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 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)

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)

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 Australia Location Sydney, Australia N/A Urban and Rural Rural Approx. population 250,000 140,000 Model Type Centralised / Call Centre Services the entire population in catchment area Operating Hours 27/4 Staffing Mental health clinicians Dedicated triage team Services provided Tele-Triage Assessment Referral Advice Case Management & Support Information Self Management Crisis Management   Counselling Case management support (staff leave & standing orders) (Includes sexual assault and drug and alcohol calls) Operational Guidelines and Processes Policies and guidelines, electronic triage instrument, clinical management guidelines, automated suicide assessment Clinical management guidelines Protocol Automated alert (further assessment) Electronic records Infrastructure Call centre telecommunications & IT systems Call centre telecommunications & IT Systems Case management software Dedicated office space Department of Human Services Victoria , Evaluation of the Southern Health Psychiatric Triage Service (2008)

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)

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.

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)