CAMHS & Adult Services

AuthorityDepartment of Health and Social Care
Date received2020-02-28
OutcomeSome information sent but not all held
Outcome date2020-03-26
Case ID1203949

Summary

The requester asked for statistics on adolescents refused adult mental health services and the policies authorizing such refusals. The Department of Health and Social Care responded with an operational policy document but stated that not all requested information was held.

Key Facts

  • The request covered the last 5 calendar years up to 31-12-2019 regarding adolescents transitioning from CAMHS to Adult Services.
  • The authority responded with the 'Adult Community Mental Health Service Operational Policy'.
  • The policy was ratified by Ross Bailey, Manager of Community Mental Health Service for Adults.
  • The policy has been active since March 2018.
  • The outcome was classified as 'Some information sent but not all held'.

Data Disclosed

  • 31-12-2019
  • March 2018
  • 2020-02-28
  • 2020-03-26
  • 45 pages
  • 3 documents
  • 18 - 65 Age Group
  • 16 Years
  • 65 Years

Original Request

1. In each of the last 5 calendar years, up to 31-12-2019, how many adolescents when approaching/reaching the age of 18,under the care of CAMHS, have been refused access to help in Adult Mental Health Services? 2. What are the Policy documents, Guidance Notes, Management Instructions, that authorise staff to carry out this refusal policy? 3. What is the Legislation that permits the documents/instructions & subsequent actions in question 2 to take place?

Data Tables (16)

This Operational Policy is available to partner agencies, stakeholders and service users.
It is also available on the Mental Health Service Sharepoint service.
See Appendix 8 – Policy for Storage and Administration of Depot Injections in a Community
Setting
See Appendix 9 – Standards for Depot Clinic
See Appendix 11 – Guidelines for Administration of Long Acting Olanzapine Injection in a
Community Setting
Transition Policy Child and
Adolescent Mental Health Services to Adult Mental Health Services – December 2015 - See
Appendix 19.
The Performance and Development Review ('PDR') has been developed to provide support for the
ongoing performance management of all MPTC and civil service staff and forms a core function of
management supervision. It allows staff to reflect on, and assess, how they have performed over
the previous 12 month period. It also allows staff to plan ahead by identifying any development
required for them to become more effective in their job and to progress on their chosen career
pathway.
Participation in the PDR scheme is mandatory for all MPTC and Civil Service staff regardless of
grade.
For Civil Servants, The PDR scheme runs annually from the 1 April to the 31 March.
For MPTC staff, the PDR scheme runs annually between increment dates.
 Personal Delivery Plan (PDP): This involves looking forward to the next 12 month
period and planning what needs to be achieved, how to do this and identifying any
development needed. This information comprises the personal development plan and is
usually completed immediately after the Final Review.
 Interim review(s): The interim review establishes whether staff are on target to meeting
the requirements of the PDP. These are generally held at 6 months but during probation
periods will be more frequent.
 Final Review: This involves reflection on what was achieved during the previous year and
how it was achieved. It allows decisions to be made regarding whether the individual met
their agreed objectives and competencies.
1. Justify the purpose(s)
Every single proposed use or transfer of patient identifiable information within or from an
organisation should be clearly defined and scrutinised, with continuing uses regularly
reviewed, by an appropriate guardian.
2. Don't use patient identifiable information unless it is necessary
Patient identifiable information items should not be included unless it is essential for the
specified purpose(s) of that flow. The need for patients to be identified should be
considered at each stage of satisfying the purpose(s).
3. Use the minimum necessary patient-identifiable information
Where use of patient identifiable information is considered to be essential, the inclusion of
each individual item of information should be considered and justified so that the
minimum amount of identifiable information is transferred or accessible as is necessary for
a given function to be carried out.
4. Access to patient identifiable information should be on a strict need-to-know
basis
Only those individuals who need access to patient identifiable information should have
access to it, and they should only have access to the information items that they need to
see. This may mean introducing access controls or splitting information flows where one
information flow is used for several purposes.
5. Everyone with access to patient identifiable information should be aware of
their responsibilities
Action should be taken to ensure that those handling patient identifiable information -
both clinical and non-clinical staff - are made fully aware of their responsibilities and
obligations to respect patient confidentiality.
6. Understand and comply with the law
Every use of patient identifiable information must be lawful. Someone in each organisation
handling patient information should be responsible for ensuring that the organisation
complies with legal requirements.
7. The duty to share information can be as important as the duty to protect patient
confidentiality
Professionals should in the patient's interest share information within this framework.
Official policies should support them doing so.
All paper Health Care Records must be physically secured and access restricted in such a way as
to maintain confidentiality and facilitate ease of access for authorised personnel.
All paper records should be scanned and uploaded onto the electronic system. The paper copy
should then be securely stored at the team base.
All scanned documentation should be checked for readability prior to uploading to ensure it is of a
high quality.
Practitioners are responsible for the safe storage of paper care records and these should be stored
in accordance with agreed service policies.
It is the responsibility of individual practitioners to ensure that all records are secure at the end of
each working day.
Title Policy for Transition from Child and Adolescent Mental Health Service (CAMHS) to Community Mental Health Service for Adults (CMHSA).
Purpose of document This policy is designed to provide guidance for the procedure and practice in the transition of young people from CAMHS to CMHSA
Authors Nicola Howard- CMHSA Emma McClean- CAMHS
Ratified by Emma McClean CAMHS Manager & Ross Bailey, CMHSA Manager
Status Operational since 2010
Date of this version May 2017
Circulated to CAMHS CMHSA
Next Review Date May 2020 or before if service area specifications change.
mental health of children and young people. Driven by young people’s experiences they
campaign, research and influence policy and practice. The two links below provide guides
for young people and their parents on transition and can be used as a resource to help
young people and to guide professional practice.
 Young people should have an assessment of their needs and have a care plan setting
out what support they will need before they leave CAMHS.
 Transition planning should take place in good time so that young people know what
to expect and when.
 Young People should be asked if they want their parents or carers to be involved in
their care.

Full Response Text

MENTAL HEALTH SERVICE Adult Community Mental Health Service Operational Policy

Ratified: Ross Bailey, Manager Community mental Health Service for Adults Active from: March 2018

Index

(i) Philosophy

(ii) Mission Statement

Part 1

Philosophy ....................................................................................................... 1 Location ....................................................................................................... 1 Care Planning Standards .................................................................................... 1 Standard Care .................................................................................................. 2 Care Programme Approach ................................................................................ 2 Health of the Nation Outcomes Scales (HoNOS) ................................................... 3 Electronic Database ........................................................................................... 3 Principals of Care and Client Group ..................................................................... 4 CMHT Waiting List ............................................................................................. 4 Standard 1 - Referrals, Allocations and Information ............................................. 5 Patients Outside the 18 - 65 Age Group .............................................................. 6 Care for Adolescents Reaching 16 Years .............................................................. 6 Care for Patients Reaching 65 Years ................................................................... 6 Criminal Justice Mental Health Liaison Service ..................................................... 6 Child and Adolescent Mental Health Service Liaison .............................................. 8 Referral Pathway for CMHSA .............................................................................. 9 Eating Disorders ............................................................................................... 10 Patients with Learning Disabilities ....................................................................... 11 CMHSA Referral and Duty System ....................................................................... 11 Allocation ....................................................................................................... 12 Assessment ...................................................................................................... 12 Care Planning Documentation ............................................................................ 13 Care Plan Review .............................................................................................. 13 Standard 2 - Care Co-ordinator Documentation.................................................... 14 Clinical Communication Meeting ......................................................................... 15 Medical Responsibility ........................................................................................ 15 Assessment by a Psychiatrist .............................................................................. 16 Prescribing ....................................................................................................... 16 Depot Clinic ...................................................................................................... 17 Discharge ....................................................................................................... 17 Non Attendance ................................................................................................ 17 Refusal of Service ............................................................................................. 18 Standard 3 - Case Load Management ................................................................. 19 Temporary Reallocation ..................................................................................... 20 Change of Care Co-ordinator .............................................................................. 20 Protocol for Transfer of Clients Between CMHT’s .................................................. 21 Standard 4 - Communication .............................................................................. 23

Role and Responsibility of A Care Co-Ordinator .................................................... 24 Accountability ................................................................................................... 25 Skills of a Care Co-Ordinator .............................................................................. 27 Management and Supervision of Staff ................................................................. 29 Clinical Governance ........................................................................................... 31 Records and Record Keeping .............................................................................. 32 Access and Safe Storage of Records ................................................................... 32 Team Communication ........................................................................................ 33 Staff Security/Safety.......................................................................................... 34 Interagency Working ......................................................................................... 35 CMHT Liaison .................................................................................................... 35 Voluntary Organisations ..................................................................................... 36 SUN ....................................................................................................... 36 Autism Initiatives .............................................................................................. 37 Praxis .............................................................................................................. 37 Home Support .................................................................................................. 37 Accommodation ................................................................................................ 38 Key Club ....................................................................................................... 38 Salvation Army ................................................................................................. 39 Mental Health Act and Care Programme Approach (CPA) Manager ........................ 39 Child Protection and Mental Health ..................................................................... 39 Acting as an Appropriate Adult ........................................................................... 39 General Principals - Preserving Confidentiality ...................................................... 40 Complaints ....................................................................................................... 42 Quality and Audit .............................................................................................. 43

Appendices

  1. Lone working Policy
  2. Best Practice Guidelines for Lone Working Policy
  3. Policy/Procedure for Qualified Staff Validating Health Care Record Entries
  4. Procedure for Informal Audit of Health Care Records
  5. Minimum Standards for Health Care Records Audit Tool
  6. NMC Record Keeping Guidance
  7. Policy and Procedure for the Use of the Social Assessment Fund
  8. Policy for Storage and Administration of Depot Injections in a Community Setting
  9. Standards for Depot Clinic
  10. Standards for Depot Clinic Audit Tool
  11. Guidelines for Administration of Long Acting Olanzapine Injection in A Community Setting
  12. Policy and Procedure for Personal Safety and Security at Community Mental Health Team Base (CMHT) within Central Community Health Centre
  13. Policy and Procedure Regarding Storage of Keys at Community Mental Health Team Base
  14. Policy Guidelines on Dress Code
  15. Guidelines for Receiving Sickness/Absence Messages
  16. Guidelines for Administrative Staff Regarding Communication
  17. Fire Procedure
  18. Fire Safety Policy

  19. Policy for Transition from Child and Adolescent Mental Health Services to Adult Mental Health Services (May 12)

  20. Leaflet - Eating Disorder

  21. Policy on Visits to the Isle of Man Prison by Visiting Healthcare Professionals
  22. Feedback from Mental Health Service Users Form
  23. Confidentiality Statement
  24. Confidentiality and Consent Leaflet
  25. Leaflet - Personal Information – Your records and how to see them
  26. Leaflet – The Care Programme Approach (CPA)
  27. Leaflet – Copying Letters to Service Users
  28. Leaflet - Service Users Network
  29. Leaflet - CMHT
  30. Leaflet – CMHT Discharge Questionnaire
  31. Leaflet – What you can Expect from Us
  32. DSC Standards and Guidelines for Producing Service User and Public Information
  33. Terms of Reference
  34. Annual Leave/Training/Absence Protocol
  35. Policy and Procedure for the Use of the Social Assessment Fund
  36. Transition Policy Adult Community Mental Health Team to Older Person’s Mental Health Service – March 2016 – Appendix 36
  37. CMHT Eating Disorders Policy and Care Pathways
  38. Eligibility Criteria
  39. Guidelines for Management of Lost Property
  40. Giving Permissions to Outlook Folders
  41. Signature List

PREFACE

Operational issues outlined in this document are underpinned by the following core values:

 pursuit of high quality care

 adherence to evidence-based practice

 valuing staff

 encouraging service user involvement

 promoting equity of access

 Fostering collaborative relationships with allied agencies and third-sector organisations

It is envisaged that by working to these principles it will allow the service to:

 Ensure quality is achieved

 Ensure patients access the support they need to address their mental health difficulties, promoting a recovery-focused approach

 Minimise risk

 Maintain public confidence

 Meet the responsibilities and guiding principles of Mental Health and Wellbeing Plan IOM 2015-2020

Scope

This Operational Policy applies to all staff and students engaged in delivering services on behalf of the CMHSA. This Operational Policy is available to partner agencies, stakeholders and service users.
It is also available on the Mental Health Service Sharepoint service.

CMHSA Mission Statement “To provide an accessible, evidence-based, recovery-focused and efficient mental health service to adults experiencing mental ill health in the Isle of Man”

Aims and objectives

 Providing specialist services to adults presenting with moderate to severe mental ill health.  Ensuring priority is given to the most acutely unwell, particularly where there is a risk of deteriorating mental health, self-harm or suicide;  Enabling families, carers and other professionals to positively support patients with mental health needs, by providing them with appropriate strategies and skills to improve mental health.  Promoting mental health and the prevention of mental illness.  Attracting and sustaining resources for specialist CMHSA service provision/delivery.  Providing training and consultation to front line professionals to maximise their ability to promote mental health within a primary care setting.

We aim to do this by:

 Promoting recovery and mental wellbeing.  Utilising a range of evidence-based psychotherapeutic and pharmacological approaches.  Supporting family, carers and other professionals to manage existing mental health problems more effectively.  Having a positive impact on the individuals’ resilience to assist them to manage negative stressors more effectively.  Providing diagnosis, formulation and understanding of mental health problems.  Promoting knowledge and skills of universal and targeted staff.  Being committed to multi-disciplinary and multi-agency working.

Patients and their carers can expect:

 To be treated with dignity, respect and appropriate privacy.  To receive treatment and care that is appropriate to their need.  To have their rights to confidentiality respected.  To be collaborative partners in their treatment and care, by having the information they need to help them make appropriate choices in the type and method of their interventions.

 The service to consider the context and influences that effect their environment including family, friends, and local communities.  The services to be accessible, and use appropriate means to encourage them to engage in their treatment.

Eligibility Criteria

The CMHSA currently accepts referrals of patients between the ages of 18-65 experiencing moderate to severe mental illness. This includes:

 Severe and/or enduring mental illness (e.g. psychosis)  Complex needs (e.g. dual diagnosis, eating disorders)  Patients subject to the provisions of the Mental Health Act 1998 (e.g. Section 115)  Patients assessed as posing a risk to self and/or others as a result of mental illness  Severe depression or severe anxiety disorders (unsuccessfully treated at Step 0, 1 or 2)

The CMHSA is not resourced to accept referrals of:

 People who have marital, relationship or other life event problems that could be addressed by a community Step 0, 1 or 2 provider  People whose impaired cognitive function prevents them from being able to work within a therapeutic treatment programme (e.g. severe learning disability)
 People whose primary problem is alcohol and/or drug related without a concurrent mental illness  Individuals with primary diagnosis of Neuro Development Disorder i.e. Attention Deficit Hyperactivity Disorder, Autism or an Acquired Brain Injury without a concurrent mental illness

CMHSA Current Team Establishment

The CMHSA employs the following Whole Time Equivalent (WTE) staff:

CMHSA Manager 1.0 CMHSA Deputy Manager 1.0 Clinical Director 1.0 Consultant Psychiatrists 3.75 Associate Specialist Psychiatrist 1.0 Consultant Clinical Psychologist 1.0 Clinical Psychologist 2.6 Cognitive Behavioural Therapist 1.0 Community Mental Health Professionals (Nursing) 11.0 Community Mental Health Professionals (Social Work) 5.8 Community Support Workers 6.6 Personal Secretary 1.0 Senior Secretary 2.0 Secretary 2.0 Admin Assistant 2.0

The Community Mental Health Service for Adults (CMHSA) is a multi-disciplinary service.
The team comprises of experienced mental health nurses, social workers, community support workers, dedicated Psychiatrists, Psychol

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