Policy Title: Referral Policy Document Document Assured by Review Cycle Origin Author Second Step Chris Kinston Corporate Team 3 years Document Version tracking Version Date Revision Description Editor Status 28/01/15 1st Draft Bill Draft Version 1 Peacham 03/03/15 2 nd Draft Post service User, Version 2 carer and stakeholder meeting Version 3 20/05/15 3 rd Draft Amended in light of receipt of contract and negotiations with CCG Version 4 01/06/15 Final Amendments following Second Step Corporate Team Bill Peacham Chris Kinston Chris Kinston Draft Draft Approved Version Number Expiry date Pages 4 01/06/2016 7 0
Bristol Mental Health Community Rehabilitation Service Referrals Policy Policy Owner: Paul Siddall Director of Services 1
Bristol Mental Health Community Rehabilitation Service Referrals Policy Table of Contents Page Introduction. 3 Purpose 3 Eligibility Criteria 3 Referral Process. 5 Referral Appeals. 6 Referral Priority and Waiting List... 6 Protocols 7 2
Bristol Mental Health Community Rehabilitation Service Referrals Policy 1.0. Introduction 1.1. It is well reported with in mental health rehabilitation services that clear criteria for referral and clarity of process assists the referred, the referrer and the provider of rehabilitation services. 1.2. It is often argued that criteria makes rehabilitation services elitist but evidence suggests that unless clear criteria, protocols and processes are agreed and delivered, service demand will exceed supply, bottlenecks will become evident and throughput and exit diminish. 2.0. Purpose The purpose of this policy is to ensure all parties are clear as to the referral eligibility criteria, the referral process and, when demand exceeds supply, the process for fair allocation, waiting, throughput and exit. 3.0. Protocols Services that are likely to refer service users more frequently than others will have agreed referral protocols to assist in clarity of process, transparency and to assist in seamless provision. 4.0. Eligibility Criteria Inclusion Criteria Clients eligible for the service will: Be aged 16 or older Have complex mental health issues and/or severe and enduring mental health needs Have long term problems with social and personal functioning Need significant support with their daily living skills, requiring an intensity of support that cannot be provided by the community teams. (For example the Assessment and Recovery Community Team or the Early Intervention in Psychosis Service) Have an awareness of their rehabilitation needs and will show some commitment to engage with the Community Rehabilitation Service to address these Be aware of and agree with the referral Be able to manage their own medication with prompting and supervision Be registered with a Bristol CCG GP or be eligible to register, or returning to Bristol from an out of area placement, criminal justice system or specialised care 3
Exclusion Criteria People who are acutely unwell People with a diagnosis of severe learning disability People who pose a significant risk of self-harm to themselves or others that cannot be managed in the community People who pose significant risk to self or others People with a neuro-degenerative disease People with a primary diagnosis of personality disorder or developmental disorder People whose need for intervention relates to substance or alcohol misuse and whose mental health needs do not require the intensity of service offered by this service 4.1. The two most contentious elements of the referral criteria are the definitions of: 1. Complex mental health and/or severe and enduring mental health problems; and 2. The awareness of the individual referred of their own rehabilitation needs and their commitment to engage in addressing these. 4.2. The recognised criteria for severe and enduring mental health problems is taken to mean individuals who: have a mental health problem; experience a substantial disability as a result of their mental health problems, such as an inability to care for themselves independently, sustain relationships or work; are either currently displaying obvious and severe symptoms; or have a remitting/relapsing condition; have experienced recurring crisis leading to frequent admission/intervention; Occasional significant risk to their own safety or that of others. Definition of severe and/or enduring mental health problems is based not only on the clinical diagnosis of the condition but on the duration of their mental health problem, the degree of disability caused, whether informal or formal care is needed, and the risk posed to themselves or to the safety of others. 4.3. The referred will have an awareness of their rehabilitation needs. This will be clarified after discussion with the referrer and the referred plus any other appropriate persons. At initial referral interview, the assessors will discuss this with the potential client and others involved, using open questions. These questions will illicit information on need for change, commitment, self awareness, environmental awareness and personal closeness. 4
4.4. It is helpful but not essential that an up to date Recovery Outcomes Star is completed and available. The Recovery Outcomes Star has ten areas, with each area on a ten point scale. If the patient/client scores 1 or 2 consistently, especially in areas such as self care, living skills, social networks or responsibilities and indicates either no awareness of difficulty or no desire to tackle identified problem then this may indicate an inappropriateness of referral at this stage. 5.0. Referral Process Across the Rehabilitation Pathway 5.1. If the referral is from a Bristol Mental Health inpatient service then the referral will be made with RIO information, plus risk assessment, HoNOS and recent medical/nursing and OT record. 5.2. If referral is from a RiO connected service and in partnership with Bristol Mental Health then a RiO referral will be sent plus agreed information as described in agreed protocols. If it is from a team/agency not connected to RiO then a written referral will be required and documentation attached as per agreed protocol. 5.3. If a referral is from a team/agency who have not yet established agreed protocols then a written referral will be required explaining the reason for referral and the expectations of the Community Rehabilitation Service. Supporting documents will include up to date demographic and contact data, an up to date mental health assessment (including risk assessment), past and present treatment programmes, a social functioning assessment and recent care/support plans. 5.4. Referrals can be sent to the Community Rehabilitation Service e-mail address awp.bmhcommunityrehabilitationreferrals@nhs.net Please note that this is a NHS secure e-mail address and any personal / confidential information must be sent only from another nhs.net e-mail address. Alternatively, referrals can be delivered in person or by post to 9 Brunswick Square, Bristol, BS2 8PE, marked Private and Confidential and for the attention of the Community Rehabilitation Service. 5.5. Where there is a possibility that the person referred could benefit from either Bristol Community Rehabilitation Service or the Bristol Mental Health Inpatient Rehabilitation service, a joint referral assessment will be arranged (subject to the referrer and referee s agreement). 5.6. A monthly meeting between Community Rehabilitation Service and the Inpatient Rehabilitation service will take place to review the referral pathways, to ensure this is working effectively. 5.7. The Service will review referral flows, bottlenecks and blockages as well as waiting lists for the service with regular frequency and in partnership with Bristol Mental Health System Lead. 5
5.8. Contact with the referred person will be made within 5 working days of receipt of referral with an appointment to meet both the referred and referrer. 5.9. At least two assessors from the Community Rehabilitation Service will carry out the assessment. The assessors may collate or request further information. A decision on the outcome of the referral will be made at the earliest opportunity within the routine service referrals meeting. The final decision maker regarding referrals is the Community Rehabilitation Service Clinical Lead. 5.10. The outcome will be communicated to the person referred and, where consent is provided, the referrer, both verbally and in writing and, if accepted, the likely lead time to the start of the service. 5.11. Before acceptance the referred service user may visit Wellbridge House or the independent flats, so they can make an informed decision about whether to accept the offer of the service and accommodation. The rehabilitation service and the referring body have an important role in supporting the individual in reviewing options and making an informed choice. 5.12. Because transfer and change is an anxious time for service users, an individual programme of introduction, visits and support will be designed in. 5.13. A meeting will take place to support and co-ordinate the service user s move into the Community Rehabilitation Service. Where required, this will be used to plan or any handover of medical and prescribing responsibility. 6.0. Referral Appeals Procedure 6.1 If the referred, the referring agent or carers/supporters of the referred disagree with the outcome of the referral, they can appeal to the referral panel (comprising the Service Delivery Manager, Deputy Team Manager and Clinical Lead). The Referral Panel will review the referral, the information collected, the process and the decision of the team. The Referral Panel will keep all interested parties informed of the review, the process and outcome of the appeal. 7.0. Referral Priority Criteria and Waiting Lists 7.1. Experience from rehabilitation services elsewhere in the UK suggests that demand outstrips supply and referral priority criteria guidelines are required. Thus the Service has developed a prioritisation process. Referrals will be prioritised according to the date of referral. At times when demand exceeds supply the Referral Panel will decide on priority. The referral waiting list will be managed by the Referral Panel by reviewing blockages and bottlenecks within various pathways and making crucial decisions to fast track certain referrals or to circumnavigate certain procedures or services. 6
7.2. The Referral Panel will always strive to be transparent and provide up to date information on waiting lists, as well as reasons why certain referrals have been delayed or progressed. Table1. Prioritisation Process Considerations for Rehabilitation Level 1: High Priority Need for Community Rehabilitation Service Urgent need for the service. Currently staying in an inpatient service that is no longer meeting their needs with risk of deterioration in their mental health; Or Living in the community at severe risk of social isolation, self neglect, risk of relapse into acute illness, or at risk of exploitation and the accommodation service or the community service is the correct service to prevent an admission or to maintain their ability to live in the community. Level 2: Medium Priority Level 3: Low Priority Delay in access to rehabilitation is perceived to have some significant impact on recovery. Delay in access to rehabilitation is perceived to have minimal impact upon recovery. 8.0. Protocols 8.1. Protocols have been agreed (and will be annually reviewed) between Bristol Mental Health Community Rehabilitation Service and the following teams: Alder Ward which includes protocols re OATS (inpatient unit AWP) Acute Care pathway (Acute Wards AWP) Community mental health teams (Including EIP and Assessment and Recovery teams). Golden Key Bristol Adult Social Care 7