Mental Health Liaison Team Referrals

Operational Hours

1. The Mental Health Liaison Service (MHLS) operates in DGRI seven days a week, from 08.00 to 18.00. The MHLS is now based in DGRI and is available by telephone (duty phone extension, 71098).  Referrals should be made via Cortix.  Outside operational hours, the Mental Health Crisis Team (CATS Team) can be contacted who can give advice or action any query accordingly.
2. Mental Health assessments in A&E are considered crisis referrals, and should be directed to the Crisis Team (CATS Team), and can be contacted through DGRI switchboard.

Categories

1. Emergency – This would be when there is an immediate need to address a patient’s mental state, perhaps due to acutely disturbed behaviour, which may pose a risk to the patient themselves or to others; including staff and other inpatients. Out of hours these calls should be directed through DGRI Switchboard to Crisis Service (CATS).  In some cases, an ANP, Duty Doctor or Psychiatrist may assist. During working hours, calls should be directed to the MHLS; however these may be passed to the CATS Service, Duty Doctor or Psychiatrist to manage, depending on the balance of clinical priorities.
2. Drugs and alcohol – Where Drug and Alcohol issues are the primary concern, referral should be made to the Specialist Drug and Alcohol Service (SDAS), who provide a Drug and Alcohol Liaison Service (DALS). These referrals should be made via the CORTIX referral system. Some cases may involve both addiction difficulties and elements of mental disorder; in these cases, the MHLS can take the referral, triage and gather more details and liaise with DALS colleagues (or vice versa) around how best to proceed; this may result in a joint assessment.
3. Non-emergency – For all other cases, referral should be made to the MHLS, as a single point of contact for referrals via the CORTIX referral system. This includes special groups such as elderly, dementia, intellectual disability, etc. The MHLS may liaise and negotiate with other services within the Mental Health Directorate, to agree on how best to proceed and provide updates on plans developed to the referring ward. This may involve joint assessment with specialist services. The internal system for handling referrals prevents the DGRI wards having to make a series of referral to find the ‘right’ service to respond to a particular case.

Referral Criteria

1. Referral to the MHLS should be considered for patients in Dumfries and Galloway Royal Infirmary (DGRI), whereby a concern pertaining to their mental health has arisen or when mental health may be influencing their physical health presentation.
2. Patients admitted with overdose (and other suicidal type presentations) should be referred for mental health assessment. Once the patient has been agreed to be medically fit, a nursing assessment and risk assessment may be completed. It is desirable for these patients to have an initial mental health assessment prior to discharge from DGRI. Similarly a patient who appears to have suicidal thinking or intent should be referred.
3. Patients with medical and surgical conditions, who present with psychiatric symptoms, and those who’s physical presentation lacks evidence of significant physical pathology, may benefit from a mental health assessment; either while they are an inpatient in DGRI or following discharge. This might include patients with endocrine or neurological conditions, repeated presentations with medically unexplained pain etc.
4. Patients with mental disorder, whose symptoms deteriorate while an inpatient in DGRI, or who present a challenge for management in DGRI, should be referred. Also, some patients may develop mental illness for other reasons, while in DGRI. This could include patients with severe and enduring mental illnesses, such as schizophrenia or bipolar, presenting with a physical illness. It could also include severe disturbance of mental state triggered by a physical condition such as puerperal psychosis. Patients presenting with significant depressive symptoms, paranoid thinking, anorexia nervosa etc. or other mental illnesses, which appears not to be under control, should be referred.
5. Presentation of delirium is common in general hospitals and has many causes. It can affect all groups but is more common in older people, and those with an underlying cognitive impairment. There are SIGN guidelines on management of delirium (www.scottishdeiriumassociation.com/sda-delirium-management-pathways.html); these guidelines should be followed in the first instance when a Delirium has been identified and confirmed by medical staff. If delirium screening fails to explain the presentation or it does not resolve within a brief period, the MHLS providing an assessment at that time is likely to be supportive.
6. For other cognitive impairment (once a delirium has been treated, resolved or excluded), referral to the MHLS for direct input or signposting may be appropriate. Also a patient with known cognitive impairment presenting with some management challenges within DGRI may benefit from Mental Health Liaison assessment.
7. An exhaustive list of referral criteria is impossible to provide. If a patient presents with psychiatric symptoms or in an unusual way, referral to facilitate discussion may be worth considering.
8. The MHLS can be asked to be involved with any patients who are subject to detention under the Mental Health (Care and Treatment) (Scotland) Act 2003. Patients, who are on special medications such as Clozapine and long acting injectable antipsychotic medicines, should be referred in case advice or support is required.
9. The MHLS does not provide routine assessments of capacity, as this is a core medical skills and not specific to mental health, and is dependent on the specific situation and decisions being considered. However, in particularly complex situations, mental health service medical staff may assess or offer advice or second opinion. In these circumstances, the referrer should be clear about the capacity issue and the decisions being considered, as well as indicating what makes the situation complex or difficult to assess. These referrals will then be discussed MHLS Psychiatrists to determine if appropriate or not

Referral Triage

1. Referrals will be triaged by the MHLS. Cortix referrals will usually trigger a phone call to the referring ward if additional information is required.  Other clinical details (e.g. from mental health records, staff usually involved in the patient’s care, etc.) will be gathered to assist in assessment of whether the patient needs to be seen by the MHLS, or can be referred on to other agencies or for mental health assessment by community services after discharge from DGRI.
2. If the patient does need to be seen, clinical information including the level of disturbance to the patients behaviour and their mental state, will inform what priority is given to the assessment is indicated
3. Normally higher priority patients would be assessed the same day and lower priority patients within 48 hours. Lower priority but more complex cases may have their initial assessment delayed to allow discussion with psychiatric medical staff that supports MHLS nurses. The level of clinical activity may have an impact of how quickly patients can be seen.
4. The MHLS initial contact will involve:
   • Gathering of additional information;
   • Assessment for mental illness;
   • Assessment for the impact of the mental illness;
   • Assessment of clinical risk;
   • Provide advice on management of mental health elements of a patient’s presentation;
   • Plan further input where needed, which may include handing over to other parts of the mental health service;
   • When admission to Midpark Hospital is required, MHLS will facilitate transfer as quickly as practicable, once the patient is medically fit to be transferred.

Content Updated by Antony Travas