What is Mental Health Triage (Australia)?

Introduction

Mental health triage is a clinical function conducted at point of entry to health services which aims to assess and categorise the urgency of mental health related problems.

Background

The mental health triage service may be located in the Emergency Department, Community Mental Health Services, Call Centre, or co-located with other specialist mental health services such as the Crisis Assessment and Treatment Team.

Emergency Services such as police and ambulance may also have a co-located mental health triage service.

There is considerable variation in the clinical settings in which mental health triage services may be operating, therefore service delivery models vary, however, the essential function is to determine the nature and severity of the mental health problem, determine which service response would best meet the needs of the patient, and how urgently the response is required.

A core function of mental health triage is to conduct risk assessment that aims to determine whether the patient is a risk of harming self or others as a result of their mental state, and to assess other risks related to mental illness. As with other triage models, the mental health triage clinician must assign a category of urgency to the case, which is recorded using verbal indicators of risk such as ‘extreme risk’ through to ‘low risk’, or by using numerical (urgency= time-to-treatment) categories 1 (immediate) to 5 (2 hours), as per the 5-point Australasian Triage Scale.

Mental Health Triage Training

In 2006 the Centre for Psychiatric Nursing Research and Practice introduced a 2 day mental health triage training programme designed and facilitated by Dr Natisha Sands.

The focus of the programme is on providing specific, targeted education to support triage duty and intake clinicians in conducting point of entry mental health assessment and service provision to Area Mental Health Services.

The aim of the programme is to increase the quality and consistency of mental health triage service delivery, by providing the clinician with sound theoretical and practical knowledge to guide clinical practice.

The expected outcomes of participation in the program are increased confidence and skill in triage clinical practice, improvement in the quality of service delivery, improvement in the quality of triage documentation, and professional development and support of clinical staff.

Brief Overview of the Programme

  • Telephone skills (phone manner, phone assessment, problem callers).
  • Risk assessment (assessment, diagnosis, priority, action).
  • Medico-legal issues.
  • Decision-making (the phases of triage, under pressure, influences, resource management, decision-making frameworks).
  • Negotiation skills (other agencies, team, clients, families).
  • Crisis management (identification, types of crises, problem solving, diffusion, resolution).
  • Secondary consultation and education (other services/agencies, clients, families).
  • Effective documentation (risk assessment, incidents, care planning, confidentiality, electronic documentation, exchange of information).
  • Engaging consumers (consumer centred service delivery).

The programme is open to mental health triage, duty, and intake clinicians of all disciplines, and is suitable for both novice and expert clinicians and is designed to assist clinicians engaged in both face-to-face and telephone only triage.

Book: Clinical Psychology

Book Title:

Clinical Pschology.

Author(s): Timothy J. Trull and Mitchell J. Prinstein.

Year: 2012.

Edition: Eighth (8th).

Publisher: Wadsworth Publishing Co Inc.

Type(s): Hardcover and Paperback.

Synopsis:

In language your students will understand and enjoy reading, Timothy Trull’s Clinical Psychology offers a concrete and well-rounded introduction to clinical psychology.

A highly respected clinician and researcher, Dr. Trull examines the rigorous research training that clinicians receive, along with the empirically supported assessment methods and interventions that clinical psychologists must understand to be successful in the field.

This new edition of Trull’s bestselling text covers cutting-edge trends, as well as offers enhanced coverage of culture, gender and diversity, and contemporary issues of health care.

Written to inspire students thinking of pursuing careers in the field of clinical psychology, this text is a complete introduction.

Is More Clarification is Needed of Mental Health Practitioner’s Engagement Experiences in Early Intervention Settings?

Research Paper Title

Mental Health Practitioner Experiences of Engaging With Service Users in Community Mental Health Settings: A Systematic Review and Thematic Synthesis of Qualitative Evidence.

What is Known on the Subject?

Engagement is regarded as important and beneficial for service users and mental health services A universal definition of engagement is not yet fully agreed upon.

What this paper adds to existing knowledge?

Based upon their experience, mental health staff use varied engagement approaches to fit with the changeable and unique needs of people who use services (service users). Mental health staff demonstrate qualities such as persistence and adaptability to successfully engage with service users.

What are the implications for practice?

Irrespective of professional background, the role of community mental health staff is not restricted to any single approach. Practical help and social support are as seen as important as clinical treatment to establish successful engagement. Little is known about the engagement experiences of mental health staff working in early intervention settings as most studies in this review focused on the perspectives of staff based in assertive outreach or community mental health teams. There is a need to further understand staff experiences of engagement with service users in early intervention settings. Role descriptions and expectations of community mental health workers should account for the wide-ranging flexible approach required in order to deliver appropriate interventions. This may involve a focus on engagement in training programmes.

Background

Effective mental health care is dependent on engaging service users, but some individuals do not actively attend appointments, and may stop engaging with mental health services. Quantitative studies reveal some salient factors that seem to predict engagement, but these studies miss the nuances of good clinical practice in this area. A number of qualitative studies of health professionals’ experiences and understanding of effective engagement have been published.

This review aimed to systematically identify, evaluate and synthesise results from these studies with a view to informing effective practice in this area.

Methods

Electronic databases MEDLINE, EMBASE, CINAHL, PsychINFO and AMED were searched (PROSPERO systematic review protocol registry (www.crd.york.ac.uk/prospero/; ID CRD42017083976). Of 799 records, ten papers met the inclusion criteria. All papers were subjected to quality appraisal based on the CASP checklist and data systematically extracted. A thematic synthesis of included studies examining mental health practitioners’ experiences of engagement in community mental health settings was conducted.

Results

Mental health practitioners see engaging service users as depending upon complex, multi-dimensional phenomena which should include individualised person-centred approaches as well as practical, social and clinical support. Mental health practitioners demonstrate qualities such as determination and adaptability to establish and maintain engagement with service users.

Conclusions

As a core aspect of nurse education, registered mental health nurses and other professionals would benefit from systematic guidance regarding engagement strategies. Most studies in this review focused on assertive outreach or community mental health teams, more clarification is needed of practitioner’s engagement experiences in early intervention settings.

Reference

Henderson, P., Fisher, N.R., Ball, J. & Sellwood, W. (2020) Mental Health Practitioner Experiences of Engaging With Service Users in Community Mental Health Settings: A Systematic Review and Thematic Synthesis of Qualitative Evidence. Journal of Psychiatric and Mental Health Nursing. doi: 10.1111/jpm.12628. Online ahead of print.

Education & Training should Aim to improve the Recognition & Treatment of Postpartum OCD

Research Paper Title

Advances in the pharmacological management of obsessive-compulsive disorder in the postpartum period.

Background

Obsessive-compulsive disorder (OCD) is a psychiatric disorder characterised by obsessions and compulsions.

Obsessions are defined as intrusive, recurrent and distressing thoughts, images or impulses, whereas compulsions are defined as repetitive behaviours or mental acts.

While there is an associated distress, and indeed oftentimes, the individual’s awareness that these behaviours are excessive and unreasonable, the individual continues to be disabled by an inability to cease their compulsions.

The postpartum period may herald the onset of OCD or precipitate an exacerbation of the preexisting OCD symptoms.

Common OCD symptom clusters occur in the postpartum period, with specific challenges associated with motherhood and lactation.

Areas Covered

This brief review aims to review the extent and nature of publications evaluating pharmacological treatment of OCD in the postpartum period.

Expert Opinion

Education and training should aim to improve the recognition and treatment of postpartum OCD.

Due to the limited nature of studies, more research is required to assess the role of selective serotonin reuptake inhibitors in the postpartum period.

Reference

Brakoulias, V., Viswasam, K., Dwyer, A., Raine, K.H. & Starcevic, V. (2020) Advances in the pharmacological management of obsessive-compulsive disorder in the postpartum period. Expert Opinion on Pharmacotherapy. 21(2), pp.163-165. doi: 10.1080/14656566.2019.1700229. Epub 2020 Jan 1.

Course: Applied Suicide Intervention Skills Training (ASIST)

Just completed the 2-day Applied Suicide Intervention Skills Training (ASIST) course.

ASIST is intended as ‘suicide first-aid’ training.

It aims to enable helpers (anyone in a position of trust) to become more willing, ready, and able to recognise and intervene effectively to help persons at risk of suicide.

You can find out more about the ASIST course here.

Book: Psychiatric-Mental Health Nursing

Book Title:

Psychiatric-Mental Health Nursing.

Author(s): Sheila L. Videback.

Year: 2019.

Edition: Eighth (8th); North American Edition.

Publisher: Wolters Kluwer Health.

Type(s): Paperback and Kindle.

Synopsis:

With an accessible, clear and student-friendly approach, Psychiatric-Mental Health Nursing clarifies challenging concepts and helps you build a foundation for working successfully with clients experiencing mental health challenges regardless of care setting. The text explores the full spectrum of psychiatric nursing, helping you master specific nursing interventions, hone your therapeutic communication skills and learn to apply content effectively within the framework of the nursing process.

  • New! Unfolding Patient Stories written by the National League for Nursing put the nursing process in a realistic context to prepare you for successful client interactions and interventions.
  • Clinical Vignettes familiarise you with the features of major disorders you are likely to encounter in practice.
  • Therapeutic Dialogues help you perfect your communication skills with specific examples of nurse-client interactions.
  • Best Practice boxes provide the latest evidence-based findings in psychiatric nursing.
  • Self-Awareness features foster your personal and professional development through self-reflection.
  • Concept Mastery Alerts clarify important concepts essential to your classroom and clinical success.
  • Watch and Learn icons point you to corresponding true-to-life Lippincott(R) Theory to Practice Video Series videos for a richer understanding of important mental health disorders.
  • Built-In Study Guide reinforces your understanding with multiple-choice questions, multiple-response questions and clinical examples at the end of each chapter.
  • Nursing Care Plans demonstrate effective approaches for addressing specific client disorders.
  • Drug Alerts highlight essential concerns related to psychotropic drugs.
  • Warning boxes alert you to FDA considerations for specific medications.
  • Cultural Considerations help you ensure culturally sensitive care for a wide range of client populations.
  • Elder Considerations sections prepare you to care for the growing population of older adults.
  • Client/Family Education boxes boost your teaching capabilities.
  • Nursing Interventions etail key treatment strategies for specific disorders.
  • DSM-5 Diagnostic Criteria boxes summarise the medical diagnostic features of specific disorders.

Book: Psychiatric-Mental Health Nursing

Book Title:

Psychiatric-Mental Health Nursing: Evidence-Based Concepts, Skills, and Practices.

Author(s): Wanda K. Mohr.

Year: 2013.

Edition: Eighth (8th).

Publisher: Lippincott, Williams, and Wilkins.

Type(s): Hardcover and Kindle.

Synopsis:

This edition focuses on evidence-based practice and rational practice with more case-oriented content that helps students better understand how to apply key concepts to practice.

Plus, new illustrations, photographs, and special features actively engage students in learning and appeal to a variety of different types of learners.

Wanda Mohr aims to empower students by the down-to-earth discussion of theory and theoretical frame-work.