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Adult Mental Health Team CMHT Standard Operating Procedure
Adult Mental Health Team CMHT Standard Operating Procedure
Summary: Southern Health NHS Foundation Trust (SHFT) Adult Mental Health
Service in partnership with other statutory agencies such as Local
Authorities and Police services have developed a way of working
together to provide a community care pathway within Hampshire
and Southampton City.
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Adult Mental Health Team CMHT Standard Operating Procedure
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Version Control
Change Record
Reviewers/contributors
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Adult Mental Health Team CMHT Standard Operating Procedure
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Adult Mental Health
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Adult Mental Health Team CMHT Standard Operating Procedure
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Contents
1. Introduction 5
6. Specialist Functions 7
6.1 Shared Care
6.2 Response
6.3 Social Services
6.4 Psychological Therapy Services
7. Processes & Systems of Governance 12
7.1 Caseload Management
7.2 MDT Shared Care Meeting
7.3 Business Meetings
7.4 Leadership Meetings
7.5 Supervision
7.6 Training
8. Outcome Measures 13
8.1 Research & Audit
9. Customer Care 14
10. Confidentiality 14
10.1 Access to Health and Personal Records
10.2 Freedom of Information
11. Concerns & Complaints 15
14. CQC 15
18. Appendices 18
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Adult Mental Health Team CMHT Standard Operating Procedure
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Adult Mental Health Team
CMHT Standard Operating Procedure
1. Introduction
Southern Health NHS Foundation Trust (SHFT) Adult Mental Health Service in
partnership with other statutory agencies such as Local Authorities and Police services
have developed a way of working together to provide a community care pathway within
Hampshire and Southampton City.
2.1 Objectives – which incorporate the WRAP model of Hope, Agency and Opportunity
are:
To provide person centred recovery focussed care
To base care on the individuals strengths
To provide the least intrusive and restrictive of care
To encourage self-management and choice
To work collaboratively with all individuals and agencies
To utilise multi-disciplinary and multi-agency expertise
To deliver evidence based interventions
To apply positive risk management whilst maintaining safety
3. Service description
The Community Mental Health Team (CMHT) is available Monday to Friday 09:00 –
17.00hrs with some team bases opening at 08:30. All CMHT’s offer planned shared care
during weekday, weekends and bank holidays
CMHT is an umbrella term for a range of adult mental health community based functions
and interventions that are delivered by a multi-professional, Southern Health NHS
Foundation Trust consisting of nurses, occupational therapists, Clinical Psychologists,
psychological therapists, psychiatrists, and support workers. The CMHT provides a local
single point of access for individuals who present with severe, complex and enduring
mental health problems. The role of the CMHT is to provide assessment and community-
based treatment which is undertaken in partnership with referred individuals and focusses
on individual needs, self-determination and recovery. To achieve this, the CMHT works
closely with other Southern Health services, Acute service, Specialist Services, Primary
Care services, local community networks and other agencies.
From 1st April 2016, the current S75 agreement between Southern Health NHS
Foundation Trust and Hampshire County Council Adult Services will cease and be
replaced with a memorandum of understanding. The two respective organisations will
continue to be co-located in some bases and the HCC Adult Services will be responsible
for assessing social care needs under Section 9 of the Care Act 2014 and will develop
separate direct contact arrangements by September 2016.
The 3 EIP teams cover East area, Southampton and a combined North/West area the
teams are often based within a CMHT building and are in the process of developing a
SOP.
North Area
Basingstoke CMHT – Bridge Centre, Basingstoke
West Area
Winchester & Andover CMHT – 68b Junction Road, Andover
Avalon House, Winchester
Eastleigh & Romsey CMHT – Horsefair Mews, Romsey
Desborough House, Eastleigh
New Forest CMHT – Waterford House, New Milton
Anchor House, Totton
Southampton Area
Southampton Central CMHT – College Keep, Terminus Terrace
Southampton West CMHT- Cannon House, Shirley
Southampton East CMHT - Tom Rudd Unit, Moorgreen
The provision of Mental Health services will improve mental health or prevent
deterioration.
Poor response to previous mental health treatment in primary care
History of violence or persistent offending.
At significant risk of persistent self-harm or neglect
Dual diagnosis of serious mental illness and substance misuse
Severe difficulties in living at home safely without support
Severe difficulties in maintaining independent living without support
Reliant on a carer who is no longer able to support all of their needs
Mental health illness which mean that the individual is unable to carry on caring for a
child, or the child may be at risk of harm
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Neurodegenerative disease with associated mood or psychotic disorder where needs
are best met by Adult Mental Health Services.
Assessed in IAPT services as needing a specialist mental health treatment
Military veterans with severe and persistent mental health difficulties which are likely to
be related to their service in the armed forces.
14 - 35 year old individuals who experience a first episode of psychosis, early
intervention in psychosis will be referred to EIP
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4.1. Referrals
Each CMHT will have in place arrangements to allow for referrals to be accepted,
processed and acted upon within the contractual agreed timescales.
There are a variety of referral routes including telephone, letters, emails and fax. Some
CMHT’s refer urgent assessments to AMHT.
The referrals accepted for CMHT assessment are those categorised as:-
Soon referrals - to be seen within 10 working days
Routine referrals - are to be seen within 7 weeks
Urgent referrals - those to be seen within 24 hours. These referrals are seen by the
Acute Mental Health Team.
For those referrals suspected of First Episode Psychosis if under the age of 35 years will
be referred to the Early Intervention Team for assessment. For those over the age of 35
years will be assessed and allocated within 14 days
4.2. Screening
CMHTs will have robust processes in place to ensure that all referrals are screened daily
and within 4 hours of receipt if urgent. Routine referrals will be screened based on need
within a MDT and with representation from Hampshire County Council if a Hampshire
resident. Screening entails cross checking referrals with RIO, archived notes, and other
services who may be involved in the individuals care. If further referral information is
required to determine appropriate intervention the screener will contact the referrer.
If the referrer has referred the individual as being Urgent then the referral must be treated
as such unless robust communication has occurred with the referee who has agreed an
alternative time scale. This must be documented on RIO. Downgrading of a referral from
urgent cannot occur without agreement from the referrer. If the refer cannot be contacted
a fax must be sent to them outlining the rationale to downgrade the referral to a SOON
referral
4.3. Assessments
A comprehensive mental health assessment will be undertaken by an appropriate
member of the team within agreed timescales
Routine assessments - contact will be made with the service user and an appointment
arranged that is suitable to them
CMHTs will ensure procedures are in place to discuss complex assessments within the
wider MDT.
If the assessment identifies first episode psychosis or an ‘at risk mental state’, then the
psychosis pathway will be followed. Those individuals under the age of 35 years will be
referred to the EIP team. Those over 35 years the CMHT will allocate a Care Co-ordinator
within 14 days of the date of referral.
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If the assessment indicates social care needs the CMHT will refer to the local AMH social
care team.
If an assessor determines that the referred individual presents as Urgent or with risk to
self or others that cannot be managed within the CMHT then the individual will be referred
to the Acute Mental Health Team.
It may be determined on assessment that the referred individual’s needs are best met at
step 2 or 3 interventions as per stepped care. The assessor will liaise with italk and in
agreement arrange transfer to their services.
In cases where non statutory services are recommended, signposting and information
sheets will be provided.
SHCP27 The Assessment & Management of Clinical Risk Policy. This policy
describes the processes SHFT uses to ensure risks relating to the clinical presentation of
patients and their care and support are assessed and managed. It should be read in
conjunction with the Practice Guidance for Managing Clinical Risk Document
(SHCP28) which supports the implementation of this policy.
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“Activities of daily living” may be under taken by the CMHT Occupational Therapist and
the outcome will contribute to the overall plan of care where available.
Review of health funded high cost placement
4.7. Discharge
Recovery is the focus of all mental health interventions and discharge from services is
planned in partnership with the individual at their initial assessment and reviewed
regularly. Discharge is based on the individual completing a recovery focused
intervention, or no longer benefitting from or accepting of support. Families and Carers
will be involved in the discharge process in collaboration and agreement with the patient.
All imminent discharges should be discussed with the Team Leader or at weekly
meetings. At discharge care clustering should reflect improved recovery.
Prior to discharge, it is essential that the Section 117 Mental Health Act 1983 status of the
Service User is reviewed and Local Authority staff should be involved.
A written discharge summary will be provided to both the individual and their GP within 10
days of discharge and much sooner in most cases.
Disengagement of individuals with on-going mental health needs who are deemed at risk
to self and others will not automatically be discharged from the CMHT – please refer to
the Clinical Disengagement / Did Not Attend Policy SHCP 97.
Within the first 24 hours of an individual being discharged from Acute Inpatient Care the
CMHT or AMHT will arrange a face-to-face follow up to occur within 7 days of the Acute
discharge.
4.8. Transfer
There are arrangements for transfers between the CMHT and other Southern Health
services. Transfers will be facilitated by liaison between the services or teams and RIO
transfer mechanisms,
The default position will be the Team Manager, Team Leader or designated deputy. The
Care Plan / Care Programme Approach (CPA), will be collaboratively reviewed and
revised by the allocated worker in the CMHT 4 weeks after transfer, or sooner if indicated.
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All individuals who provide care for a person on the team’s caseload should be offered an
assessment of their own mental and physical health needs and referred to Social
Services to undertake this.
The CMHT will ensure that carers are meaningfully engaged and involved in individual
care planning and will also identify any opportunity where a carer is expressing a wish to
become further involved in aspects of service design and delivery.
The sharing of sensitive information can be difficult but is often crucial to the wellbeing of
both patient and carers. Often it is the carer or family who knows the person best and it
is important that the CMHT recognises these existing relationships and work with the
family and carer to manage clinical situations appropriately. The wellbeing of the carer
and risks to the individual can be greatly improved if they can be encouraged to be
involved in the care provided.
The Mental Health Act 1983 and 2007 has set out various roles and responsibilities which
relate to carers. When a service user is assessed using the Mental Health Act, the
Nearest Relative has certain legal rights which all teams need to ensure are respected
and adhered to. When treating a person under the Mental Health Act, family members
and other carers should be proactively involved wherever possible
6. Specialist Functions
Service Users meet the criteria for Shared Care if they require more intense clinical
intervention, for a time limited period, than a Care Co-ordinator can reasonably give them
within their normal working week, and the risks associated with their presentation are
complex enough to raise significant concerns for themselves or others
Shared care provides planned visits for those most in need. This can include those
showing signs of relapse, increasing risk and facilitate early discharge with joint working
with AMHT
Teams have daily shared care meetings and provide planned contact up until 8pm
weekdays and interventions may include regular daily telephone contacts, increased visits
up to daily or visits, planned weekend work, monitoring of medication, enhanced liaison
with police, and other relevant agencies, and increased family intervention as agreed.
The Mental Health Social Work Team will arrange for the investigation of safeguarding
concerns under the framework of the Safeguarding Adult Multi-Agency policy. This will
include assessing the seriousness of the situation, the level of risk and any action needed
to ensure the safety of the concerned.
Social Care also performs the statutory Local Authority duty of the Approved Mental
Health Practitioner role (AMHP). This requires the AMHP arranging and performing
Mental Health Act assessments following referral.
It is expected that people referred for formal psychological therapies will have received a
recent psychological assessment by a member of the CMHT to ensure s/he has
consolidated any previous psychological treatment.
Psychological Therapy is always time limited and the psychological therapist is expected
to contract all interventions with the service users.
Case management includes review of potential or existing clinical risks, reflective practice,
caseload capacity, outcome measures and discharge planning.
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Team brief
Quality issues and Key Performance issues
Local issues to include Local Authority and Case Law updates
Health and Safety
Learning from incidents/complaints/audit etc.
What’s going well/what we can do differently
Hotspots
AOB
This meeting will need to maintain robust records, these will provide evidence of the work
the teams are doing to ensure that the core business is appropriately monitored, reviewed
and developed and the team are kept informed.
7.5 Supervision
The CMHT Manager is responsible for ensuring that each team member receives
management, clinical and professional supervision according to individual need and
experience. Where this involves someone other than the line manager, this will be ratified
by that manager.
The CMHT place significant importance on supervision and have developed a supervision
strategy. (Appendix 19)
The supervision process will inform the annual appraisal process, to ensure that staff
professional training and development needs are addressed. This will include
opportunities to access professional group supervision
7.6 Training
All staff within the CMHT are required to complete a yearly appraisal and undertake
statutory and mandatory training that is monitored by the Trust’s Learning, Education,
Appraisal Department (LEAD). Each staff member is responsible in ensuring they remain
compliant with statutory and mandatory training.
Other training needs will be identified at the yearly appraisal, or sooner if required, to
ensure staff have the relevant skills and knowledge to provide the appropriate evidence
based interventions and meet service needs.
8. Outcome measures
PREMS
All individuals following assessment, completion of interventions and or on discharge will
receive a standard patient experience form (appendix). These will be collated and
outcomes disseminated to the team to improve future performance.
PROMS
Patient reported outcome measures should be offered to service users close to initial
assessment, routinely at care plan reviews and wherever possible prior to discharge.
Content from the Hope, Agency and Opportunity PROM (appendix 29) should be used to
populate care plan documents (appendix 30)
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8.1. Research & Audit
Research and audit is undertaken to ensure the effectiveness and safety of our services
and for services to be innovative in introducing new approaches. Research and audits are
registered with the Trust to ensure they are carried out appropriately and within guidance.
Various audit models may be used but the Plan, Do, Study, Act is the most common. No
research should be undertaken without the Trust’s permission and the individual’s
informed consent.
9. Customer Care
We work with people to promote diversity and should an interpreter be required we are
able to provide service users with one. (See appendix 24)
10. Confidentiality
The policy, SHIG46 Information Sharing Policy outlines the principles of confidentiality,
and establishes an interagency code of conduct with regard to the confidential
management of service user information by Hampshire County Council Adult Services,
Southampton City Adult Services and Southern Health NHS Foundation Trust. The policy
applies to all service user information managed in all work undertaken by employees of
the parties working in Southampton and Hampshire.
All paper/electronic records must adhere to the Trust/Local Authority recording policies
and in accordance with professional standards to provide an objective overview of all
contacts and actions relating to the individual service user.
All records, paper or electronic are kept within the guidelines of the Data Protection Act
and are treated a confidential documents. Information is only shared on a ‘need to
know’ basis with the service user’s permission and under the scrutiny of the Caldecott
principles, unless the situation meets necessary risk requirements which would require
those rights to be breached.
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SHIG47 Disclosure of Information to Police Procedure
Compliments will also be passed to the Team Manager and then be recognised formally
within Team Meetings and Trust Bulletins.
Should a Service User or carer wish to comment about the service they have received the
Customer Care Team offers a means of resolving concerns of service users and carers at
an early stage of the process.
14. CQC
The Team Manager will ensure that the CMHT meets and maintains the requirements for
CQC registration.
All records, paper or electronic are kept within the guidelines of the data protection act
and are treated as confidential documents. Information is only shared on a ‘need to know’
basis with the service user’s permission and under the scrutiny of the Caldecott principles,
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unless the situation meets necessary risk requirements which would require those rights
to be breached.
Each team will have a range of standard letters to ensure effective, consistent
communication with referrers, service users, carers and other services. Consent to share
forms will be completed with all Service Users and RIO will be updated accordingly.
RIO is the primary method for recording clinical information, secondary paper files for
each individual are also held and must be referred to by the CMHT when accepting
referral for individuals who are not known to the service or who have not been with the
service for over 24 months.
List of items to be filed in secondary care records can be found in the RIO handbook.
Standard letters for use in clinical practice can be found in the editable letters section of
RIO these can be adapted for local use and new templates requested from the RIO team.
All records must adhere to the Trust/Local Authority recording policies and in accordance
with professional standards to provide an objective overview of all contacts and actions
relating to the individual.
All Care Plans, Crisis Plans and Risk Assessments are to be recorded on RIO in line with
Trust policy. All records, paper or electronic are kept within the guidelines of the Data
Protection Act and are treated as confidential documents. Information is only shared on a
‘need to know’ basis with the individual’s permission and under the scrutiny of the
Caldecott principles, unless the situation meets necessary risk requirements which would
require those rights to be breached.
16.2 Policy for the Positive Prevention and Management of Violence and Aggressive
incidents
Incidents of violence and aggression are a recognised risk when working in a healthcare
environment; however, such incidents are unacceptable whatever form they take and
whatever reasons are given for the persons actions.
The Trust accepts that the prevention of violence and aggression towards staff requires a
high level of management commitment, professional competence and adequate
resources. Furthermore, it recognises that actual or threatened violence and aggression
towards staff can be very frightening and / or traumatic. The Trust recognises that the
nature of being a Mental Health, Learning Disabilities and Social Care Trust, will mean
caring for Service Users who at times exhibit challenging behaviours and/or display
behaviours which can be aggressive and/or violent. As such, The Trust will provide
appropriate training to meet the diverse needs of our workforce in line with all national
guidelines. SHNCP74 Management of Violence and Aggression Procedure
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17. Business Continuity
A folder is to be held within each team base describing their business continuity plan for
that team/unit and an area process will be in place to raise issues.
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Appendices
1. italk SOP
Italk_SOP_Insert_(FI
NAL_DRAFT)_25_01_1111.docx
2. Talking Therapies
Talking Therapies a
four year plan dh_123985.pdf
3. SHCP199 - AMHT SOP See the Intranet, search using the reference
number SH CP 199
CG23NICEguidelinea
mended depression.pdf
CG022NICEguideline
amended anxiety.pdf
9. GP No Opt in Letter
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12. Demographics
Demographics.doc
Discharge procedure
CMHT.docx
IAPT History.mht
Serious and
Persistent Mental Illness.docx
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