HNY Policy and Pathway Repository - Humber

This service aims to provide a treatment service for people that are experiencing severe and complex mental health issue that is seriously affecting their day-to-day functioning. 

This service is aimed at people who would be rated at Mental Health Clustering Tool (MHCT) 5+

For patients with low level needs not requiring input from Secondary Care MH Services please use agreed pathways

• For patients who present with characteristics found within the non-Psychotic 1-4 cluster please see the IAPT - Lets Talk page for Hull Patients and the IAPT Emotional Wellbeing Page for ER Patients.
• Referral to Primary Care Mental Health Wellbeing Practitioner

Referral to MHPCN Team if patient does not meet criteria for MHWBC or IAPT and does not require full MH Assessment or secondary care

If someone has taken an overdose or self-harmed and need urgent medical treatment refer to A&E or call 999. 

If a patient has urgent mental health problems, contact the Humber Teaching NHS Foundations Trust’s Mental Health Crisis Intervention Team on 01482 205555. If a patient has complex needs but does not require an urgent response, please refer routinely

If a patient has difficulties in caring for themselves or dependants, or are in need of urgent social support contact Hull City Council on 01482 300300. In cases outside of normal office hours please contact the Emergency Duty Team on 01482 788080.

Samaritans who will help patients to talk things through in a confidential manner. They are available 24 hours a day for 365 days per year. The local Hull number is 01482 323456 and their national number is 08457 909090. Samaritans services are free to access but call charges apply.

Any patient presenting with risk to self or others or immediacy of needs to be discussed by telephone with the MH Crisis Intervention Service

DO NOT REFER

For all routine referrals for patients requiring a secondary care mental health assessment please refer via eRS to the Humber Teaching NHS Foundation Trust Mental Health Triage and Assessment Team.

Should you wish to discuss your referral with the team prior to making it, please contact the team via the Humber Teaching NHS Foundation Trust’s Mental Health Professional Enquiry Line on 01482 216624

Referred patients will be seen and triaged/assessed as appropriate by a suitably qualified mental health professional, their needs and associated risks identified, and allocated to a Mental Health Cluster.

Individuals allocated to a 5+ cluster may be referred onto secondary mental health services, with treatment and interventions offered appropriate to their needs which may include referral to an integrated locality MH team for primary and/or secondary level MH support as identified at assessment.

People who were initially expected to have a cluster of 5+ but following assessment actually cluster at 1-4 will be referred into the The Hull Depression and Anxiety Service (IAPT - Lets Talk page). They will then receive appropriate support and treatment as indicated by their cluster and presentation. 

• For all routine referrals for patients requiring a secondary care mental health assessment please complete the ARDENS Secondary Mental Health Referral Form and then refer via eRS to the Humber Teaching NHS Foundation Trust Mental Health Triage and Assessment Team and Book a triage appointment on behalf of the patient. Once a triage appointment has been booked, please inform the patient of the details.

Should you wish to discuss your referral with the team prior to making it, please contact the team via the Humber Teaching NHS Foundation Trust’s Mental Health Professional Enquiry Line on 01482 216624

• For any referrals for patients requiring support from a MHWBC (Mental Health Wellbeing Coach), please refer via PCMHN Referral Template on ARDENS.
• For any referrals to the Mental Health Primary Care Network for those patients who do not require a secondary care mental health assessment and do not meet the referral criteria for IAPT services – please task the relevant network via your GP System using the agreed process – Please Refer via PCMHN Referral Template Via ARDENS

Mental Health Clustering Tool (MHCT) 1-4 Refer to IAPT Services

Cluster 1 - This group has definite but minor problems of depressed mood, anxiety or other disorder but they do not present with any distressing psychotic symptoms. May not attract a formal diagnosis but may include mild symptoms of: F32 Depressive episode, F40 Phobic anxiety disorders, F41 Other anxiety disorders, F42 Obsessive-compulsive disorder, F43 Stress reaction/adjustment disorder, F50 Eating disorder

Cluster 2 - This group has definite but minor problems of depressed mood, anxiety or other disorder but they do not present with any distressing psychotic symptoms. They may have already received care associated with cluster 1 and require more specific intervention, or previously been successfully treated at a higher level but are re-presenting with low level symptoms. Likely to include: F32 Depressive episode, F40 Phobic anxiety disorders, F41 Other anxiety disorders, F42 Obsessive-compulsive disorder, F43 Stress reaction/adjustment disorder, F50 Eating disorder.

Cluster 3 - Moderate problems involving depressed mood, anxiety or other disorder (not including psychosis). Likely to include: F32 Depressive episode, F40 Phobic anxiety disorders, F41 Other anxiety disorders, F42 Obsessive-compulsive disorder, F43 Stress reaction/adjustment disorder, F50 Eating disorder.

Cluster 4 - The group is characterised by severe mood disturbance and/or anxiety and/or other increasing complexity of needs. They may experience disruption to function in everyday life and there is an increasing likelihood of significant risks. Likely to include: F32 Depressive episode, F40 Phobic anxiety disorders, F41 Other anxiety disorders, F42 Obsessive-compulsive disorder, F43 Stress reaction/adjustment disorder, F44 Dissociative disorder, F45 Somatoform disorder, F48 Other neurotic disorders, F50 Eating disorder. Impairment: Some may experience significant disruption in everyday functioning. Risk: Some may experience moderate risk in self through self-harm or suicidal thoughts or behaviours.

Mental Health Clustering Tool (MHCT) 5+

To make sure people are referred to the appropriate service, the following summary highlights typical characteristics that individuals may present with that would place them in MHCT 5+:

Cluster 5: Non-psychotic disorders (very severe) severe depression and/or anxiety. May have unreasonable beliefs. May often be at high risk for non-accidental self-injury. Severe-disruption to everyday living.

Cluster 6: Non-psychotic disorder of over valued ideas Moderate to severe disorders that are difficult to treat. May include treatment resistive eating disorder, OCD where extreme beliefs are held, some personality disorders and enduring depression.

Cluster 7: Enduring non-psychotic disorders (high disability) moderate to severe disorders that are very disabling. Have received treatment for a number of years but considerable disability remains that affects functioning.

Cluster 8: Non-psychotic chaotic challenging disorders Wide range of symptoms and chaotic challenging lifestyles. Moderate to very severe repeat deliberate self-harm and/or other impulsive behaviour and chaotic over dependent engagement and often hostile with services. 

Cluster 10: First episode psychosis First presentation with mild to severe psychotic phenomena. May have depressed mood and/or anxiety symptoms. Drinking or drug taking may be present but will not be the only problem.

Cluster 11: Ongoing recurrent psychosis (low symptoms) History of psychotic symptoms but currently controlled. 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) History of psychotic symptoms with a significant disability with major impact on role functioning. Likely to be vulnerable to abuse or exploitation.

Cluster 13: Ongoing or recurrent psychosis (high symptom & disability) History of psychotic symptoms which are not controlled. Will present with severe to very severe psychotic symptoms and some anxiety and depression. Have a significant disability with major impact on role functioning.

Cluster 14: Psychotic crisis Will be experiencing an acute psychotic episode with severe symptoms that cause severe disruption to role functioning. May present as vulnerable and a risk to themselves or others.

Cluster 15: Severe psychotic depression Acute episode of moderate to severe depressive symptoms. Hallucinations and delusions. Risk of non-accidental self-injury and disruption in many areas of their lives.

Cluster 16: Psychosis & affective disorder (high substance misuse & engagement) Enduring moderate to severe psychotic or bipolar affective symptoms with unstable, chaotic lifestyles and co-existing problem drinking or drug taking. May present a risk to self and others. Engage poorly with services. Role functioning is often globally impaired.

Cluster 17: Psychosis & effective disorder - difficult to engage Moderate to severe psychotic symptoms with unstable, chaotic lifestyles. May be some problems with drugs or alcohol but not as severe as cluster 16. History of non-concordance, are vulnerable and engage poorly with services.

Cluster 18 (under age of 65): Cognitive impairment (low need) Early stage dementia (or may have an organic brain disorder affecting cognitive function) who have some memory problems, or other low level cognitive impairment but who are managing to cope reasonably well. Underlying reversible physical causes ruled out.

Cluster 19 (under age of 65): Cognitive impairment or dementia (moderate need) Problems with memory and/or other aspects of cognitive functioning resulting in moderate problems looking after themselves and maintaining social relationships. Probable risk of self-neglect or harm to others. May be experiencing some anxiety or depression. 

Information to include

PHQ 9 Scores

GAD 7 Scores