Action 8.12

Ensure that there is a clear process for escalating care when deterioration in a person’s mental state is recognised, which includes:

• Designation of roles and responsibilities for members of the healthcare workforce
• Time frames for response.

Tailor the escalation protocol to the specific health setting, taking into account:

• The size, location and role of the setting
• The available resources, including the clinical workforce skill mix
• The capacity to engage specialist help.

Large tertiary hospitals typically have consultation liaison psychiatry services available internally. Ensure that all members of the workforce are aware of how to contact the service when they recognise deterioration in a patient’s mental state. Many consultation liaison services provide templates for referral that support effective communication and enable reviews to be prioritised across the hospital. Support consultation liaison processes with education for the workforce. Consultations can provide opportunities for further education and upskilling of the workforce.

For organisations that do not have consultation liaison services on site, develop and maintain local partnerships to enable rapid referral. This may involve linking with the local community mental health service, a general practitioner or on-call psychiatrists.

Provide access to essential psychiatric medications at all times.

Provide members of the clinical workforce with access to legal advice relating to delivery of treatment under mental health and other relevant legislation.

Support referral processes with systems to encourage appropriate documentation about the person’s mental state at transitions of care, and to reduce the burden of documentation and data collection when possible.

Because of the short duration of stay in day procedure services and the use of pre-admission screening to determine that it is currently safe for a person to undergo a procedure, there is very low prevalence of acute deterioration in a person’s mental state in day procedure services.

Day procedure services do not typically have workforce members with mental health expertise on site. It is therefore recommended that services develop partnerships with local services that can provided emergency mental health assistance in the rare instances that it is needed. Maintain these partnerships, and ensure that all members of the workforce can escalate care appropriately.

Examples of evidence

Select only examples currently in use:

• Policy documents about rapid referral to mental health services
• Audit results of episodes when patients’ mental states have acutely deteriorated, to determine whether rapid referrals were made to mental health services
• Document that identifies areas of the health service organisation where the risk of acute deterioration in mental state is highest.

MPSs and small hospitals should:

• Develop a protocol for escalating care when a person’s mental state is deteriorating, which includes designation of roles and responsibilities for members of the healthcare workforce and time frames for response
• Develop partnerships with other relevant organisations if responding to acute deterioration in a person’s mental state is outside the scope of the health service organisation
• Ensure that members of the workforce are aware of, and use, the escalation protocol.

Tailor the escalation protocol to the specific health setting, taking into account:

• The size, location and role of the setting
• The available resources, including the clinical workforce skill mix
• The capacity to engage specialist help.

Develop and maintain partnerships with other organisations if the MPS or small hospital is required to provide a safe and effective response to deterioration in a person’s mental state. This may involve linking with the local community mental health service, a general practitioner or on-call psychiatrists. Technological resources such as teleconferencing or videoconferencing facilities can also enable prompt mental health review when a person’s mental state deteriorates.

Provide access to essential psychiatric medicines at all times.

Provide members of the clinical workforce with access to legal advice relating to delivery of treatment under mental health and other relevant legislation.

Support referral processes with systems to encourage appropriate documentation about the person’s mental state at transitions of care, and to reduce the burden of documentation and data collection when possible.