Tag: mental

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

Addictions Guidelines

Scott McLaughlin

Criteria for Referral to Tier 3 Services

Dependency
Pharmacological
Psychiatry /Psychology
Physical Health Damaged
Alcohol Related Brain Damage
Complex Social / Health Needs
Access to rehabilitation / residential in Patient Interventions

Criteria for Referral to Tier 2 Services

Early Intervention
Harmful / Hazardous Drinking
Drinking Drugs Precipitated by Major Life Events
Counselling / Support Work for Individuals and Families
Family Counselling / Mediation
Non-medical Interventions
Education / Prevention / Information/Advice

 

North Lanarkshire: Definitions for Tier 3: Referral to North Lanarkshire Integrated Service

DependencyUsing alcohol/drugs daily : unable to function without use or consumption
1Pharmacological NeedsDetoxification / substitute prescribing / Antabuse / Disulfiram
2Psychiatric IssuesRequires specialist Psychiatric Input
3Physical HealthAny Addiction Related Health Problem
4Access to Rehabilitation / Residential InpatientAcute mental health care, requiring comprehensive assessment and funding to be identified
5Alcohol Related Brain DamageChanges to the structure and function of the brain resulting from long term consumption of alcohol
6PsychologyRequires specialist Psychological Input, Psychosocial Interventions
7ASP
Adults who have addiction issues which could meet the criteria for Adult Support and Protection		“Adults at risk” are adults who:-
Are unable to safeguard their own wellbeing, property, rights and other interests
Are at risk of harm
Because they are affected by disability, mental disorder, illness or physical or mental infirmity, are more vulnerable to being harmed than an adult who are so affected
8Child ProtectionIssues where children may be offered by parental substance misuse
9Complex Social NeedsHomeless / Criminal Justice Involvement / Multi Agency Involvement
10Community Care NeedsComplex needs requiring specialist input: health; family; relationships; problems in taking care of themselves; not coping with everyday events; multiple problems

North Lanarkshire: Common Definitions for Tier 2 Service

Early Intervention:Pre - Dependency
1Non-medical interventionsCounselling / Support Work / Group work / Telephone Support
2Harmful / Hazardous DrinkingHazardous drinking above safer drinking limits. The person has so far avoided significant alcohol-related problems. Harmful - is drinking above safe levels with evidence of alcohol-related problems. May show a mild level of dependence
3Experiential / Recreational drug use:A drug used non-medically for personal enjoyment. Usually used in affecting mental activity, behaviour, or perception, as a mood-altering drug.
4Drinking / Drugs Precipitated by Major Life Events:Individuals using alcohol/drugs to cope with major events, e.g., death, divorce, financial hardship; unemployment
5Counselling / Support Work for IndividualsCounselling involves one person (the counsellor) helping another person (the client) to work through some difficult or painful emotional, behavioural or relationship problem or difficulty
6Counselling / Support Work for significant others / families:Support for significant others who are concerned about a loved one’s drink or drug use. The support enables the significant other to be heard and feel more able to understand and cope with the situation
7ASP
Family Counselling / Mediation		Family counselling / mediation can help reduce conflict which means fewer rows at home and can help everyone cope better with their situation.
8Education / PreventionGroup work / Information leaflets
9Information/AdviceUp to date information e.g. Alcohol Unit calculation, Alcohol / Drug effects on the body

South Lanarkshire: Common Definitions for Tier 2:

Early Intervention:Pre - Dependency
1Non-medical interventionsCounselling / Support Work / Group work / Telephone Support
2Harmful / Hazardous DrinkingHazardous - drinking above safer drinking limits. The person has so far avoided significant alcohol-related problems. Harmful - is drinking above safe levels with evidence of alcohol-related problems. May show a mild level of dependence
3Experiential/recreational drug use:A drug used non-medically for personal enjoyment. Usually used in affecting mental activity, behaviour, or perception, as a mood-altering drug.
4Drinking / Drugs Precipitated by Major Life Events:Individuals using alcohol/drugs to cope with major events, e.g., death, divorce, financial hardship; unemployment
5Counselling / Support Work for IndividualsCounselling involves one person (the counsellor) helping another person (the client) to work through some difficult or painful emotional, behavioural or relationship problem or difficulty
6Counselling / Support Work for significant others / families:Support for significant others who are concerned about a loved one’s drink or drug use. The support enables the significant other to be heard and feel more able to understand and cope with the situation
7Family Counselling / MediationFamily counselling/ mediation can help reduce conflict which means fewer rows at home and can help everyone cope better with their situation.
8Education / PreventionGroup work / information leaflets
Relapse Prevention / Alcohol Brief Intervention
9Information / AdviceUp to date information e.g. Alcohol Unit calculation Alcohol/Drug effects on the body

South Lanarkshire: Definitions for Tier 3: Referral to LAADS or SMT

DependencyUsing alcohol/drugs daily : unable to function without use or consumptionRefer to
1Pharmacological NeedsDetoxification / Substitute prescribing / Antabuse / DisulfiramLAADS
2Psychiatric IssuesRequires specialist Psychiatric InputLAADS
3Physical HealthAny Addiction Related Health ProblemLAADS
4Access to Rehabilitation / Residential In-PatientAcute mental health care, requiring comprehensive assessment and funding to be identifiedLAADS / SMT
5Alcohol Related Brain Damage:Changes to the structure and function of the brain resulting from long term consumption of alcohol.LAADS / SMT
6Psychosocial InterventionsRequires specialist Psychological InputLAADS / SMT
7ASP
Adults who have addiction issues which could meet the criteria for Adult Support and Protection.		"Adults at risk” are adults who:-
Are unable to safeguard their own wellbeing, property, rights and other interests
Are at risk of harm
Because they are affected by disability, mental disorder, illness or physical or mental infirmity, are more vulnerable to being harmed than an adult who are so affected.
8Child ProtectionSMT
9Complex Social NeedsHomeless / Criminal Justice Involvement / Multi Agency InvolvementSMT
10Community Care NeedsComplex needs requiring specialist input: health; family; relationships; problems in taking care of themselves; not coping with everyday events; multiple problemsSMT

South Lanarkshire

Teir 3HealthLAADS
Teir 3SocialSMT
Teir 2Non MedicalMeridian

Addictions Referral Template