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Mental Health Justice Health Alcohol and Drug Services (MHJHADS)Standard Operating Procedure: Clinical Management in Mental Health Services

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Mental Health Justice Health Alcohol and Drug Services (MHJHADS)

Standard Operating Procedure: Clinical Management in Mental Health Services

Purpose

The National Standards for Mental Health Services 2010 state that care management is a cyclical process, in which needs are assessed, services are delivered in response, and needs are re-assessed, leading to a changed service response.

Scope

This Standard Operating Procedure applies to all staff employed in a clinical capacity in all Mental Health services, including community mental health settings. The principles of evidence based practice (Clinical Practice Guidelines; psychological interventions;

pharmacological interventions) will be used to support people during their episode of care.

An allocated medical officer will have a clinical leadership role with all clinically managed people.

Procedure Background

When clinically indicated, Mental Health provides services using a clinical management [CM]

framework to consumers across the age span during an episode of care. Within this framework, Mental Health services clinicians provide a comprehensive and collaborative assessment which is summarised in a formulation with an interim clinical plan, engagement in collaborative recovery planning, care coordination and therapeutic interventions inclusive of psychological therapies. Standardised clinical processes are defined for case review and clinical handover for transfer of care and/or episode of care closure.

Mental Health services is a person centred service that promotes a collaborative approach with other service providers and agencies. Mental Health services aim to foster

independence for people experiencing mental disorder or mental illness to promote wellbeing and autonomy to support ongoing recovery.

The recovery principles for Mental Health services (see at Attachment 1) and the Recovery Standard of the National Mental Health Standards (see at Attachment 2) guide this approach to care and are applied in Mental Health services within the context of standardised clinical processes.

Roles & Responsibilities

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Consistent with The National Standards for Mental Health Services 2010 (NSMHS), 10.3.8, at the point of entry, a nominated clinician is allocated as the primary point of contact for all stakeholders related to the person’s care. Within Mental Health services, the nominated contact point for requests for medical consultation with a consultant psychiatrist is the administrative officer.

Team Leaders, Operational Directors and Clinical Directors ensure that processes are in place in all teams to support the provision of clinical management. These processes encompass, but are not limited to: multidisciplinary team meetings, clinical review, allocation of people and clinical handover.

Relevant Policies, SOPs and the Clinical Processes and Documentation Resource Package V4 (2011) outline the processes and define the expectations of CM. The determination to provide CM is made by the multidisciplinary team inclusive of medical leadership. The interventions provided [psychological - inclusive of psychosocial and family interventions - and pharmacological] are to be evidenced-based and consistent with the Royal Australian &

New Zealand College of Psychiatry (RANZCP) Clinical Practice Guidelines.

Clinical Management also acknowledges the importance of a holistic approach to support people in their mental health recovery and for this reason values the contributions of the multidisciplinary team including non-clinical support staff, peer workers and community agency staff. Interventions to address ongoing functional difficulties, strategies to address obstacles to social inclusion and harnessing adequate supports and resources may be required to assist the person’s ongoing recovery. Clinical Managers will have some core and specialist skills to inform appropriate interventions to assist in these areas and it is

anticipated that Clinical Managers would also refer to, and collaborate with other rehabilitation and support services as required.

Mental Health services have a range of strategies to support clinicians, including daily clinical meetings, scheduled case reviews, clinical and operational supervision and professional development/training.

General Practitioners [GPs] are an integral part of the treating team and Clinical Managers will liaise with GPs within structured timeframes such as initial assessment and three monthly reviews as well as ad hoc contact in the event of any change in treatment or identified deterioration of people’s mental health.

The scheduled three monthly review is a flag for Clinical Managers to regularly review the outcomes of interventions and liaise with all stakeholders. The completed Case Review form, Outcome Measurement/s, progress in psychological therapy, response to pharmacological treatment, considerations for rehabilitation and/or ongoing recovery will be discussed at these reviews.

Planning for discharge is an ongoing discussion and takes into account the needs and perspectives all stakeholders. Early recognition of deterioration and Keeping Well Plans will be developed as a component of discharge planning.

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If re-contact with mental health services results in a decision to re-commence CM, the previous Clinical Manager will be re-allocated if capacity exists.

Triaging, Intake & Referral and Screening Guidelines

Entry refers to the process by which the mental health service assists the person and their carers to make contact with the mental health service and receive appropriate assistance.

Mental Health services have multiple sites of entry with a single process that is consistent across the ACT. When a person first makes contact with or is referred to Mental Health services, a clinician will undertake an assessment. This assessment will include an overview of the person and their situation inclusive of an assessment of the level of risk. The

presentation and the level of response required is informed by the Mental Health Triage Scale (2010; See at Attachment 3).

All assessment documents generated on the electronic clinical record will include the completion of the response category section of the document. Response categories are allocated according to the level of risk assessed at presentation.

Additionally, Screening Guidelines for Mental Health Services (see at Attachment 4) are provided to support clinicians in referral of persons to facilitate their access to optimal, appropriate care. The guidelines also provide referral options to other agencies where specialist mental health interventions are not indicated, or to identify potential partners to provide coordinated care where specialist mental health services are indicated.

Process of case allocation

Clinical Management must be considered for all clients who are identified as having high vulnerability or risks, complex and long-term needs. When there is a determination that an individual is to be provided clinical management, the Team Leader will monitor all referrals and ensure that people’s allocations for CM occur in a transparent, equitable and sustainable manner matching the person’s needs to clinician skills and knowledge.

Caseload size for CMs will be based on a matrix inclusive of: complexity (e.g. considering factors such as comorbidity of other mental and physical health, substance use issues, social/occupational functioning); acuity (e.g. intensity of contact required, as reflected by the frequency and duration of Occasions of Service); diagnosis; focus of care and the phase of engagement (e.g whether CM is in the initial 6 months or longer), recognising that this period of engagement often requires a higher level of intensity; number of people on the clinician’s existing caseload; and skill set and level of experience of the staff member.

The following guide should be adapted to the clinician’s employment status {FT or PT] and additional formal roles and responsibilities. This figure is not intended to ‘cap’ caseloads but along with the above matrix is monitored in meetings between the Team Leader and

clinician. The team-based monthly reports generated from the electronic clinical record will be used to support this process.

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Case load allocation can be expected to be within the following range:

Designation Case load allocation HPO1 / RN 1 10 to 15 persons HPO2 / RN2 20 to 25 persons

HPO3 / RN3 25 to 30 persons (to include consumers with complex needs)

“Doctor-only” Managed Clients

It is acknowledged that some people may require some degree of ongoing contact with Mental Health services yet not require the additional support and resources associated with clinical management.

In such cases, a person may remain primarily under the care of a Consultant Psychiatrist with minimal, if any, support and contact from other clinicians within the community mental health team. The interventions for such people may be limited to periodic review by the Consultant Psychiatrist, and as a general rule they should only require review every 3 months or more. For people who require more frequent contact, consideration should be given to referral for clinical management.

Additionally, where there is an identified marked deterioration in a person’s mental state, the treating Consultant Psychiatrist should refer the consumer to the Multi-disciplinary Team (MDT). Consideration for clinical management and/or other team interventions is to be given during the course of the Daily Clinical Meeting.

Transfer of Clinical Management

Where transfer of care is required, particularly in the context of a long-term therapeutic relationship, the formal handover process should include discussion with the person, their identified supports (e.g. carers, family) and should outline current and past management strategies and any other relevant information that may impact on the new clinical

management relationship.

Evaluation

Outcome Measures

 Clinical managers will be allocated people managed by MHJHADS according to the procedures described above.

Method

 Monitoring by Team Leaders/Managers of incident reports via Riskman and Consumer Feedback where appropriate clinical management allocation has not occurred or has not adequately met the standard as described in this Standard Operating Procedure.

 Team Leaders will meet regularly (at least every 2 months) with each Clinical Manager to ensure oversight of their practice, review of their caseload and to offer support where required, as well as promoting quality assurance and improvement

opportunities.

 Clinical Case reviews should be conducted for each clinically managed consumer every 3 months (or ad hoc as required) to access MDT contributions to Recovery Planning.

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 Evaluation will also occur via a review of all aggregate Riskman incident data relating to clinical management allocation. This review will be conducted by the Operational Director of Adult Community & Older Persons Mental Health Services prior to the review date for this Standard Operating Procedure.

Related Legislation, Policies and Standards Legislation

Mental Health (Treatment and Care) Act 1994 Health Records (Privacy and Access) Act 1997 Human Rights Act 2004

Policies

MHJHADS SOP: Clinical Handover in Community Mental Health Settings MHJHADS SOP: Clinical Case Review in Mental Health Services

MHJHADS SOP: Confidentiality and Privacy

MHJHADS SOP: Daily Clinical Meetings in Community Mental Health Settings MHJHADS SOP: Episode of Care Closure

MHJHADS Publication: Clinical Processes and Documentation Resource Package 4th edition.

Standards

National Standards for Mental Health Services 2010 References

King R, Lloyd C, Meehan T, Handbook of Psychosocial Rehabilitation. Blackwell Publishing 2007.

Shepherd G, Boardman J, Slade M, Making Recovery a Reality. Sainsbury Centre for Mental Health March 2008.

Auditor General’s Report No 8 of 2010: Delivery of Mental Health Services to Older Persons.

Attachments

Attachment 1: Mental Health Services recovery principles

Attachment 2: Principles of recovery-oriented mental health practice Attachment 3: Mental Health Triage Scale

Attachment 4: Screening Guidelines for Mental Health Services

Disclaimer: This document has been developed by Health Directorate/ Mental Health, Justice Health, Alcohol & Drug Services specifically for its own use. Use of this document and any

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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: Mental Health services Recovery Principles

These principles have been developed to inform and guide the ACT community, and in particular mental health service providers, to support the spirit of recovery and enhance potential contributions to a person’s recovery journey. They have been developed after reflection on principles, dimensions and key elements from other states in Australia and around the world. Underlying these principles is acknowledgement of the unique nature of the recovery journey and the importance of creating a culture of optimism, healing and inclusion.

.  Hope is fundamental to a person’s recovery journey.

 A person’s unique life context - encompassing, though not limited to, culture, spirituality, gender, age, life roles - is acknowledged and valued.

 People are encouraged to take the lead in their recovery journey and collaborate with a range of services and supports as required.

 Maintaining and developing connections to valued people and activities is critical to the recovery journey.

 Partnerships are based on trust and mutual respect.

 People are provided with the necessary information to enable them to make informed decisions about their recovery journey.

 Everyone has responsibility for creating and sustaining a culture that promotes recovery

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Attachment 2: Principles of recovery-oriented mental health practice

From the perspective of the individual with mental illness, recovery means gaining and retaining hope, understanding of one’s abilities and disabilities, engagement in an active life, personal autonomy, social identity, meaning and purpose in life, and a positive sense of self.

It is important to remember that recovery is not synonymous with cure.

Recovery refers to both internal conditions experienced by persons who describe themselves as being in recovery— hope, healing, empowerment and connection—and external

conditions that facilitate recovery—implementation of human rights, a positive culture of healing, and recovery-oriented services1.

The purpose of principles of recovery oriented mental health practice is to ensure that mental health services are being delivered in a way that supports the recovery of mental health consumers.

1. Uniqueness of the individual

Recovery oriented mental health practice:

 Recognises that recovery is not necessarily about cure but is about having

opportunities for choices and living a meaningful, satisfying and purposeful life, and being a valued member of the community

 Accepts that recovery outcomes are personal and unique for each individual and go beyond

 An exclusive health focus to include an emphasis on social inclusion and quality of life

 Empowers individuals so they recognise that they are at the centre of the care they receive.

2. Real choices

Recovery oriented mental health practice:

 Supports and empowers individuals to make their own choices about how they want to lead their lives and acknowledges choices need to be meaningful and creatively explored

 Supports individuals to build on their strengths and take as much responsibility for their lives as they can at any given time

 Ensures that there is a balance between duty of care and support for individuals to take positive risks and make the most of new opportunities.

3. Attitudes and rights

Recovery oriented mental health practice:

 Involves listening to, learning from and acting upon communications from the individual and their carers about what is important to each individual

 Promotes and protects individual’s legal, citizenship and human rights

 Supports individuals to maintain and develop social, recreational, occupational and vocational activities which are meaningful to the individual

 Instils hope in an individual’s future and ability to live a meaningful life.

4. Dignity and respect

Recovery oriented mental health practice:

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 Consists of being courteous, respectful and honest in all interactions

 Involves sensitivity and respect for each individual, particularly for their values, beliefs and culture

 Challenges discrimination and stigma wherever it exists within our own services or the broader community.

5. Partnership and communication

Recovery oriented mental health practice:

 Acknowledges each individual is an expert on their own life and that recovery

involves working in partnership with individuals and their carers to provide support in a way that makes sense to them

 Values the importance of sharing relevant information and the need to communicate clearly to enable effective engagement

 Involves working in positive and realistic ways with individuals and their carers to help them realise their own hopes, goals and aspirations.

6. Evaluating recovery

Recovery oriented mental health practice:

 Ensures and enables continuous evaluation of recovery based practice at several levels

 Individuals and their carers can track their own progress

 Services demonstrate that they use the individual’s experiences of care to inform quality improvement activities

 The mental health system reports on key outcomes that indicate recovery including (but not limited to) housing, employment, education and social and family

relationships as well as health and well being measures.

These Recovery Principles have been adapted from the Hertfordshire Partnership NHS Foundation Trust Recovery Principles in the UK.

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Attachment 3: Mental Health Triage Scale

Mental Health Triage Scale 2010 (Victorian Department of Health)

CODE/

DESCRIPTION

RESPONSE TYPE/TIME TO FACE- TO-FACE CONTACT

TYPICAL PRESENTATIONS MENTAL HEALTH

SERVICE

ACTION/RESPONSE

ADDITIONAL ACTIONS TO BE CONSIDERED

A

Current actions endangering self or others

Emergency services response IMMEDIATE 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 arrive CATT notification/attendance Notification of other relevant services (e.g. child protection)

B

Very high risk of imminent harm to self or others

Crisis mental health response WITHIN 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 37 of the ACT Mental Health (Treatment & Care) Act 1994.

Face-to-face assessment The 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

C High risk of harm to self or others and/or high distress, especially in absence of capable supports

Urgent mental health response 2 – 12 HOURS

Rapidly increasing symptoms of psychosis and/or severe mood disorder

High risk behaviour associated with 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

Face-to-face assessment within 12 HOURS AND

telephone follow-up within ONE HOUR of triage contact

As above

Obtaining collateral/additional information from relevant others

D

Moderate risk of harm and/or significant distress

Semi-urgent mental health response 12 – 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

E

Low risk of harm in short term or moderate risk with high support/

stabilising factors

Non-urgent mental health response WITHIN 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: not requiring face- to-face response from MHS in this instance

Referral or advice to contact alternative service provider

Other services (e.g. GPs, private mental 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

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

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

G Advice or information only/ Service provider consultation/

MHS requires more information

Advice or information only OR More information needed

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Attachment 4: Screening Guidelines for Mental Health Services

All contacts with Mental Health services require the level of assessment necessary for the development of a plan for clinical intervention by Mental Health services or referral on to an alternative service. Assessment is a process by which the characteristics and needs of consumers, groups or situations are evaluated or determined so they can be addressed. The assessment forms the basis of a plan for services or action. The clinician / treating team determine the level of urgency based on the assessment and use of the Mental Health Triage Scale.

These screening guidelines will be used to support clinicians in referral of persons to facilitate their access to optimal appropriate care. The guidelines also provide referral options to other agencies where specialist mental health interventions are not indicated, or to identify potential partners to provide coordinated care where specialist mental health services are indicated. To support this sector, Mental Health services will provide care co-ordination and liaison to General Practitioners and Community Agencies. General Practitioners will have timely access to Consultant Psychiatrists for consultation.

In 2013, the Mental Health Adult services are available, with some flexibility, to adults aged 18 years old to 65 years old. The most appropriate service to meet an identified need will be determined clinically and, if an age related mental illness exists, the individual will be referred to the appropriate services e.g. Child and Adolescent Mental Health Services, Older Persons Mental Health Services.

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Referral Criteria Referral Response A

Accommodation Issues (primary presenting problem) – No mental health concerns

Community Services Directorate (ACT Housing) Phone: 6207 1150

Anglicare Housing Program Phone: 1800 228 150

Canberra Emergency Accommodation Service Phone: 6257 2333

Ainslie Village Phone: 6162 6800 Canberra Mens Centre Phone: 6230 6999

Centacare Homelessness Service Coordinator Phone: 6163 7600

Dickson Backpackers Phone: 6262 9922

Havelock Housing Association Phone: 6257 2277

Inanna South (women) Phone: 6295 3323 Toora (women) Phone: 6247 2399

Inanna North - Raja (for families) Phone: 6163 6300

GROW

Phone: 6295 7791 Richmond Fellowship Phone: 6249 7912 Samaritan House Phone:6247 6691

Mary’s Place (Queanbeyan) Phone: 6299 1619

Adjustment disorder – with an inability to function at usual level – including situational

Refer to Mental Health services General Practitioner

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crises where there is risk to self

or others ANU Psychology Clinic

Phone: 02 6125 0412

University of Canberra Psychology Clinic Phone: 6201 2883

Better Access to Mental Health Care – Up to 12 Free Sessions available per annum when referred by a G.P. under Medicare Access Program - Bulk Billing available for some service providers.

(e.g. Centacare ) Private Practitioners Anger Management

issues/problems Relationships Australia Canberra and Region Phone: 6122 7100

Centacare

Phone: 6163 7600 Lifeline

Phone: 13 11 14

Canberra Mens Centre (Men) Phone: 6230 6999

Innana South (Women) Phone: 6295 3323

ANU Psychology Clinic Phone: 02 6125 0412

University of Canberra Psychology Clinic Phone: 6201 2883

Better Access to Mental Health Care – Up to 12 Free Sessions available per annum when referred by a G.P. under Medicare Access Program - Bulk Billing available for some service providers.

(e.g. Centacare )

Consider private practitioner.

Anxiety Disorder/Symptoms (Consider severity, intensity and duration of symptoms, level of functional impairment, and degree of insight, available support, and history of illness).

If impact on functioning is significant – refer to Mental Health services.

If symptoms are manageable but support/intervention is required:

University of Canberra (Headspace) Phone: 6201 5343 (for 12 – 25 year olds)

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Symptoms may include panic attacks, constant worry, inability to function properly due to anxiety (unable to leave house, go to work); phobias, physical symptoms (nausea, sweating, racing heart, shaking) unwanted intrusive thoughts and images

ANU Psychology Clinic Phone: 02 6125 0412

University of Canberra Psychology Clinic Phone: 6201 2883

Better Access to Mental Health Care – Up to 12 Free Sessions available per annum when referred by a G.P. under Medicare Access Program - Bulk Billing available for some service providers.

(e.g. Centacare )

Calvary 2N Anxiety/Depression Group Phone: 62016020 (one group per year)

Consider private practitioner.

Assault/Violence

Domestic Violence (victim) – can include different forms of abuse such as physical, sexual,

psychological.

Sexual assault (current sexual assault crisis or chronic, unresolved sexual assault)

If immediate violence refer to police Domestic Violence Crisis Service Phone: 62800900 (24hours)

Domestic Violence Orders and Protection Orders Unit Phone: 6217 4299

Women’s Health Service Phone: 6205 1078

Women’s Information and Referral Centre (business hours) Phone: 6205 1075

Victims Support Unit 4th Floor 1Moore St

Northside Women’s Supported Accommodation Program Phone: 6249 1113

See accommodation if required

Care and Protection notification if required

Canberra Rape Crisis Centre Phone: 6247 8071

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SAMSA

Phone: 6262 7377

National Domestic Violence and Sexual Assault Helpline Phone:

1800 200 526

Domestic Violence Orders and Protection Orders Unit Phone: 6217 4299

Refer matter to police if appropriate.

Consider Forensic Medical Unit at ED if appropriate.

Care and Protection notification if required.

B

Borderline personality/traits See P Personality Disorders/traits Bipolar Disorder/traits See M Mood Disorders

Bereavement

Bereavement is a normal part of life and is not appropriate for Mental Health services unless complicated by the following:

Bereavement/Grief [traumatic or non-resolving] –may involve the death of a friend or loved one. Acute impact on level of functioning. Associated with major depression. Suicidal ideation/intent may be present.

Bereavement – normal grief reaction, limited impact on daily functioning

GP

Refer to Mental Health services for assessment if there are traumatic events involved and/or.

Unresolved grief reactions.

Lifeline(if crisis) Phone: 13 11 14

University of Canberra Headspace Phone: 6201 5343 (for 12 – 25 year olds) Consider private practitioner.

Grief Resource Centre ACT Phone: 02 6291 4994

ANU Psychology Clinic Phone: 02 6125 0412

University of Canberra Psychology Clinic Phone: 6201 2883

Better Access to Mental Health Care – Up to 12 Free Sessions available per annum when referred by a G.P. under Medicare Access Program - Bulk Billing available for some service providers.

(e.g. Centacare )

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Compassionate Friends Phone: 6286 6134

Lifeline(if crisis) – 13 11 14

University of Canberra Headspace Phone: 6201 5343 (for 12 – 25 year olds) Consider private practitioner.

Grief Resource Centre ACT Phone: 02 6291 4994

ANU Psychology Clinic Phone: 02 6125 0412

University of Canberra Psychology Clinic Phone: 6201 2883

Better Access to Mental Health Care – Up to 12 Free Sessions available per annum when referred by a G.P. under Medicare Access Program - Bulk Billing available for some service providers.

(e.g. Centacare )

Compassionate Friends Phone: 6286 6134

SIDS & Kids ACT (support following stillbirth, infant or young child death from any cause) 24hrs

Phone: 62874255

C

Childhood – Mental health concerns/symptoms in young people under the age of 18 years

Child and Adolescent Mental Health Service (CAMHS):

CAMHS South office Phone: 6205 1469

CAMHS North office Phone: 6205 1050

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Headspace Phone: 6201 5343

Court Matters See L Legal Matters

D

Dementia with no mental health issues

If Behavoural or Psychological Symptoms of Dementia are present, consider

Community Options Inc Phone: 02 6295 8800

Home from Home Respite Phone: 02 6285 2082

ACT Dementia Network Phone: 02 6255 0722

ACAT Teams

General Practioners

Department of Aged Care and Rehabilitation Alzheimer’s Australia

DBMAS

Older Persons Mental Health Services Link to Organic Brain Disorders

Depression See M Mood Disorders

Distress – Acute mental distress displaying agitation,

uncontrollable crying not able to be consoled, affecting their level of functionality

Refer to Mental Health services

Drug and Alcohol issues - comorbid with mental illness,

Drug and Alcohol is the primary

Refer to Mental Health services and Alcohol & Drug services

Drug and Alcohol Central Intake

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presenting problem and no mental health concerns

Phone: 62079977

Drugs In The Family Phone: 6257 3043

WIREDD - Women’s Information Resources and Education on Drugs and Dependency

Phone: 02 6248 8600

Directions ACT Phone: 6122 8000

Arcadia House Phone: 6253 3055

Salvation Army Canberra Recovery Centre Phone: 62951256

Karilika Drug Rehab Phone: 6292 2733 E

Early psychosis

Displaying impaired role functioning over time resulting in mental illness e.g. prodromal Over 24 years age

Under 24 years age

Refer to Mental Health services for a full assessment.

Psychological Assistance Services ANU Psychology Clinic

Phone: 6125 0412

University of Canberra Psychology Clinic Phone: 6201 2883

Better Access to Mental Health Care – Up to 12 Free Sessions available per annum when referred by a G.P. under Medicare Access Program - Bulk Billing available for some service providers (e.g. CatholicCare ).

Consider private practitioner.

Refer to Child and Adolescent Mental Health Service (CAMHS):

CAMHS South office

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Phone: 6205 1469

CAMHS North office Phone: 6205 1050

Headspace Phone: 6201 5343 Early Psychosis

Recent onset of symptoms related to mental

illness/disorder, no previous history

Refer to Mental Health services.

Also consider private practitioner where symptoms have been effectively managed.

Discuss referral to GP.

Eating Disorders – Anorexia, Bulimia, Eating Disorder NOS, Binge Eating Disorder

Eating difficulties and self image (Disordered eating, not meeting eating disorder diagnostic criteria)

Referral to Mental Health services - Eating Disorders Program for referral information and general assistance

Phone: 6205 1519

Better Access to Mental Health Care – Up to 12 Free Sessions available per annum when referred by a G.P. under Medicare Access Program - Bulk Billing available for some service providers (e.g. private psychologists who specialise in Eating Disorders - there are a few in ACT)

Financial Issues Lifeline

Phone: 13 11 14

Centrelink – Financial Information Service Phone: 13 10 21

Public Advocate of the ACT Phone: 6207 0707

CARE Financial Counselling Phone: 6257 1788

Public Trustee Forensic Matters See L Legal Matters G

Gambling issues Lifeline

Phone: 13 11 14

Centrelink – Financial Information Service Phone: 13 10 21

CARE Financial Counselling Phone: 6257 1788

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G Line Gambling Hotline Phone: 1800633635 Gambling Care Phone: 6247 0655 H

I

Impairment in Functioning – symptoms causing clinically significant distress or impairment in social, occupational, or other

important areas of functioning.

Refer to Mental Health services for assessment.

Intellectual Disability with co morbid mental health issues

Refer to Mental Health services – (Note: These cases should come through Triage and then be referred to MH-IDS within Mental Health services for a joint assessment with the age and regionally appropriate team. If it is deemed necessary to have further treatment and care, then these consumers recovery plans are collaboratively developed between teams for ongoing care.) Mental Health- Intellectual Disability Service (MH-IDS) Phone: 62078210

Centacare Disability Services Support Programs Phone: 6163 7600

Canberra Men’s Centre MASS program Phone: 6230 6999

Disability ACT Phone: 133427 J

L

Legal Matters and Treatment and Care Orders

Forensic Mental Health Report (can only be ordered by ACT Law Courts)

Forensic Services Phone: 6205 1551

Note: no report is supplied unless a court order is directed to Forensic services.

Private practitioner.

Determination of Mental Impairment and whether ACAT could consider a Community Treatment Order or Psychiatric Treatment Order (this category only relevant to persons with

Mental Health services with option to discuss with Forensic Services for expert input.

On receiving an Assessment Order from ACAT or the courts, Forensic Services (Phone: 62051551) will complete the relevant

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CURRENT criminal matters) report.

Assessment Order for Psychiatric Treatment Order (no ongoing criminal proceedings)

On receiving an Assessment Order from ACAT medical staff from the relevant Mental Health services community team will complete a report (this includes OPMH and CAMHS) with input from Clinical Manager and MDT.

Assessment Order for Community Care Order (no ongoing criminal proceedings)

On rare occasions ACAT may request additional information from a Mental Health services community team on whether a CCO is warranted. Usually information is provided to ACAT by family, Care and Protection, Disability ACT, GPs.

M

Medication non-compliance See N non-compliance Mood Disorders/Symptoms

Moderate to Acute symptoms of major depressive disorder

Bipolar disorder – consider severity of symptoms, level of functional impairment, degree of insight, available support, history of illness.

Mild disturbance and depressive symptoms

Refer to Mental Health services

Refer to Mental Health services

Refer to GP in the first instance.

Better Access to Mental Health Care – Up to 12 Free Sessions available per annum when referred by a G.P. under Medicare Access Program - Bulk Billing available for some service providers (e.g. CatholicCare).

Consider private practitioner.

ANU Psychology Clinic Phone: 02 6125 0412

University of Canberra Psychology Clinic Phone: 62012883

Calvary 2N Anxiety/Depression Group Phone: 62016020

PANDSI (Post and Antenatal Depression Support and Information) Phone: 62326664

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Headspace

Phone: 6201 5343 (for 12 – 25 year olds) Beyond Blue

Phone: 1300 22 4636

N

Non-adherance with treatment/medication – individual with a mental illness who has not been adherent with their prescribed

treatment/psychotropic medication

Refer to Mental Health services.

O

Older persons - Mental health concerns/symptoms in older people over the age of 65 years

Refer to Older Persons Mental Health for assessment of

suitability/appropriateness of Mental Health services involvement Phone : 6205 1957 (Business Hours)

Link to Dementia

Link to Organic Brain Disorders

Orders – Psychiatric Treatment Orders (PTO) and Community Care Orders (CCO)

See L Legal Matters and Treatment and Care Orders

Organic Brain disorder with significant (acute) psychiatric features

Organic Brain Disorder but without significant (acute) psychiatric features

Neurologist.

Refer to Mental Health services (note - the problem is most difficult with those suffering from a delirium or dementia resulting from brain injury. This cohort of consumers should be first treated by neurologists; and then psychiatric intervention only after the onset of clearly defined psychiatric symptoms which persist once the acute stage has been dealt with).

Where there is a strong acute or ongoing neurological component such as seen in a tumour, HIV or MS Mental Health services could be co-treated along with the relevant neurologist.

Consider referral to neuropsychiatry.

Alzheimer’s Australia ACT Helpline Phone: 1800 100500

National Brain Injury Foundation and Headway ACT Phone: 6282 2880

Doc Number Issued Review Date Area Responsible Page

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National Brain Injury Foundation and Headway ACT Phone: 6282 2880

P

Pain management Consider private practitioner.

Pain Management Unit

Phone: 02 6244 3055 (note waiting time is 3 months)

Community Health Intake - ACT Health Phone: 6207 9977

GP request.

Parenting Pregnancy, Birth and Baby Helpline - ph:1800 88 24 36 (available 24 hours a day, seven days a week)

Barnardos parenting outreach - ph: 6241 5466 Child Youth and Women's Health - ph: 62079977 Parentline - ph: 62873833

Queen Elizabeth II Family Centre - ph: 62052333 Marymead Child and Family Centre - ph: 61625800

Care and Protection Services (ACT)- ph: 1300 556 729 (where the child is in the ACT)

Dept of Community Services - ph: 132111 (where the child is NSW)

Kidsafe (Child & Accident Prevention Foundation) - ph: 62902244 Psychiatric Treatment Order

(PTO)

See L Legal Matters and Treatment and Care Orders

Psychotic illness/symptoms – Acute psychotic symptoms.

Problems may include hearing voices, thought disorder,

delusional thinking or displaying bizarre behaviour

Refer to Mental Health services.

Personality disorder - current level of emotional distress is associated with significant decline in functionality, self harming behaviours – may be in crisis

Refer to Mental Health services.

Centre for Psychotherapy (if meet criteria).

Consider private practitioner.

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Women’s Health Service Phone: 6205 1078

Women’s Information and Referral Centre Phone: 6205 1075

Canberra Men’s Centre Phone: 6230 6999 Innana South (Women) Phone: 6295 3323 ANU Psychology Clinic Phone: 6125 0412

University of Canberra Psychology Clinic Phone: 6201 2883

Better Access to Mental Health Care – Up to 12 Free Sessions available per annum when referred by a G.P. under Medicare Access Program - Bulk Billing available for some service providers (e.g. CatholicCare )

Q R

Relationship problems Relationships Australia Canberra and Region Phone: 6122 7100

CatholicCare Counselling Services Phone: 6163 7600

Consider private practitioner.

ANU Psychology Clinic Phone: 6125 0412

University of Canberra Psychology Clinic Phone: 6201 2883

Better Access to Mental Health Care – Up to 12 Free Sessions available per annum when referred by a G.P. under Medicare Access Program - Bulk Billing available for some service providers (e.g. CatholicCare ).

Doc Number Issued Review Date Area Responsible Page

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CatholicCare FACES (for family counselling with a person between 10 and 21 yrs).

Phone: 6161 6100

Richmond Fellowship (12 – 25 yrs) Phone: 6248 6118

Risk to Self

Suicidal ideation - with no current stressors or intent

Suicidal thoughts/ideation – Acute suicidal thoughts. Active and current intent may express a means and plan

Discuss referral to GP.

Lifeline

Phone: 13 11 14 ANU Psychology Clinic Phone: 6125 0412

University of Canberra Psychology Clinic Phone: 6201 2883

Better Access to Mental Health Care – Up to 12 Free Sessions available per annum when referred by a G.P. under Medicare Access Program - Bulk Billing available for some service providers (e.g. CatholicCare).

Consider private practitioner.

Refer to Mental Health services and consider police or ambulance involvement.

Risk to Others/Violence Homicidal intention or threat without signs of mental illness.

Homicidal intention or threat with signs of mental illness or signs of high agitation (which may be a symptom of mental illness)

Perpetrators of violence with evidence of mental illness

Refer to AFP.

If currently threatening someone call the AFP .

Refer to Mental Health services with option of seeking specialist input from Forensic Services.

Refer to AFP if immediate threat.

Refer to Mental Health services with view of liaising with Forensic Services fro specialist input.

Lifeline program for male perpetrators Phone: 13 11 14

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Perpetrators of violence with NO evidence of mental illness

Canberra Men’s Centre Phone: 6230 6999 Dads In Distress Inc Phone: 1300 853 437 ANU Psychology Clinic Phone: 02 6125 0412

University of Canberra Psychology Clinic Phone: 6201 2883

Better Access to Mental Health Care – Up to 12 Free Sessions available per annum when referred by a G.P. under Medicare Access Program - Bulk Billing available for some service providers (e.g. CatholicCare).

Refer to AFP if immediate threat.

Lifeline program for male perpetrators Phone: 13 11 14

Canberra Mens Centre Phone: 6230 6999

Dads In Distress Inc Phone: 1300 853 437 ANU Psychology Clinic Phone: 6125 0412

University of Canberra Psychology Clinic Phone: 6201 2883

Better Access to Mental Health Care – Up to 12 Free Sessions available per annum when referred by a G.P. under Medicare Access Program - Bulk Billing available for some service providers (e.g. CatholicCare).

S

Schizophrenia See P Psychotic illness/symptoms Self esteem issues Consider private practitioner.

University of Canberra Headspace Phone: 6201 5343 (for 12 – 25 year olds)

Doc Number Issued Review Date Area Responsible Page

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ANU Psychology Clinic Phone: 6125 0412

University of Canberra Psychology Clinic Phone: 6201 2883

Better Access to Mental Health Care – Up to 12 Free Sessions available per annum when referred by a G.P. under Medicare Access Program - Bulk Billing available for some service providers (e.g. CatholicCare )

Richmond Fellowship (12-25yrs) Phone: 6248 6118

Stress related issues

Could we add a reference to functionality etc?

Consider private practitioner.

University of Canberra Headspace Phone: 6201 5343 (for 12 – 25 year olds) ANU Psychology Clinic

Phone: 6125 0412

University of Canberra Psychology Clinic Phone: 6201 2883

Better Access to Mental Health Care – Up to 12 Free Sessions available per annum when referred by a G.P. under Medicare Access Program - Bulk Billing available for some service providers (e.g. Belconnen Community Centre).

CatholicCare (12 -25 yrs) Phone: 6162 6100

Richmond Fellowship (12 – 25 yrs) Phone: 6248 6118

T

Trauma-related

symptoms/PTSD – consider impact on functioning and severity of symptoms

Centre for Psychotherapy.

Vietnam Veterans Counselling Services.

Victims of Crime Services.

Consider private practitioner.

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Canberra Veterans Affairs Network Phone: 1300 551 918

Centre for Road Trauma Support Phone: 6291 4994

Companion House Assisting Survivors of Torture and Trauma Phone: 6247 7227

Department of Defence.

Refer to Mental Health services.

U V

Violence See A Assault and R Risk to Others W

X Y Z

Doc Number Issued Review Date Area Responsible Page

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Screening Guideline for Older Persons Mental Health

Referral Criteria Referral Response

A

Accommodation Issues (primary presenting problem) – No mental health concerns

Residential Aged Care Facilities – see separate listing Abbeyfield House – Ainslie (6257 5307) and Garran (6232 5398)

Council of the Ageing (6282 3777) Housing and Community Services Phone: 6207 1150

Adjustment disorder – with an inability to function at usual level – including situational crises where there is risk to self or others

Refer to Mental Health services – eligible for OPMHS

Anger Management issues/problems If associated with:

 Adjustment disorder;

 Dementia (BPSD);

 Mental illness then eligible for OPMHS.

Otherwise, refer to GP.

Anxiety Disorder/Symptoms

(Consider severity, intensity and duration of symptoms, level of functional impairment, and degree of insight, available support, and history of illness).

Symptoms may include panic attacks, constant worry, inability to function properly due to anxiety (unable to leave house, go to work);

phobias, physical symptoms (nausea, sweating, racing heart, shaking) unwanted intrusive thoughts and images

If impact on functioning is significant – refer to OPMHS.

If symptoms are manageable but support/intervention is required:

refer to GP.

Assault/Violence

Domestic Violence (victim) – can include different forms of abuse such as physical, sexual,

psychological.

If immediate violence refer to police Domestic Violence Crisis Service Phone: 62800900 (24hours)

Domestic Violence Orders and Protection Orders Unit Phone: 6217 4299

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Sexual assault (current sexual assault crisis or chronic, unresolved sexual assault)

If associated with

 Dementia;

 Mental illness;

 Huntington’s Disease;

 Chronic organic cause

OR if no previous history – eligible for OPMHS.

Consider Public Advocate.

National Domestic Violence and Sexual Assault Helpline Phone: 1800 200 526

Refer matter to police if appropriate.

Consider Forensic Medical Unit at ED if appropriate.

B

Borderline personality/traits See P Personality Disorders/traits

Bipolar Disorder/traits See M Mood Disorders

Bereavement

Bereavement is a normal part of life and is not appropriate for Mental Health services unless complicated by the following:

Bereavement/Grief [traumatic or non-resolving] – may involve the death of a friend or loved one.

Acute impact on level of functioning. Associated with major depression. Suicidal ideation/intent may be present.

Bereavement – normal grief reaction, limited impact on daily functioning

GP

Refer to Mental Health services for assessment if there are traumatic events involved and/or.

Unresolved grief reactions.

Not eligible for OPMHS - refer back to GP for further information or to monitor.

C

Childhood – Mental health concerns/symptoms

in young people under the age of 18 years Child and Adolescent Mental Health Service (CAMHS):

CAMHS South office Phone: 6205 1469

CAMHS North office Phone: 6205 1050

Doc Number Issued Review Date Area Responsible Page

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Court Matters See L Legal Matters

D

Dementia

with Behavioural and Psychological Symptoms of Dementia (BPSD)

with no mental health issues

Eligible for OPMHS – referral through GP

Refer to geriatrician

Alzheimer’s Australia, ACT (6255 0722)

(Dementia Behaviour Management and Advisory Service (DBMAS) available through Alzheimer’s Australia ACT)

Carers ACT (1800 059 059)

Depression See M Mood Disorders

Distress – Acute mental distress displaying agitation, uncontrollable crying not able to be consoled, affecting their level of functionality

May be eligible for OPMHS – refer through GP

Drug and Alcohol issues Comorbid with mental illness,

Drug and Alcohol is the primary presenting problem and no mental health concerns

Refer to Mental Health services and AOD

Referral through GP (medical clearance before D&A Intake)

Drug and Alcohol Central Intake Phone: 62079977

E

Early psychosis see P Psychotic Illness/Symptoms)

Refer to Mental Health services for a full assessment.

Eating Disorders – (Anorexia, Bulimia, Eating Disorder NOS, Binge Eating Disorder)

With depression

No evidence of depression

Eligible for OPMHS

Referral through GP to exclude organic cause.

Financial Issues

(without mental health symptoms)

Public Advocate of the ACT Phone: 6207 0707

Public Trustee

Area Community Services (financial counselling services

References

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