for services such as Lifeline 13 11 14 which may better suit needs);

Providing support and advice to current MHJHADS consumers, especially afterhours; Supporting and advising family and carers of consumers, and linking them with

appropriate services to meet their own needs; Providing consultation advice to other service providers to assist them in managing and

supporting people with mental health issues.


Section 6 – Core Components of Initial Triage Assessment

Referrer information (including relationship to consumer, and contact number/s for the referrer is especially important if additional information is required and referrer needs to be recontacted);

Consumer demographic information and contact details (especially for new consumers but also contact details should be checked for current and previously known consumers including phone numbers and addresses as these may frequently change, current location of the consumer may also be needed for more acute referrals);

Information relating to the presenting problem which should include material relating to the consumer’s mental state and possible experience of psychiatric symptomatology. It should also incorporate a Risk Assessment (including use of Suicide Risk Assessment- Part A, Risk of violence or aggressive behaviour, and any risk issues pertaining to safety and welfare of children or others);

Previous psychiatric history, including information about previous mental health contacts within ACT and interstate. There may be times when Triage should contact other interstate MH services to obtain collateral information to help inform triage decisions, especially when not referring to CATT or other part of MHJHADS service;

Drug and alcohol use, including current use (e.g possible intoxication) and previous history of substance abuse;

Possible co-morbid medical issues that may be influencing presentation (e.g delirium); Current health care providers already involved in the consumer’s care including General

Practitioner, Private Psychologist, etc and appointments scheduled if known. Other interested parties who may be able to provide collateral information, where

relevant, including family members and carers. Also see Appendix C: Tips for Effective Telephone Triage & Appendix D “Basic Triage

Information”




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Section 7 – Triage Response Categories

Mental Health ACT has adopted the National Triage Scale 2007, amended for local use (see Appendix A.)

The National Triage Scale rating between A and E require the completion and documentation of an assessment. An F rating requires the clinician to make a decision on whether it is appropriate to complete a clinical assessment or manage the presentation as a contact. A rating of G is for information or advice only and does not require a clinical assessment. The information related to a rating of F as non-clinical contact and all G rating need to be recorded

Prior to Mhagic being updated to accommodate the new Triage scale, the following classifications can be used when completing the occasion of service entry:

CRISIS: A and B; PRIORITY: C and D; DEFERRED: E; REFERRED: F; INQUIRY/CHAT: G ADVICE OR INFORMATION

See Attachment 1 – MHJHADS Triage Scale for more detail of Triage Response Categories including examples of typical presentations.

Please also see the current Mental Health, Justice Health and Alcohol and Drug Services policy "Triage Category of Response" which can also be found on the intranet via this link: http://acthealth/c/healthintranet?a=sendfile&ft=p&fid=1226969168&sid=

Note: for Triage Response Category Code “A” where an emergency services response is required, the MHJHADS should either contact ACT Ambulance Service (ACTAS) or Australian Federal Police (AFP) for the caller, or at minimum and only if appropriate, transfer the caller to “000” (to transfer call externally have to enter another “0” ie “0000”).

For example, it is expected that Triage would call an ambulance for a consumer who reports having engaged in significant self-harm (e.g. taken an overdose of medications), even if consumer indicates they could do this themselves. If consumer or other caller stated they have done this already, at very least it should be confirmed by Triage with the relevant emergency service.

In less acute situations, if a client identifies that they will attend ED by private transport, Triage should inform ED Triage of client’s likely attendance, document an initial presentation, and arrange to call back to the client/referrer if they have not presented to ED by an agreed time.

For calls which receive a Triage Category Response Code of “F” or “G” (ie. for consumers who are not referred to CATT or other parts of MHJHADS), a file note should be made in their Mhagic file if they are a previous or current client, or under the “anon male/female” contact in Mhagic if the consumer does not have an existing file.




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Section 8 – Referral Types

8.1. New consumers and/or new episodes of contact All referrals for new consumers or consumers who present in a new episode of contact

with MHJHADS require completion of an Initial Presentation Module on Mhagic, including a Risk Assessment (Suicide Risk Assessment-Part A minimum).

8.2. Referrals from Triage to CATTWhere Triage determines that a response is required from CATT the following steps should be taken: relevant documentation should be completed on Mhagic including the Initial

Assessment, Suicide Risk Assessment- Part A (Part B can be completed by CATT upon assessment of consumer, if relevant). The Initial Assessment should also note the Triage Response Category- “Cat A, B, C etc” can be written in the section “Commitment Given to Client” or in body of a file note as another means of alerting clinicians to the urgency of this referral;

the consumer should be immediately registered with CATT on the Mhagic database; the consumer’s details should be immediately added to the electronic CATT Whiteboard

(see Appendix B- CATT Whiteboard Documentation) and hand-written on the printed version of whiteboard to ensure that CATT are aware of referral;

the CATT shift coordinator or other senior clinician should be notified immediately, by phone if necessary, of any referral with a Triage Response Category Code A or B requiring urgent CATT attendance. Response Category Codes C and higher may should be brought to attention of CATT clinicians as soon as possible, otherwise;

where the referral has come from another service within MHJHADS requesting CATT follow-up (e.g discharge from Adult Mental Health Unit), initial presentation documentation and suicide risk assessment may not be required by Triage. However, some reference should be made as to specific concerns for the consumer and the request for follow-up from CATT (this note should be preferably made by the referring MHJHADS service but could also be noted by the Triage worker).

8.3. New Referrals from Triage to other MHJHADS ServicesWhere Triage determines that a CATT response is not required, but believes a consumer should be referred to another area of MHJHADS the following steps should be taken: The Initial Presentation Module should be completed as well as a risk assessment,

including Suicide Risk Assessment- Form A, with specific reference to why this consumer is being referred to the Community Mental Health Team (CMHT). Such reasons can include, but not limited to:o assessment for suitability for clinical management and ongoing care (e.g for

someone with a established history of mental illness who may have recently moved into ACT, as referred by an interstate mental health service and requires additional support);

o psychiatric appointment for medication review (as frequently requested by GPs)



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o further assessment for mental health issues (as may be the case for someone who displays evidence of a mental illness but does not present with acute risk issues, necessitating a more urgent CATT assessment)

o specialist mental health assessment or service (e.g Eating Disorders Program); The Initial Presentation should list the Triage Response Category (A through to F) and

the expected follow-up requested of CMHT to give guidance as to nature/urgency of referral.

An electronic message via Mhagic should be sent to the relevant CMHT, including specialty services within MHJHADS. It is important that the message be linked to the consumer’s file when given this option by Mhagic (i.e when sending the message, a text box appears reading “Would you like this message to be associated with the client’s clinical documents”- ensure you are in the relevant client’s file, and then click “Yes”). Also please ensure that the message includes name of consumer (and perhaps also their DOB, to avoid possible confusion);Eg of e-message via Mhagic:“Attention Referral Manager (CMHT)Hello,Please note referral for Mr John Citizen (DOB 26/1/1900) from GP requesting non-urgent psychiatric review of medications. We have faxed a copy of GP letter to your office also.

Thank you,Name of clinicianTriage”

NOTE: Mhagic is a medical record and any notes made within, including e-messages, should only pertain to the clinical issues for that consumer.

The Triage worker should register the consumer on Mhagic with the relevant CMHT, such that the CMHT can readily access the initial presentation information;

Any additional information received with initial referral (e.g faxed referral letter from GP; Discharge summary from non-MHJHADS facilities etc) should also be faxed to the CMHT;Exception: Monday to Friday during business hours, Child and Adolescent Mental Health Service (CAMHS) operate their own triage service for children and adolescents under the age of 18 years, so calls for CAMHS at these times should be transferred immediately and directly to CAMHS Intake on 6205 1971, rather than Triage completing initial assessment.

CAMHS also have a weekend worker Saturday and Sunday mornings between 9-5pm, who can complete this initial assessment and thus calls can be immediately and directly transferred to the CAMHS worker located in the CATT office on 6205 1979 or via their mobile (displayed on CATT Whiteboard). However, the CAMHS Clinician has no phone contact when at Bimberi, so CATT will have to progress the initial presentation during these times (usually 1-2 hours Sat/Sun AM).



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However, Triage should take referrals for any CAMHS clients occurring outside of these hours listed above.

8.4. Existing Mental Health Clients Contacts with Triage During business hours Monday to Friday, contacts about existing MHJHADS clients made

to Triage may be transferred directly to their treating team and supplying with direct number if not known. This simply involves transferring the call directly from the VOIP phone using the extension number (last five digits for all ACT government phone numbers or selecting from the list using the Cisco Agent system available on the computer);

However, in cases where an emergency response is required for an existing MHJHADS consumer regardless of time of contact, Triage should confirm that appropriate assistance has been provided in the first instance, before transferring such calls.

Afterhours and on weekends, Triage should assess any calls regarding existing MHJHADS consumers and document these contacts in Mhagic.

8.5. Triage/CATT Referrals and Messaging to Community Mental Health Teams and Special Client GroupsWhenever Triage or CATT has contact with consumers from the following groups, a message and request for follow-up, should be sent to the relevant mental health team. This includes:o existing mental health clients- a message should be sent to the relevant CMHT. This

includes specialist services such as CAMHS or Forensic Mental Health. o children or adolescent (under age of 18 years)- a referral should always be made and

message sent to Child & Adolescent Mental Health Services (CAMHS) for follow-up or at least, review of their contact with CATT, to make a determination as to whether further follow-up is required. If referring to CAMHS weekend worker, a message should also be sent to CAMHS Intake, in addition to notifying the worker.

o individuals who are in Police Custody- a referral should be made and message sent to the Forensic Court Liaison Services (FCLS);

o Individuals of Indigenous background- should always be offered referral to the Aboriginal Liaison Officer (ALO) and message sent to same.

8.6. Calls regarding consumers residing or located interstate Triage frequently receives contact about consumers residing or locating interstate.

Assistance should be provided to ensure that they receive access to more appropriate services. Perhaps, most commonly Triage receives call about consumers located or residing in nearby areas (such as Queanbeyan, Braidwood, Goulburn or Yass which fall under catchment Greater Southern Area Mental Health Service- GSAMHS).

In addition to providing callers with the number for the appropriate service, it is expected that, in the presence of acute risk/wellbeing issues, their call can be immediately and directly transferred by Triage to the appropriate service (e.g GSAMHS or Emergency Services on ‘000’- noting that another “0” must be placed before any phone number to transfer the call externally).



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For other mental health services interstate, in the presence of acute risk/wellbeing issues, assistance can also be provided by searching websites (e.g NSW/VIC/QLD Health website) on internet to link person with appropriate mental health service or nearby hospital, if known. For example, someone living in Frankston area in Victoria, simply “Google” “Frankston Mental Health” and should find link to Victorian Health website, showing contact details including 1300 number.

Details of these calls, including name of consumer, if known, should be documented in Mhagic (under “anon male/female client” if no current Mhagic file exists).

Any individual located within the ACT, regardless of residency, is entitled to receive a service from CATT, if appropriate. For interstate consumers who are seen by CATT in ACT, it is also expected that they would be referred back to their local mental health service when returning home interstate, as appropriate.

Interstate residents may also request an ongoing service (i.e non-crisis) from MHJHADS under some circumstances (e.g if individual work within a region of ACT and are unable to attend their local mental health service during business hours). Such referrals should be referred to the relevant CMHT to make decisions regarding such requests and not simply declined by Triage.

If an ACT resident contacts Triage and they are in another state at the time of the call, after ensuring they are not in immediate danger they should be referred to local area mental health services for follow-up and treatment.


Section 9 – Clinical Escalation and Resolution Process

There may be situations where there is uncertainty about a triage response or a difference of professional opinion about the triage category assigned to a referral. In these situations the triage worker has a number of people they can contact to discuss management of the situation;o The designated senior on CATT shift and/oro The Team Leader or after hours the on-call Operational Director and/oro CATT psychiatrist or after hours on-call Psychiatric registrar

No referral should be triaged as Multi-Disciplinary Team Review (MDTR) rather the triage worker should make contact with one or more of the aforementioned to determine the appropriate response category.




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Section 10 – Training

10.1. Triage Training ProgramCATT staff will be provided with a day’s in-service on triage roles and responsibilities prior to undertaking the triage role. On completion of this in-service participants will demonstrate the ability to; Identify the principal aims of triage assessment. Describe the role and responsibilities of the triage function and describe the different

triage categories. Outline the key components that form the basis of an Initial Triage Document and

Suicide Risk A. Assessment. Describe the process of escalating clinical issues or differences in clinical opinion Within a peer group, allocate appropriate categories to case scenarios and discuss

rationale for decisions made Operate CISCO phone system including transferring calls to night phone.

10.2. Training Shifts After completion of the training program staff will be rostered one supernummary triage

shift in order to observe another clinician undertake the triage role. Any new triage worker will undertake 10 shifts alongside another triage worker prior to

working as sole/independent triage worker on weekends, evenings or at AFP operations.


Evaluation

Outcome Measures Triage Audit results Clinical Documentation Audits Riskman reporting

Method Critical incidents reported in Riskman that relate to processes connected with ACT Triage

will be reviewed by the CATT team leader and ACT Wide Operational Director. As appropriate critical incidents can be referred to and reviewed by the Clinical Review Committee and any recommendations will be reported to the Quality and Safety Committee.

The CATT Team Leader or delegate will undertake regular audits in line with the MHJHADS Procedure: Crisis Assessment and Treatment Team – Triage Audits. The Information will be collated according to the Audit Schedule and the data reviewed as indicated through ACT Wide Program Meeting, Divisional Quality & Safety Meeting and Scorecard Meeting.

Triage performance is also evaluated via the regular Clinical Documentation Audits.



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Related Legislation, Policies and Standards

LegislationMental Health (Treatment and Care) Act 1994 Health Records (Privacy and Access) Act 1997

Human Rights Act 2004Public Sector Management Act 1994Health Practitioner Regulation National Law (ACT) Act 2010Health Practitioner Regulation National Law Act 2009Health Practitioner Regulation National Law RegulationWork Safety Act 2008

PoliciesACT Mental Health, Justice Health and Alcohol and Drug Services Policy: Triage Category of Responsehttp://health.act.gov.au/c/health?a=dldivpoldoc&document=150ACT Mental Health, Justice Health and Alcohol and Drug Services Policy: Suicidal Behaviour: Treatment and Care of Consumers with Suicidal Behaviourhttp://health.act.gov.au/c/health?a=dldivpoldoc&document=1951ACT Mental Health, Justice Health and Alcohol and Drug Services: Clinical Processes and Health Directorate Policy: Clinical HandoverMHJHADS Procedure: Confidentiality and PrivacyMHJHADS Publication: Clinical Processes and Documentation Resource Package 4th editionMHJHADS Procedure: Crisis Assessment and Treatment Team – Initial Triage Documentation Audits.

Standards National Standards for Mental Health Services 2010National Safety and Quality Health Services Standards 2012

ConventionsACT Charter of Rights for people who experience mental health issuesMental Health Statement of Rights and Responsibilities 2012Australian Charter of Healthcare Rights 2008



http://www.safetyandquality.gov.au/wp-content/uploads/2012/01/Charter-PDf.pdf

http://www.health.gov.au/internet/mhsc/publishing.nsf/Content/8F44E16A905D0537CA257B330073084D/$File/rights.pdf

http://www.health.act.gov.au/c/health?a=sendfile&ft=p&fid=1318389674&sid=

http://www.safetyandquality.gov.au/publications/national-safety-and-quality-health-service-standards/

http://www.health.gov.au/internet/main/publishing.nsf/Content/CFA833CB8C1AA178CA257BF0001E7520/$File/servst10v2.pdf

http://health.act.gov.au/c/health?a=dldivpoldoc&document=1951

http://health.act.gov.au/c/health?a=dldivpoldoc&document=150

http://www.legislation.act.gov.au/a/2004-5/current/pdf/2004-5.pdf



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Attachments

Attachment 1: MHJHADS Triage ScaleAttachment 2: CATT Whiteboard DocumentationAttachment 3: Tips for Effective Telephone Triage Attachment 4: Basic Triage Information

Disclaimer: This document has been developed by Health Directorate, <Name of Division/ Branch/Unit> specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.



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Attachment 1: MHJHADS Triage Scale

CODE/

DESCRIPTION

RESPONSE TYPE/TIME TO FACE-TO-FACE CONTACT

TYPICAL PRESENTATIONS MENTAL HEALTH SERVICE ACTION/RESPONSE

ADDITIONAL ACTIONS TO BE CONSIDERED

ACurrent actions endangering self or othersCRISIS

Emergency services responseIMMEDIATE REFERRAL

Overdose Other medical emergency Siege Suicide attempt/serious self-harm in

progress Violence/threats of violence and

possession of weapon

Clinician to notify ambulance, police and/or fire brigade

Keeping caller on line until emergency services arriveCATT notification/attendanceNotification of other relevant services (e.g. child protection)

BVery high risk of imminent harm to self or othersCRISIS

Crisis mental health responseWITHIN 2 HOURS

Acute suicidal ideation or risk of harm to others with clear plan and means and/or history of self-harm or aggression

Very high risk behaviour associated with perceptual/thought disturbance, delirium, dementia, or impaired impulse control

Crisis assessment requested by Police under Section 10 of MH Act

Face-to-face assessmentThe venue of this assessment is to be determined by the identified risk factors.

Providing or arranging support for consumer and/or carer while awaiting face-to-face response (e.g. telephone support/therapy; alternative provider response)Telephone secondary consultation to other service provider while awaiting face-to-face response

CHigh risk of harm to self or others and/or high

Urgent mental health response2 – 12 HOURS

Rapidly increasing symptoms of psychosis and/or severe mood disorder

High risk behaviour associated with

Face-to-face assessment within 12 HOURS

As aboveObtaining collateral/additional



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distress, especially in absence of capable supportsPRIORITY

perceptual/thought disturbance, delirium, dementia, or impaired impulse control

Unable to care for self or dependents or perform activities of daily living

Known consumer requiring urgent intervention to prevent or contain relapse

ANDtelephone follow-up within ONE HOUR of triage contact

information from relevant others

DModerate risk of harm and/or significant distressPRIORITY

Semi-urgent mental health response12 – 48 HOURS

Significant client/carer distress associated with serious mental illness (including mood/anxiety disorder) but not suicidal

Early psychosis symptoms Requires priority face-to-face

assessment in order to clarify diagnostic status

Known consumer requiring priority treatment or review

Face-to-face assessment

As above

ELow risk of harm in short term or moderate risk with high support/ stabilising factorsDEFERRED

Non-urgent mental health responseWITHIN 14 DAYS

Requires specialist mental health assessment but is stable and at low risk of harm in waiting period

Other service providers able to manage the person until MHS appointment (with or without MHS phone support)

Known consumer requiring non-urgent review, treatment or follow-up

Face-to-face assessment

As above

F Referral or advice to contact Other services (e.g. GPs, private mental Clinician to provide Facilitating appointment



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Referral: not requiring face-to-face response from MHS in this instanceREFERRED

alternative service provider health practitioners, ACAS) more appropriate to person’s current needs

Symptoms of mild to moderate depressive, anxiety, adjustment and/or developmental disorder

Early cognitive changes in an older person

formal or informal referral to an alternative service provider or advice to attend a particular type of service provider

with alternative provider (subject to consent/privacy requirements), especially if alternative intervention is time-critical

GAdvice or information only/ Service provider consultation/ MHS requires more informationINQUIRY OR CHAT

Advice or information onlyORMore information needed

Consumer/carer requiring advice or opportunity to talk

Service provider requiring telephone consultation/advice

Issue not requiring mental health or other services

Mental health service awaiting possible further contact

More information needed to determine whether MHS intervention is required

Clinician to provide consultation, advice and/or brief counselling if requiredAND/ORMental health service to collect further information over telephone

Making follow-up telephone contact as a courtesy



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Attachment 2: CATT Whiteboard Documentation

Open the ‘live file’ Q:\MH\Access and Specialties\Crisis Assessment and Treatment Team\CATTWhiteboard\CATTWhiteboardActive.xls file.

The CATT Whiteboard will contain the following categories.

Triage Cat: Denotes the Triage Category Response Code from A= “emergency services” response up to E= “ up to 14 day” response (By definition, we would not anticipate too many Category E, F and G responses, to be placed on CATT whiteboard)

Shift Worker: Remains Blank- this is where CATT workers write their name on printed copy of whiteboard to signify which worker/s will complete the shift action.

Shift Action 1 and 2 : Is updated at each handover. When you highlight that square an arrow will appear and if you click on that it will provide a drop down menu with options, Select the appropriate option. Shift Action 1 is the primary shift action and Shift Action 2 represents any secondary action e.g if an individual is to be seen at home but also assessment needs to be faxed to a GP then Shift Action 1= DOM; Shift Action 2= Fax. If there is no shift action, leave it blank. If it is a p/c DOM allocate it to DOM.

Name: Consumers NameAge: Consumers AgeReferral Date: Date of referralReferral Source: Select from drop down box

Presenting Problem: Primary & Secondary : Drop down boxes. Select as appropriate. For example primary referral option may relate to thoughts of self harm but the person has significant drug and alcohol issues so Primary presentation with be TOSH and secondary D&A.

Presentation Detail/Alerts: Document any particulars of the referral including any possible risk to staff attending or other alert information.

Age and Referral Date: are not typically changed during handover Presentation/Diagnosis: are updated as appropriate

CATT PLAN is updated each handover and outlines plan beyond shift action.

Area: As with the Shift Action, find the arrow and a pull down menu will appear. Select the region as appropriate “Belconnen, City etc” or “NFA” if of no fixed address. “Other” refers to interstate.



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Attachment 3: Tips for Effective Telephone Triage (adapted from Mental Health Branch Department of Human Services, VIC which was in turn adapted from Bendigo Health Psychiatric Services Mental Health Triage Orientation Program, Knight & Lenten, 2006)

6 steps for effective triage: Introduce yourself by name and open communication channels with a warm and

receptive greeting such as “Mental Health Triage. Good morning/afternoon/evening, (clinician’s first name) speaking…etc..”. Explain the triage process to the caller.

Perform the interview and complete documentation requirements –see section above “Core Components of Initial Triage Assessment” and use Initial Presentation document and specific Risk Assessment tools to help guide questioning.

Make the triage decision and explain reasons for same Offer advice according to the established response category. Incorporate follow-up plans when concluding the call, including offer for caller to

recontact Triage in future or in interim as required. Review the call and finalise documentation on Mhagic

Other suggestions for conducting triage:

Remember the caller/client’s name (write it down), and use during interview; Give caller sufficient time to explain situation (although re-direction at times may be

necessary, given time constraints and demand for Triage services); Be aware of “how” the person is talking, not only the content as sometimes people may

be unable to clearly articulate the mental health issues at hand, but their level of distress on phone may give some indication that these issues are quite acute.

Restate questions if answers are ambiguous; Refine your ability to elicit information needed to make a triage decision through

questioning- use open-ended questions and offer suggestions to spur the caller’s memory;

Be aware of your voice tone and use of language- maintain an even, unhurried tone of voice and maintain a courteous manner at all times (this is particularly important when a caller disagrees with the triage decision and in such circumstances callers should be offered the opportunity to have such decisions reviewed);

Be aware of barriers to effective telephone communication- including semantic barriers, such as use of jargon, cultural and language barriers, as well as personal assumptions and preconceptions;

Ask callers to repeat or summarise instructions/advice when given and suggest they write them down also. Ask callers whether they are comfortable with the topics discussed and advice given (and document where plans are agreed upon);

Encourage caller to call back if the situation changes or further assistance is required; Document the call, not necessarily “word for word”, but summarizing the main issues

described, particularly around presentation described, risk issues, decision and plan.



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Attachment 4: Basic Triage Information

1. GREETINGQ. “Mental Health Triage., (clinician’s first name) speaking. How may I help you? etc..”.

2. IDENTIFYING CALLER and DEMOGRAPHIC INFORMATIONQ. “Who am I speaking to?”

Suggestion 1: Ensure you get full name of caller and, if referring someone else, their relationship to client and contact details. Referrer name: Relationship to client (if not the client themselves calling): Phone number of referrer (especially, important if CATT worker needs to call them back

to get further information about referral) :

Client demographic details: Name: Phone number: Address: Current location (if not at home):

Suggestion 2: Check Mhagic as soon as possible to see if they are an existing or previous MH client- most clients will offer this information, but some may not even if asked directly about this.

If they are an existing or previous client do not assume that their contact details are correct as often consumers may have moved since last contact.

Also use 3x3 search when checking if they are client (ie first 3 letters of first name and first 3 letters of surname) as Mhagic is sometimes “a bit particular” and may not show clients if a single letter in name is incorrect. Alternatively an “Advanced Search” using date of birth, street address etc, can be used to verify if a consumer is known to MHJHADS or not.

Suggestion 3: Some consumers may actually be located interstate at time of call, so check their current location early in conversation, and then refer to appropriate service. For example, if living in Qbn/Yass may be more appropriate to refer to Greater Southern Area Mental Health Service on 1800 677 114. If located elsewhere in Australia, may need to use internet to find appropriate mental health service – e.g “Google, “nearest major suburb/town name” and “mental health service” and should be able to find local service, otherwise look on state health website.



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NOTE: However, if someone from interstate calls and is in immediate crisis (e.g engaging in self-harm or threatening serious self-harm) a call should be made to “000” immediately to ensure they get assistance, rather than rely upon them to do so- a note of this contact should be documented, even briefly, in Mhagic under the “anon male” or “anon female” client record.

3. NEW CONSUMERS for any new consumers there will be no expectation to complete a new registration on ACTPAS, but merely the attached assessment document be completed.

4. ANNONYMOUS CONSUMERS: Sometimes consumers may not wish to give their names due to concerns for privacy or confidentiality or other purpose, and these contacts can be recorded in the “anon male” and “anon female” files on Mhagic. If concerned about the immediate safety of an individual who refuses to give or is unable to give identifying information, call AFP to notify of contact as they may be able to “trace call”

5. PRESENTING PROBLEM:Essentially, your existing skills as a mental health clinician performing a mental state examination and risk assessment/s should be used when on Triage although obviously your inability to sight the client means that often further face-to-face assessment may be required to complete this process.

Callers may have a variety of concerns ranging from simply seeking information to being in acute emotional distress. However, the main categories of clients who may require mental health assistance, more immediately, include:

5.1 Consumers engaged in or threatening self-harm/suicidal behaviours and/or significant aggression or violence, regardless of mental health issues.

NOTE: Questions around suicide and thoughts of self-harm should be asked of all callers regardless if presenting problem does not appear specifically related to this.

5.1.1 If a person is engaged in significant self-harm or attempting suicide, the first response by the Triage worker should be to call “000” immediately (e.g reported overdose call “000” and ask for ACT Ambulance Service- ACTAS; or someone behaving in a physically violent or significantly aggressive manner towards others, call “000” and request Australian Federal Police- AFP- attendance) DO NOT simply rely on the caller to notify these services, regardless of if they appear responsible or able to perform this function. Sometimes a joint AFP/ACTAS response may be required.

If AFP or ACTAS are called they should be alerted to any potential risk issues related to these consumers and any past psychiatric history that may be relevant, if known at all.

5.1.2 If an individual is having intense thoughts about self-harm or suicide but has not yet attempted self-harm, attempt in first instance to speak to the consumer directly (especially if they were not the initial caller or referrer). If unable to speak to consumer within timely manner, it is always best to err on the side of caution and request welfare check by AFP Doc Number Version Issued Review Date Area Responsible PageCHHS14/037 1.0 June 2014 Dec 2017 MHJHADS 20 of 23


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calling “131 444” and supplying them with relevant available information about the consumer.

Suggestion 4: Some key questions to ask about thoughts of self-harm or suicide?

(Also see Suicide Risk Assessment Forms A & B for more information)

What thoughts are they having? (eg. Passive thoughts such as “I wish I would never wake up” vs more Active Thoughts “I’m going to hang myself” or voices (command hallucinations perhaps) instructing them to harm themselves”

When did these thoughts begin and how frequent are they?(e.g first time tonight and persistent vs chronic suicidal ideation occurring a couple of times week)

Do they have a plan of how you might hurt yourself? (e.g take overdose of pills) Do they have access to means to carry out such a plan? (e.g stockpile of pills for

overdose, hose for car if thinking of carbon monoxide poisoning) Do they think it is likely that they would harm themselves in this way? When do they think they might do this? (some unknown time in distant future vs within

the next few minutes) Is there anything which is preventing them from acting on these thoughts? (e.g

thoughts about impact on family, religious beliefs, present company) Do they have a previous history of self-harm? Obtain details of this, if so. Are they home alone or is there someone with them? If so, it is recommended that you

speak with this other person for more information and to formulate safety plan. Have they been consuming any substances such as alcohol and drugs? These may

impact on their mental state and increase their impulsivity or risk of self-harm Do they think they can keep themself safe until the CATT Night shift worker can speak

to them further? Are they willing or able to work with MHJHADS to manage these thoughts. Where appropriate, do they have prn medications which may assist? Can we offer CATT workers to call them back, if needed or should we be exploring means to transport to hospital now?

Is there anything that they can do that will/might help you feel better right now? (e.g watching a bit of television, listening to music, trying some relaxation, prn medication etc)

What is their tone of voice?- e.g Does the caller sound flat, distressed vs a conversational in tone of voice.

The answers to these questions will assist you in determining whether or not the person will be safe enough until contact by CATT. Some consumers, especially those who call themselves, may be ambivalent about self-harm/suicide as reflected by the fact that most are calling to seek assistance and the aim of the Triage worker should be to work with them to develop a plan of safety.

If you have doubts about the ability of the consumer to keep themselves safe before being able to consult with the CATT senior clinician or Team leader, always err on side of caution and request welfare check by AFP by calling “131 444”; or if individual is agreeable and



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considered appropriate, request presentation to nearest Emergency Department (if necessary, may be appropriate to offer taxi voucher for same).

5.2 Consumers experiencing psychotic phenomena:Sometimes symptoms of psychotic illness may be reported by caller and evidence of symptomatology may become evident in course of conversation and hence Triage caller must be aware to note these as evidenced. It is important when receiving such calls to be mindful of the level of distress of the caller as an indicator of the acuity, whether it is the client themselves or a family member or friend calling.

Again, performing mental state examination based on listening to client (if they are the caller or available to speak to) or through direct questioning about the key symptoms of psychosis such as:Hallucinations- e.g are they hearing any voices or seeing any persons/objects that they think might not be there. Especially, important if person may be experiencing command hallucinations to hurt themselves or others. Delusions- e.g callers expressing unusual or odd beliefs, ideas of reference from TV and other media. Speech- poverty of speech vs pressured speech etcThought disorder- e.g tangentiality, poverty of thought content etcCognitive functioning- e.g difficulties in attention, concentration or memory, orientation to time, person and place. Insight- does the client have awareness and understanding of their possible mental health problems and are they willing to get helpD&A use- current and historically

NOTE: As with all presentations, it is important to assess risk of self-harm and violence as shown in sections above.

Suggestion 5: Some consumers may experience some “baseline” level of psychotic symptoms so it is worthwhile to check recent notes/assessments for existing or previous MHJHADS consumers to determine if this presentation fits with previous contacts or represents an exacerbation in their illness.

However, particular caution should be exhibited when receiving calls from or about individuals who have no previous known history of psychotic illness as they could be experiencing “first episode psychosis”- particularly younger individuals. Hence, such consumers should be treated with a lower threshold for assessment and may require to be presented to ED for comprehensive medical review and psychiatric assessment, regardless of suspected aetiology of presentation.

Again, performing mental state examination based on listening to client or through direct questioning the key symptoms of psychotic episode such as:



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Hallucinations- e.g are they hearing any voices or seeing any persons/objects that they think might not be there. Especially, important if person may be experiencing command hallucinations to hurt themselves or others. Delusions- e.g callers expressing unusual or odd beliefs, ideas of reference from TV and other media. Speech- poverty of speech vs pressured speech etcThought disorder- e.g tangentiality, poverty of thought content etcCognitive functioning- e.g difficulties in attention, concentration or memory, orientation to time, person and place. Insight- does the client have awareness and understanding of their possible mental health problems and are they willing to get helpD&A use- current and historically

NOTE: As with all presentations, it is important to assess risk of self-harm and violence as shown in sections above.

5.3 Consumers experiencing depressionAs well as suicide risk, explore characteristic symptoms of depression and ask questions directly around issues such as: sleep, appetite, feelings of hopelessness, guilt, libido, concentration/memory, energy

and fatigue, negative thinking etc



Documents

Crisis Assessment and Treatment Team - health.act.gov.au · Web viewTo provide Triage/CATT staff with a Procedure to outline processes specific to the area of mental health triage