Category: All Referrals

Rapid Access Chest Pain

Scott McLaughlin

This protocol should only be used where the following conditions apply

  • The patient has experienced recent onset of suspected stable angina.
  • The patient is experiencing deterioration of stable angina.

****** This protocol should not be used where the following conditions apply ******

  • Patients suspected of having unstable angina (frequent and recurrent chest pain at rest or on minimal exertion, lasting 15 – 20 minutes) or acute MI (these patients should be referred to the on call team for admission)
  • Patients who are attending a Cardiology Clinic (these patients should be referred to the Cardiology Consultant for an urgent appointment)
  • Patients with decompensated heart failure (these should be referred to the Cardiology Clinic)
  • Patients with known or suspected valvular disease (these should be referred to the Cardiology Clinic)
  • Patients with new, uncontrolled or symptomatic arrhythmia (these should be referred to the Cardiology Clinic)

Rapid Access Atrial Fibrillation

Scott McLaughlin

Referral Criteria

  • Rapid Access Atrial Fibrillation Clinic (RAAFC) for patients with:
  • Recent newly diagnosed atrial fibrillation.
    • Confirmed by 12 lead ECG.
    • ECG must be attached to referral.

Exclusion criteria:

  • Known long standing AF
  • Known or suspected valvular disease
  • Known alcohol abuse with liver impairment
  • Left ventricular systolic dysfunction/ cardiomyopathy.
  • Decompensated heart failure.
  • If exclusion criteria present these patients should be referred to a cardiology clinic.

Contraindication to anti coagulation therapy :

  • haemorrhagic stroke; significant bleeding.
  • conditions in which risk of bleeding is increased, e.g. history of gastro-intestinal bleeding, peptic ulcer, recent surgery, recent ischaemic stroke, bacterial endocarditis, uncontrolled hypertension. ( BNF May 2013)

 

RAAFC will appoint within 10 working days of receiving SCI referral.
Diagnosis will be confirmed.
Stroke risk will be assessed
Treatment as per AF protocol will be initiated/recommended
Follow up at RAAFC if appropriate.
Referral on to cardiology if appropriate.
Discharge to primary care if appropriate.

Public Dental Service (for GP use)

Scott McLaughlin

Who can we treat under the Public Dental Service?

The Public Dental Service’s treatment role is now focused on:

  • providing treatment to patients with special care requirements.
  • the provision of dental services that are not routinely available in general dental practice (such as dental treatment under general anesthetic for children and adults with special needs).
  • accepting referrals of patients (special care adults, vulnerable children and children with behavioural management problems) from independent contractor general dental practitioners andv other Health Care Professionals.
  • accepting referrals of patients with complex medical needs that cannot be treated in general dental practice.
  • accepting referrals of anxious children and severely anxious adults for dental treatment under sedation.
  • the provision of care for socially excluded groups such as prisoners, and those who are unable to leave their home.

The other main roles for the Public Dental Service continue to be prevention, epidemiology and teaching.
While the vast majority of referrals are perfectly acceptable, the more information we can have about a patient before we see them, the better able we are to help them.

Patient Charges

The Public Dental Service has to charge patients for the dental treatment provided (unless the patient is exempt from charges) and work under the same rules and regulations as independent contractor general dental practitioners. Patient charges must be collected unless the patient is exempt.

Normal charging arrangements will apply when a PDS dentist provides general dental services. Patients are required to pay 80% of the cost of their NHS dental treatment up to a set maximum per course of treatment (currently £384), unless they are in one of the groups entitled to free NHS dental treatment or help with the cost of dental treatment.

Contact the Public Dental Service

The Dental Office, Glendoe Building, Coathill Hospital, Hospital Street, Coatbridge ML5 4DN
Telephone: 01236 707711

Lead Clinician: Michael Devine,
Director of Public Dental Services,
NHS Lanarkshire.
Review Date: January 2016

Wishaw General Day Hospital

Scott McLaughlin

Wishaw General Day Hospital for the Elderly

Dr J A Logan Consultant Geriatrician 01698 366824

Jackie Wyllie Charge Nurse 01698 366121

Nan Sweeney Secretary 01698 366322

This service is supported by a multidisciplinary team who will be responsible for coordinating all aspects of assessment, diagnostic and rehabilitation services

Who To Refer

Patients aged >65

Living within the Wishaw General Hospital Catchment Area

No significant functional problems

Who Not to Refer

Patients who are

Acutely unwell requiring hospital admission

Chronically confused with no rehabilitation issues

Have delirium or acute confusion

Have long-term immobility

Oral Maxillofacial Surgery Template

Scott McLaughlin

This is a dictation template to provide a reminder of the information required to complete the referral. The fields in red are mandatory and must be completed on the referral protocol.

Presenting Complaint

Main presenting complaint:

  • Other lump / swelling
  • Other oral mucosal lesions
  • Oral / facial pain
  • Salivary gland problems
  • Temporo-mandibular joint problems
  • Oro-facial disproportion / deformity
  • Requiring minor oral surgery

Based upon the answer to the question above, please select the appropriate option from the questions below.
If ‘Oral/Facial pain’ is selected, no further information is required here.
If ‘Temporo-mandibular joint problems’ is selected, no further information is required here.

If ‘Other lump/swelling’:

  • Oral
  • Facial
  • Neck

If ‘Other oral mucosal lesions’:

  • Long-term mucosal pigmented lesion
  • Other mucosal abnormality
  • Mucosal bullous lesion
  • ROAU

If ‘Salivary gland problems’:

  • Major gland
  • Minor gland
  • Salivary calculus
  • Dry mouth

If ‘Oro-facial disproportion / deformity’:

  • Skeletal growth abnormalities
  • Cleft lip palate
  • Post traumatic abnormalities

If ‘Requiring minor oral surgery’:

  • Third molar/impacted tooth
  • Other tooth/root
  • Peri-radicular
  • Pre-prosthetic
  • Pre orthodontic

Reason for Referral: [Text]

Priority:

  • Routine
  • Urgent
  • Urgent – Suspicion of cancer

Date of Onset: [Date]

Priority Reason: [Text – 98 character maximum]

 

MSK Physiotherapy Referral

Scott McLaughlin

General Guidelines

Physiotherapy referrals will be vetted on a daily basis from a single site (Monday to Friday). As patients may be telephoned prior to an appointment, can you ensure that a contact number is provided in the referral

Appointment priority will be allocated on a clinical basis and booked to a site based on patients postal area.

We may be able to offer earlier appointments out with the normal postal area. If this is the case the patient will be contacted by telephone before an appointment is issued.

Patients can also self refer to a non-emergency help service for advice, information and assessment of muscle and joint problems using the following number: 0845 604 0001 (NHS24 Card)

Employment Status

Patients who work for SME (Small and Medium Enterprise) with less than 250 staff can be referred to WHSS (Working Health Services Scotland) using card provided. WHSS Phone Number 0800 019 2211.

Mental Health (Psychology) Referral

Scott McLaughlin

Access to service by General Practitioner

Mental Health One Door Access (Older People)

People over the age of 65 with a psychological/emotional/severe or enduring mental health problem, including dementia.

Cognitive Impairment

  • Evidence of memory impairment. Please:
    • consider and exclude delirium, particularly if history is less than 6 months
    • include recent cognitive screening and routine physical investigations*
  • Stress and distress which may cause harm to self or others, or affect quality of life (previously known as challenging behaviour)
  • Family education and support
  • Management of functional impairment (including OT assessment)
  • Medication review

Severe or Enduring Mental Health Problems

  • Psychosis including schizophrenia
  • Bipolar affective disorder
  • Obsessive compulsive disorder
  • Enduring and severe anxiety and/or depression
  • Difficulties related to pervasive personality issues

Other Mental Health Difficulties

  • Moderate to severe anxiety disorders e.g. GAD, panic, agoraphobia, health anxiety
  • Moderate to severe depression
  • Trauma reactions – including PTSD, sexual/emotional/physical abuse in childhood or adult life
  • Adjustment difficulties – including to physical health problems, prolonged or atypical bereavement reactions
  • Single psychotic episode
  • Thoughts/ideas of self harm/suicide in conjunction with any of the above criteria

High priority/urgent referrals should be followed up by a phone call to the relevant locality team to discuss degree of urgency, timescale for appointment etc.

* Routine Physical Investigations

A standard physical examination guided by symptoms +/- : BP, MSSU if indicated by history, CXRay if indicated by history, ECG if indicated by history etc.
Neuro-imaging is NOT expected/required to be ordered prior to referral.
NICE/RCPsych guidance on blood tests recommends full blood count, ESR or C-reactive protein (CRP), vitamin B12, folate, thyroid function, urea and electrolyte, calcium, liver function and glucose tests, with blood tests for syphilis, lipids and HIV listed as ‘optional’. (Royal College of Psychiatrists, 2005b).

Mental Health (Old Age) Referral

Scott McLaughlin

Access to service by General Practitioner

The following is a description of tiered services within mental health to guide decision making and appropriate referral and signposting. In this context a tier refers to a service requirement with appropriate training and skills for delivery of patient care and is based on patient need, increasing complexity and risk assessments. It is based on the premise that patients will need to access a variety of health services dependent on their need throughout their lives, from those at primary care to those that are more specialised, and that a strategic approach to identify needs will best inform delivery of services and support evidenced based care.

Although it is anticipated the majority of GP colleagues will deal with Tier 1, Tier 2, Tier 3 and that they will treat and manage the majority of mental health problems in primary care, it is important to have information as to how best to use the services, to understand the range of treatments and interventions available and the need to ensure there are appropriate links with primary care as regards decision making at secondary care. Although GP colleagues may have less contact with Tier 4 their role will also be important in terms of sharing information and guiding secondary care on primary care interventions and treatments as part of multidisciplinary risk assessments and planning of care.

For the sake of completion Tier 0 refers to community, public health and strategic approaches to promote the general health and well being of patients and is not included here.

Currently and to allow the service to further develop we have combined the existing structures within psychology and how it would link with psychiatry services for the purposes of facilitating a referral system that is seamless from primary to secondary care , this will be reviewed and may be subject to further revision as services further evolve.

Tier 4: Specialist community teams, specialist inpatient units and regional health services

In Tier 4 highly specialist services provide aspects of Mental Health Care (mainly Forensic and Rehabilitation services) that may not be able to be provided within community secondary care services (of Tier 2 and 3). Currently there is no direct referral into this service from primary care but future developments of service may consider this.

Tier 3: Moderate to Severe Presentations

CMHTs (Community Mental Health Teams) are at the heart of secondary care services in Tier 3 and provide services to patients aged 16-65 and who have left school.
Patients aged 16-18 years who are still at school are the remit of Child and adolescent mental health services.
CMHTS also provide an emergency response to patients who are suffering a mental health crisis and require to be seen the same day, consequently each CMHT has a duty worker system and referrals can be taken 08:30-18:30 Monday to Friday and at weekends 10:00-16:30.

General guidance as to patients who would benefit from the Service includes:

  • Patients with severe depression not responsive to primary care interventions, this includes watchful waiting, psycho education prescription of antidepressants at appropriate doses as per SIGN guidelines.
  • Psychoses or suspected psychoses including Bipolar Disorder and Schizophrenia/Psychotic Depression.
  • Obsessive Compulsive Disorders and severe Anxiety Disorders, including suspected Somatoform Disorders which include Body Dysmorphic Disorder, somatisation disorder, Conversion Disorder, pain disorder and Hypochondriasis.
  • Eating Disorder with the exception of when this is deemed severe and the individual therefore has complex needs (i.e. acute clinically significant effects on physical health; or the presence of some acute physical effects with incapacitating Eating Disorder symptomatology which pose significant threat to functioning in several domains): refer to TESS a tier 3 specialist Eating
  • Disorder Service in Coatbridge – see Firstport.
    Assessment of cognitive functioning in patients to aid management plans and to develop strategies for improving functioning, including those patients suspected of having early onset dementia.
  • Assessment of suspected or confirmed pervasive developmental disorders including Autistic spectrum disorder, Asperger’s and Attention deficit hyperactivity Disorder.
  • PTSD (at least three months post-trauma).
  • Survivors of Sexual abuse with significant psychological sequelae that have not responded to or not been able to attend other services including EVA (see the Gender Based Violence section on FirstPort) and MASA (Men Against Sexual Abuse contact 07896839415, available on Tuesday evenings only) and who are at risk of developing severe depression and /or anxiety or trauma symptoms.
  • Suspected Borderline Personality Disorders or suspected personality-related difficulties and may include those patients whose mental health problems and/or whose level of functioning has deteriorated to warrant repeated hospital presentations (usually with repeated self harm attempts or Adult support and Protection referrals) and or brief admissions to a mental health unit.
  • Provision of intensive home treatment, home visits, outpatient appointments by CMHTs in available community bases (as alternatives to hospital admission) as well as the ability to further step up care to acute inpatient care if the needs and risk assessments of the patient cannot be safely provided for in the community.

Tier 2: Mild to Moderate Presentations

Assessment/treatment of mild to moderate common mental health problems (including Specific Phobias, Panic Disorder, Generalised Anxiety Disorder, Social Phobias, Health Anxiety, complicated or prolonged grief reactions, psycho-sexual difficulties, Habit Disorders and includes mild and moderate depression.

For the purposes of clarity as regards the definition of depression it includes the following:

  • Mild depression. This doesn’t usually stop you living your daily life, but you may find it difficult to concentrate at work or do things that you normally enjoy.
  • Moderate depression. This has a significant impact on your daily life e.g. unable to work, withdrawing from friends and family, incurring negative thoughts, anxiety and or panic symptoms and you may have more symptoms than people with mild depression.

Treatment/Support Options:

(A) Community Support Options:

  • NHS 24 (Guided Self Help/Telephone CBT)
  • Well Connected (self referral) including STRESS CONTROL, healthy working lives for employees in organisation less than 250 people: Health Working Lives
  • Counselling (self referral to Workplace Employee Assistance Programmes/University and College Health Services)

(B) Specialist Mental Health Support:

  • Counselling (NHS) both individual and groups available as appropriate
  • CBT (NHS) both individual and groups available as appropriate

Tier 1: Pre-Treatment Presentations

The identification, assessment and treatment of mild common mental health problems, such as anxiety and depression.
Although it is recognised that the majority of patients with mental health problems are treated in primary care, and effective treatment is available. As part of ongoing work in NHSL to standardise treatments it is important that patients are offered choices for treatment that follow evidence based guidelines.

As a consequence, it is expected that as part of the GPs repertoire of choices for patients, it is assumed that there has been an attempt to offer and inform the patient of self help, telephone help lines, website based CBT and NHS 24 CBT, or specific counselling including:

CRUSE for bereavement – www.cruse.org.uk
RELATE for marriage or relationship difficulties – www.relate.org.uk
PETAL for patients experiencing trauma and loss after a murder or suicide – www.petalsupport.com

and that the patients have been unable to or it has not been possible to engage with these interventions before referral to the secondary care services.

Pre treatment presentations will include the identification, assessment and treatment of mild common mental health problems, such as anxiety and depression. For patients who have been unable to access or unable to engage with common interventions that include:

Treatment/Support Options:

  • Watchful Waiting
  • Well Connected (self referral including STRESS CONTROL classes)
  • Voluntary Organisation (CRUSE, etc.) (self-referral)
  • Statutory sector support services.
  • Mainstream leisure, education and recreational services.

A Helpful guide includes SIGN Guideline 114 for depression that concentrates on the non pharmaceutical management of depression. SIGN 114 Download

Exclusion Criteria

  • Understandable and time limited Psychological difficulties that exist in the context of recent life events and which can be understood as a normal reaction to adverse life events (uncomplicated bereavement; recent trauma).
  • Anger in the absence of significant other mental health difficulties
  • Substance Abuse as Primary Condition as the Lanarkshire Alcohol and Drug service may be more appropriate see first port
  • Chronic Pain (refer to the Chronic Pain Team)
  • Those patients with a definite diagnosis of Traumatic Brain Injury as their needs may be better met by the Traumatic Brain Injury Team based in Blantyre Health Centre see FirstPort
  • Learning Disability as the Learning Disability team may be more appropriate Community Learning Disability Team see Firstport

Mental Health (Adult) Referral

Scott McLaughlin

Access to service by General Practitioner

The following is a description of tiered services within mental health to guide decision making and appropriate referral and signposting. In this context a tier refers to a service requirement with appropriate training and skills for delivery of patient care and is based on patient need, increasing complexity and risk assessments. It is based on the premise that patients will need to access a variety of health services dependent on their need throughout their lives, from those at primary care to those that are more specialised, and that a strategic approach to identify needs will best inform delivery of services and support evidenced based care.

Although it is anticipated the majority of GP colleagues will deal with Tier 1, Tier 2, Tier 3 and that they will treat and manage the majority of mental health problems in primary care, it is important to have information as to how best to use the services, to understand the range of treatments and interventions available and the need to ensure there are appropriate links with primary care as regards decision making at secondary care. Although GP colleagues may have less contact with Tier 4 their role will also be important in terms of sharing information and guiding secondary care on primary care interventions and treatments as part of multidisciplinary risk assessments and planning of care.

For the sake of completion Tier 0 refers to community, public health and strategic approaches to promote the general health and well being of patients and is not included here.

Currently and to allow the service to further develop we have combined the existing structures within psychology and how it would link with psychiatry services for the purposes of facilitating a referral system that is seamless from primary to secondary care , this will be reviewed and may be subject to further revision as services further evolve.

Tier 4: Specialist community teams, specialist inpatient units and regional health services

In Tier 4 highly specialist services provide aspects of Mental Health Care (mainly Forensic and Rehabilitation services) that may not be able to be provided within community secondary care services (of Tier 2 and 3). Currently there is no direct referral into this service from primary care but future developments of service may consider this.

Tier 3: Moderate to Severe Presentations

CMHTs (Community Mental Health Teams) are at the heart of secondary care services in Tier 3 and provide services to patients aged 16-65 and who have left school.
Patients aged 16-18 years who are still at school are the remit of Child and adolescent mental health services.
CMHTS also provide an emergency response to patients who are suffering a mental health crisis and require to be seen the same day, consequently each CMHT has a duty worker system and referrals can be taken 08:30-18:30 Monday to Friday and at weekends 10:00-16:30.

General guidance as to patients who would benefit from the Service includes:

  • Patients with severe depression not responsive to primary care interventions, this includes watchful waiting, psycho education prescription of antidepressants at appropriate doses as per SIGN guidelines.
  • Psychoses or suspected psychoses including Bipolar Disorder and Schizophrenia/Psychotic Depression.
  • Obsessive Compulsive Disorders and severe Anxiety Disorders, including suspected Somatoform Disorders which include Body Dysmorphic Disorder, somatisation disorder, Conversion Disorder, pain disorder and Hypochondriasis.
  • Eating Disorder with the exception of when this is deemed severe and the individual therefore has complex needs (i.e. acute clinically significant effects on physical health; or the presence of some acute physical effects with incapacitating Eating Disorder symptomatology which pose significant threat to functioning in several domains): refer to TESS a tier 3 specialist Eating Disorder Service in Coatbridge – see Firstport.
  • Assessment of cognitive functioning in patients to aid management plans and to develop strategies for improving functioning, including those patients suspected of having early onset dementia.
  • Assessment of suspected or confirmed pervasive developmental disorders including Autistic spectrum disorder, Asperger’s and Attention deficit hyperactivity Disorder.
    PTSD (at least three months post-trauma).
  • Survivors of Sexual abuse with significant psychological sequelae that have not responded to or not been able to attend other services including EVA (see the Gender Based Violence section on FirstPort) and MASA (Men Against Sexual Abuse contact 07896 839415, available on Tuesday evenings only) and who are at risk of developing severe depression and /or anxiety or trauma symptoms.
  • Suspected Borderline Personality Disorders or suspected personality-related difficulties and may include those patients whose mental health problems and/or whose level of functioning has deteriorated to warrant repeated hospital presentations (usually with repeated self harm attempts or Adult support and Protection referrals) and or brief admissions to a mental health unit.
  • Provision of intensive home treatment, home visits, outpatient appointments by CMHTs in available community bases (as alternatives to hospital admission) as well as the ability to further step up care to acute inpatient care if the needs and risk assessments of the patient cannot be safely provided for in the community.

Tier 2: Mild to Moderate Presentations

Assessment/treatment of mild to moderate common mental health problems (including Specific Phobias, Panic Disorder, Generalised Anxiety Disorder, Social Phobias, Health Anxiety, complicated or prolonged grief reactions, psycho-sexual difficulties, Habit Disorders and includes mild and moderate depression.

For the purposes of clarity as regards the definition of depression it includes the following:

  • Mild depression. This doesn’t usually stop you living your daily life, but you may find it difficult to concentrate at work or do things that you normally enjoy.
  • Moderate depression. This has a significant impact on your daily life e.g. unable to work, withdrawing from friends and family, incurring negative thoughts, anxiety and or panic symptoms and you may have more symptoms than people with mild depression.

Treatment/Support Options:

(A) Community Support Options:

  • NHS 24 (Guided Self Help/Telephone CBT)
  • Well Connected (self referral) including STRESS CONTROL, healthy working lives for employees in organisation less than 250 people: Health Working Lives
  • Counselling (self referral to Workplace Employee Assistance Programmes/University and College Health Services)

(B) Specialist Mental Health Support:

  • Counselling (NHS) both individual and groups available as appropriate
  • CBT (NHS) both individual and groups available as appropriate

Tier 1: Pre-Treatment Presentations

The identification, assessment and treatment of mild common mental health problems, such as anxiety and depression.
Although it is recognised that the majority of patients with mental health problems are treated in primary care, and effective treatment is available. As part of ongoing work in NHSL to standardise treatments it is important that patients are offered choices for treatment that follow evidence based guidelines.

As a consequence, it is expected that as part of the GPs repertoire of choices for patients, it is assumed that there has been an attempt to offer and inform the patient of self help, telephone help lines, website based CBT and NHS 24 CBT, or specific counselling including:

CRUSE for bereavement – www.cruse.org.uk
RELATE for marriage or relationship difficulties – www.relate.org.uk
PETAL for patients experiencing trauma and loss after a murder or suicide – www.petalsupport.com

and that the patients have been unable to or it has not been possible to engage with these interventions before referral to the secondary care services.

Pre treatment presentations will include the identification, assessment and treatment of mild common mental health problems, such as anxiety and depression. For patients who have been unable to access or unable to engage with common interventions that include:

Treatment/Support Options:

  • Watchful Waiting
  • Well Connected (self referral including STRESS CONTROL classes)
  • Voluntary Organisation (CRUSE, etc.) (self-referral)
  • Statutory sector support services.
  • Mainstream leisure, education and recreational services.

A Helpful guide includes SIGN Guideline 114 for depression, that concentrates on the non pharmaceutical management of depression.

Exclusion Criteria

  • Understandable and time limited Psychological difficulties that exist in the context of recent life events and which can be understood as a normal reaction to adverse life events (uncomplicated bereavement; recent trauma).
  • Anger in the absence of significant other mental health difficulties
  • Substance Abuse as Primary Condition as the Lanarkshire Alcohol and Drug service may be more appropriate see first port
  • Chronic Pain (refer to the Chronic Pain Team)
  • Those patients with a definite diagnosis of Traumatic Brain Injury as their needs may be better met by the Traumatic Brain Injury Team based in Blantyre Health Centre see FirstPort
  • Learning Disability as the Learning Disability team may be more appropriate Community Learning Disability Team see Firstport

Mental Health – Beating The Blues Referral

Scott McLaughlin

Access to service by General Practitioner

The following is a description of tiered services within mental health to guide decision making and appropriate referral and signposting. In this context a tier refers to a service requirement with appropriate training and skills for delivery of patient care and is based on patient need, increasing complexity and risk assessments. It is based on the premise that patients will need to access a variety of health services dependent on their need throughout their lives, from those at primary care to those that are more specialised, and that a strategic approach to identify needs will best inform delivery of services and support evidenced based care.

Although it is anticipated the majority of GP colleagues will deal with Tier 1, Tier 2, Tier 3 and that they will treat and manage the majority of mental health problems in primary care, it is important to have information as to how best to use the services, to understand the range of treatments and interventions available and the need to ensure there are appropriate links with primary care as regards decision making at secondary care. Although GP colleagues may have less contact with Tier 4 their role will also be important in terms of sharing information and guiding secondary care on primary care interventions and treatments as part of multidisciplinary risk assessments and planning of care.

For the sake of completion Tier 0 refers to community, public health and strategic approaches to promote the general health and well being of patients and is not included here.

Currently and to allow the service to further develop we have combined the existing structures within psychology and how it would link with psychiatry services for the purposes of facilitating a referral system that is seamless from primary to secondary care, this will be reviewed and may be subject to further revision as services further evolve.

Tier 4: Specialist community teams, specialist inpatient units and regional health services

In Tier 4 highly specialist services provide aspects of Mental Health Care (mainly Forensic and Rehabilitation services) that may not be able to be provided within community secondary care services (of Tier 2 and 3). Currently there is no direct referral into this service from primary care but future developments of service may consider this.

Tier 3: Moderate to Severe Presentations

CMHTs (Community Mental Health Teams) are at the heart of secondary care services in Tier 3 and provide services to patients aged 16 – 65 and who have left school.
Patients aged 16-18 years who are still at school are the remit of Child and adolescent mental health services.
CMHTS also provide an emergency response to patients who are suffering a mental health crisis and require to be seen the same day, consequently each CMHT has a duty worker system and referrals can be taken 08:30 – 18:30 Monday to Friday and at weekends 10:00 – 16:30.

General guidance as to patients who would benefit from the Service includes:

  • Patients with severe depression not responsive to primary care interventions, this includes watchful waiting, psycho education prescription of antidepressants at appropriate doses as per SIGN guidelines.
  • Psychoses or suspected psychoses including Bipolar Disorder and Schizophrenia/Psychotic Depression.
  • Obsessive Compulsive Disorders and severe Anxiety Disorders, including suspected Somatoform Disorders which include Body Dysmorphic Disorder, somatisation disorder, Conversion Disorder, pain disorder and Hypochondriasis.
  • Eating Disorder with the exception of when this is deemed severe and the individual therefore has complex needs (i.e. acute clinically significant effects on physical health; or the presence of some acute physical effects with incapacitating Eating Disorder symptomatology which pose significant threat to functioning in several domains): refer to TESS a tier 3 specialist Eating Disorder Service in Coatbridge – see Firstport.
  • Assessment of cognitive functioning in patients to aid management plans and to develop strategies for improving functioning, including those patients suspected of having early onset dementia.
  • Assessment of suspected or confirmed pervasive developmental disorders including Autistic spectrum disorder, Asperger’s and Attention deficit hyperactivity Disorder.
    PTSD (at least three months post-trauma).
  • Survivors of Sexual abuse with significant psychological sequelae that have not responded to or not been able to attend other services including EVA (see the Gender Based Violence section on FirstPort) and MASA (Men Against Sexual Abuse contact 07896839415, available on Tuesday evenings only) and who are at risk of developing severe depression and /or anxiety or trauma symptoms.
  • Suspected Borderline Personality Disorders or suspected personality-related difficulties and may include those patients whose mental health problems and/or whose level of functioning has deteriorated to warrant repeated hospital presentations (usually with repeated self harm attempts or Adult support and Protection referrals) and or brief admissions to a mental health unit.
  • Provision of intensive home treatment, home visits, outpatient appointments by CMHTs in available community bases (as alternatives to hospital admission) as well as the ability to further step up care to acute inpatient care if the needs and risk assessments of the patient cannot be safely provided for in the community.

Tier 2: Mild to Moderate Presentations

Assessment/treatment of mild to moderate common mental health problems (including Specific Phobias, Panic Disorder, Generalised Anxiety Disorder, Social Phobias, Health Anxiety, complicated or prolonged grief reactions, psycho-sexual difficulties, Habit Disorders and includes mild and moderate depression.

For the purposes of clarity as regards the definition of depression it includes the following:

  • Mild depression. This doesn’t usually stop you living your daily life, but you may find it difficult to concentrate at work or do things that you normally enjoy.
  • Moderate depression. This has a significant impact on your daily life e.g. unable to work, withdrawing from friends and family, incurring negative thoughts, anxiety and or panic symptoms and you may have more symptoms than people with mild depression.

Treatment/Support Options:

(A) Community Support Options:

  • NHS 24 (Guided Self Help/Telephone CBT)
  • Well Connected (self referral) including STRESS CONTROL, healthy working lives for employees in organisation less than 250 people: Healthy Working Lives
  • Counselling (self referral to Workplace Employee Assistance Programmes/University and College Health Services)

(B) Specialist Mental Health Support:

  • Counselling (NHS) both individual and groups available as appropriate
  • CBT (NHS) both individual and groups available as appropriate

(C) Beating The Blues

Beating The Blues has a specific referral protocol which is available in the Mental Health Lanarkshire Wide Services branch of SCI Gateway.

Referral Criteria for Beating the Blues:

  • Mild to moderate depression/anxiety (including phobias and panic)
  • Without active suicidal ideation/plans
  • Without psychosis or functional cognitive disorder
  • Able to write/read English

Tier 1: Pre-Treatment Presentations

The identification, assessment and treatment of mild common mental health problems, such as anxiety and depression.
Although it is recognised that the majority of patients with mental health problems are treated in primary care, and effective treatment is available. As part of ongoing work in NHSL to standardise treatments it is important that patients are offered choices for treatment that follow evidence based guidelines.

As a consequence, it is expected that as part of the GPs repertoire of choices for patients, it is assumed that there has been an attempt to offer and inform the patient of self help, telephone help lines, website based CBT and NHS 24 CBT, or specific counselling including:

CRUSE for bereavement – www.cruse.org.uk
RELATE for marriage or relationship difficulties – www.relate.org.uk
PETAL for patients experiencing trauma and loss after a murder or suicide – www.petalsupport.com

and that the patients have been unable to or it has not been possible to engage with these interventions before referral to the secondary care services.

Pre treatment presentations will include the identification, assessment and treatment of mild common mental health problems, such as anxiety and depression. For patients who have been unable to access or unable to engage with common interventions that include:

Treatment/Support Options:

  • Watchful Waiting
  • Well Connected (self referral including STRESS CONTROL classes)
  • Voluntary Organisation (CRUSE, etc.) (self-referral)
  • Statutory sector support services.
  • Mainstream leisure, education and recreational services.

A Helpful guide includes SIGN Guideline 114 for depression that concentrates on the non pharmaceutical management of depression SIGN 114 Download

Exclusion Criteria

  • Understandable and time limited Psychological difficulties that exist in the context of recent life events and which can be understood as a normal reaction to adverse life events (uncomplicated bereavement; recent trauma).
  • Anger in the absence of significant other mental health difficulties
  • Substance Abuse as Primary Condition as the Lanarkshire Alcohol and Drug service may be more appropriate see first port
  • Chronic Pain (refer to the Chronic Pain Team)
  • Those patients with a definite diagnosis of Traumatic Brain Injury as their needs may be better met by the Traumatic Brain Injury Team based in Blantyre Health Centre see FirstPort
  • Learning Disability as the Learning Disability team may be more appropriate Community Learning Disability Team see first port

Reference:
Lead Clinician: Michael Ross, Head of Adult Psychological Services
Review Date September 2016