NSFT Integrated Delivery Teams Recovery Forum Graham Abbott June 2017

Mental Health Payment by Results ‘Clustering’ Organic Psychotic Disorder Very Severe and Complex Common Mental Health Problems (Non-Psychotic) Mild/ Moderate & Severe Common Mental Health Problems (Non-Psychotic)

Mental Health Clustering Plain text

Cluster 1 Cluster 2 Cluster 3 Cluster 4 Common Mental Health Problems (Low Severity) This group has definite but minor problems of depressed mood, anxiety or other disorder but they do not present with any distressing psychotic symptoms Cluster 2 Common Mental Health Problems (Low Severity with Greater Need) This group has definite but minor problems of depressed mood, anxiety or other disorder but they do not present with any distressing psychotic symptoms. Cluster 3 Non-Psychotic (Moderate Severity) Moderate problems involving depressed mood, anxiety or other disorders (not including psychosis). Cluster 4 Non-Psychotic (Severe)

Cluster 5 Cluster 8 Non-Psychotic Disorders (Very Severe) Cluster 6 This group will be severely depressed and/or anxious and/or other. They will not present with distressing hallucinations or delusions but may have some unreasonable beliefs. They may often be at high risk for suicide and they may present safeguarding issues and have severe disruption to everyday living. Cluster 6 Non-Psychotic Disorders of Over-valued Ideas Moderate to very severe disorders that are difficult to treat. This may include treatment resistant eating disorder, OCD, where extreme beliefs are strongly held, some personality disorders and enduring depression. Cluster 7 Enduring Non-Psychotic Disorders (High Disability) This group suffers from moderate to severe disorders that are very disabling. They will have received treatment for a number of years and although they may have improvement in positive symptoms considerable disability remains that is likely to affect role functioning in many ways. Cluster 8 Non-Psychotic Chaotic and Challenging Disorders This group will have a wide range of symptoms and chaotic and challenging lifestyles. They are characterised by moderate to very severe repeat deliberate self-harm and/or other impulsive behaviour and chaotic, over dependent engagement and often hostile with services.

Ongoing or Recurrent Psychosis Cluster 10 First Episode Psychosis   This group will be presenting to the service for the first time with mild to severe psychotic phenomena. They may also have depressed mood and/or anxiety or other behaviours. Ongoing or Recurrent Psychosis Cluster 11 Ongoing Recurrent Psychosis (Low Symptoms) This group has a history of psychotic symptoms that are currently controlled and causing minor problems if any at all. They are currently experiencing a period of recovery where they are capable of full or near functioning. However, there may be impairment in self-esteem and efficacy and vulnerability to life. Cluster 12 Ongoing or Recurrent Psychosis (High Disability) This group have a history of psychotic symptoms with a significant disability with major impact on role functioning. They are likely to be vulnerable to abuse or exploitation. Cluster 13 Ongoing or Recurrent Psychosis (High Symptom and Disability) This group will have a history of psychotic symptoms which are not controlled. They will present with severe to very severe psychotic symptoms and some anxiety or depression. They have a significant disability with major impact on role functioning.

Very Severe Psychosis with Poor Engagement Psychotic Crisis Cluster 14 They will be experiencing an acute psychotic episode with severe symptoms that cause severe disruption to role functioning. They may present as vulnerable and a risk to others or themselves. Cluster 15 Severe Psychotic Depression This group will be suffering from an acute episode of moderate to severe depressive symptoms. Hallucinations and delusions will be present. It is likely that this group will present a risk of suicide and have disruption in many areas of their lives. Very Severe Psychosis with Poor Engagement Cluster 16 Dual Diagnosis This group has enduring, moderate to severe psychotic or affective symptoms with unstable, chaotic lifestyles and coexisting substance misuse. They may present a risk to self and others and engage poorly with services. Role functioning is often globally impaired. Cluster 17 Psychosis and Affective Disorder - Difficult to Engage This group has moderate to severe psychotic symptoms with unstable, chaotic lifestyles. There may be some problems with drugs or alcohol not severe enough to warrant dual diagnosis care. This group have a history of non concordance, are vulnerable & engage poorly with services.

Cluster 18 Cognitive Impairment (Low Need) The person in this cluster will have mild cognitive impairment or early stage dementia or organic brain disorder. Cluster 19 Cognitive Impairment or Dementia Complicated (Moderate Need) The person in this cluster will have problems with their memory and/or other aspects of cognitive functionality resulting in moderate problems in their daily living and coping skills. Cluster 20 Cognitive Impairment or Dementia Complicated (High Need) The person in this cluster may have significant problems looking after themself & may have a risk of self-neglect/harm to others. The person may have high levels of anxiety, depression or psychotic symptoms and their behaviour may pose serious challenges to others. They may be at risk of their care arrangements breaking down. Cluster 21 Cognitive Impairment or Dementia (High Physical or Engagement) The person in this cluster will have significant problems looking after themselves and may have a risk of self-neglect/harm to others. The person’s physical health may be very poor possibly resulting in frailty. Their behaviour may significantly challenge others and they may be at risk of their care arrangements breaking down.

Children and families pathway This pathway is primarily for children aged 13 and under, and their parents or carers. It places emphasis on the prevention of future mental health problems by addressing parenting difficulties, attachment problems, mental health problems and neurodevelopmental difficulties in early childhood.

Young People’s Pathway Young people with emerging and severe mental health problems who are aged between 14 and 25 years, on the basis of severity and reduction of function, in context of emerging, acute or chronic illness. Adult - Clusters 5-17

Adult Pathway The adult pathway is for people aged 25 and over whose mental health needs are more severe than can be met by the Wellbeing service (Cluster 5-17). It includes adults over the age of 65 who do not have dementia or complexities associated with ageing and individuals who have mild learning disabilities with a coexisting Mental Health Problem. It incorporates assertive outreach and early intervention in psychosis for those adults who have a first episode aged 25 or older.

Enhanced community pathway This is in addition to the existing Suffolk Wellbeing Service, offering a broader social inclusion approach, aiming to make links with local resources to reduce isolation and stigma. This pathway is for people with moderate depression or anxiety, people with personality disorders and people who have a psychotic illness but are stable.

Complexity in Later Life This pathway is for people of all ages with dementia and people with mental health problems who also have complexities associated with ageing.

Neuro-developmental Pathway This pathway is for people aged 14 and over with mental health problems and/or challenging behaviour and severe, profound and multiple learning disabilities, autistic spectrum disorders or attention deficit hyperactivity disorder.

Eating-Disorder Pathway This pathway is for individuals presenting with anorexia nervosa, bulimia nervosa, binge eating disorder and related diagnoses. There is an under 18’s team and a separate smaller adult team.

Services for people likely to go into, or who are leaving hospital Step-up care Home Treatment Alternative to admission Beds Acute Admission

NSFT Dual Diagnosis Policy Quote (p8) Mental Health: Drug and alcohol use can often make mental health assessment difficult – but not impossible, therefore intoxication and/or recent use of alcohol/drugs is not a contraindication for mental health assessment. Mental health and substance misuse practitioners should, wherever possible and with the consent of the service user, discuss the case prior to making a referral to their partner service. Areas considered may include: The extent of the mental health difficulty The extent of the drug and/or alcohol misuse Current risks and needs Current care-plan History Current presentation Service user aims for treatment