ACCESSING SECONDARY MENTAL
HEALTH SERVICES IN CALDERDALE
GUIDANCE FOR REFERRERS.
1
SINGLE POINT OF ACCESS (SPA) DIAGRAM
2
AIM AND PURPOSE OF SPA
3
GUIDELINES FOR REFERRERS
4
REFERRAL FORM
5
RANGE OF SPECIALIST MENTAL HEALTH SERVICES
PROVIDED BY SWYPFT
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1
SINGLE POINT OF ACCESS DIAGRAM
Referral
SPA
Admin
14 day
response
Urgent
WAA/OPS
Non-urgent
OPS
Non-urgent
WAA
14 day
response
Daily
Urgent MDT
Assessment
Daily meeting MDT
Response 4 hours
CMHT 2
CMHT 1
Memory 2
Memory 1
Point of First Assessment
Care
Home
Liaison
Team
Acute
Hospital
Liaison
Not approp.
Signpost
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O/P Appt
Psych.
Appt.
Community
2
AIM AND PURPOSE OF SPA
South West Yorkshire Partnership NHS Foundation
Trust/Calderdale MBC
Calderdale Single Point of Access (SPA)
Protocol and guidelines
The Single Point of Access (SPA) builds upon the existing concept in Older
Peoples Services in Calderdale and aims to provide a streamlined service to
individuals referred to secondary Mental Health Services.
All referrals to secondary Mental Health services will be received and
managed by the Single Point of Access.
This approach has been developed following wide-ranging discussion with a
cross-section of staff who will be involved in ensuring the success of the SPA.
The concept has been accepted by Commissioners, Trust Board, Service
User Groups, and Carers Groups.
Purpose and benefits of SPA
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Equitability of access for individuals referred.
Clarity for referrers.
Improved response times for assessment and treatment.
Consistency of response.
Reduction of multiple assessments.
Promoting understanding of resources.
Standardised information for service users.
Increased service quality and efficiency.
Benefits identified accord with those identified regionally and nationally. The
SPA will accept ownership of incoming referrals and will not pass enquiries or
potential referrers to other departments within the Mental Health Service.
Principles of SPA
1. The Single Point of Access will manage all referrals for access to
secondary mental health care in Calderdale.
2. The service will operate 24 hours a day (every day of the year).
3. There will be a single phone number for referrers.
4. The referrer will have an opportunity to discuss a referral with a
member of the multi-disciplinary SPA team.
5. Referrals will be managed within the Mental Health Service and a
response will not be made to the referrer until a decision is made on
acceptance for assessment.
6. Links will be maintained with all partners(Commissioning, Local
Authority, Service User and Carers Dialogue Groups)
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7. Urgent referrals will be screened at the point of entry, and if accepted
will be responded to in four hours.
8. Non-urgent referrals will be screened on a daily basis by a Designated
Multi-Disciplinary Team which will rotate on a weekly basis. This team
will make a decision on allocation for assessment.
9. Internal referrals will be managed within the Mental Health Service and
will not be returned to the referrer for actioning.
10. External referrals received at other former referral points eg CMHT, will
be sent directly to the SPA and not returned to the referrer to re-direct.
Composition of the SPA team
All referrals, whether by phone, Safe Haven Fax or letter, will be received by
the SPA administrator with access to a SPA clinician as required.
The admin worker will be responsible for entering initial demographic
information on RIO.
Designated Multi-Disciplinary Team
The Designated Multi-Disciplinary Team will be responsible for screening all
non-urgent referrals on a daily basis. The team will consist of Consultant
Psychiatrist, Clinical Psychologist, Team Leader (or staff deputising for team
members) and SPA admin.
Team leaders/medics will be allocated on a weekly basis from the community
teams.
Service principles
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All urgent referrals accepted should be seen within four hours.
All non-urgent referrals accepted should be seen within 14 days.
A letter will be sent to the referrer informing them of the outcome of the
daily MDT within 4 working days.
Referrals will be reviewed on a monthly basis by the mental health
management team.
The SPA will be reviewed 3 months after commencement
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3
GUIDELINES FOR REFERRERS
South West Yorkshire Partnership Foundation
Trust/Calderdale MBC
Referring individuals to secondary Mental Health Services in Calderdale
To progress the development of secondary mental health services in Calderdale, a
Single Point of Access (SPA) for all new referrals to Working Age Adults and Older
People Services commenced on 2nd April 2012.
The SPA will provide equitability of access for individuals through a clear pathway
for referral agencies. This system will reduce the number of referral routes and
provide a consistent response to referrers – effectively a “one-stop shop”.
Single Point of Access
The SPA will operate 24 hours a day every day of the year.
All referrals both urgent and non-urgent will be received at the SPA and will be
triaged to the appropriate service.
Urgent referrals
Urgent referrals will include Mental Health Act Assessments and police enquiries.
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Urgent referrals will be received by telephone or Safe Haven Fax.
When accepted for assessment, urgent referrals will be seen within four
hours.
If not accepted for assessment, a discussion will take place with the referrer
and advice will be given as to the best way of helping the service user.
Non-urgent referrals
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It is requested that non-urgent referrals are made in writing or sent to Safe
Haven Fax using the referral form.
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The referrals will be discussed daily (Monday to Friday) by a senior
clinical team comprising Consultant, Psychologist, Team Leader and
SPA clinicians.
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If accepted by the service, referrals will be allocated for initial
assessment:
o Initial assessment clinic - 14 days
o Initial assessment Insight - 14 days
o Initial assessment AOT – 14 days
o Psychology - 14 days
o Outpatient clinics – 14 days
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If one of these options is not possible due to the individual’s disability,
arrangements can be made for the person to be seen at home or other
venue by arrangement.
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Please contact the SPA if you would like a discussion about the individual
referred to us. Those referrals not accepted will be signposted to another
service or returned to you with appropriate advice. A referral form is
attached for your use.
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A letter will be sent to referrers advising of the outcome of the referral within
4 working days. A member of the SPA team may also contact you by phone
to discuss the outcome.
Single Point of Access (SPA)
Phone
01422 222888
Safe Haven Fax
Address
01422 222881
Willowdale
The Dales
Salterhebble
Halifax
HX3 0PW.
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4 REFERRAL FORM
SINGLE POINT OF ACCESS TO
SECONDARY MENTAL HEALTH SERVICES IN CALDERDALE
REFERRAL FORM
Date of referral…………………………………………………………………………………………..
Referred by……………………………………………………………………………………………….
Urgent (to be seen within 4 hours) Yes*/No*
Routine (Assess within 14 days) Yes*/No*
SERVICE USER DETAILS
First Name: ………………………………
Last Name: …………………………
Address: …………………………………………………………………………………….
…………………………………………………………………………………………………
Postcode: ………………….....................
Male / Female
Date of Birth: …………………………….
Marital Status: …………………………
Tele No: …………………………………..
Mobile: ………………………………….
(this number may be sued to send text
reminder of appointment
Lives with: ……………………………….
(Please indicate which number they are happy to be contacted on)
Is the patient able to telephone to make an appointment? Yes/No
NHS No: ………………………………
Rio Number: ……………………(if known)
Carer name: …………………………
Carer Contact Number……………….....
Does the patient have hearing/visual impairment?
Interpreter/Signer required? Yes/No
Yes/No
Preferred First Language……………………..
Is the client aware of this referral? Yes/No
Ethnicity: ………………………….........
Do you believe this to be a memory problem, if so please provide the results below?
MMSE/AMT: Yes/No (please delete) Date…….
MSU: Yes/No (please delete) Date…………
Bloods: Yes/No (please delete) Date………….
ECG: Yes/No (Please delete) Date…………
GP DETAILS
Name: ………………………………….
Surgery Address: …………………………………..
…………………………………………………………………………………………………………
………………………..Postcode: ………………… Tel No: …………………………………….
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1. SERVICE REQUESTED
Psychological Interventions---------------------------------------WAA CMHT (Working Age Adults) -----------------------------OPS CMHT (Older people Services) ---------------------------Memory -----------------------------------------------------------------Liaison ------------------------------------------------------------------Insight -------------------------------------------------------------------REASON FOR REFERRAL (nature of the problem e.g. mood, behaviour, hallucinations,
delusions etc including views of significant others)
2. CURRENT MENTAL HEALTH PRESENTATION (please give details of the onset and
development, duration and severity of the problem including details on sleep, appetite,
concentration, hallucinations, delusions, mood, behaviour etc)
MMSE PHQ 9 and GAD 7 Scores……………Please include a copy of the questionnaires)
3. PREVIOUS MENTAL HEALTH HISTORY WITH DATES, INTERVENTIONS AND
OUTCOMES
(please include details of both psychiatric and psychological interventions including referral to
IAPT/Oakdale service, CBT).
4. RELEVANT MEDICAL HISTORY – Physical Health Issues
5. CURRENT MEDICATION – including details of when prescribed, previously tried
medications including dose and when prescribed.
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6. CURRENT CIRCUMSTANCES: (please include details of: social employment, housing,
significant others, family issues, age of children, type of benefits. Had shared care guidelines
been considered prior to referral to secondary services)?
7. FORENSIC HISTORY (including current policing involvement)
8. RISK ASSESSMENT: please provide as much information as possible
Is the Client
Historical
Current
Evidence of violence
and aggression in
what context and
who is at risk?
Yes* / No*/
Not known*
Yes / No
Inappropriate sexual
behaviour, in what
context and who is at
risk?
Yes* / No*/
Not known*
Yes / No
Substance Misuse?
Yes* / No* /
Not known*
Yes / No
Safeguarding
Children/Adults
issues?
Yes* / No* /
Not known
Yes / No
Expressing suicidal
ideation? Nature,
frequency, when last
experienced,
likelihood of acting
on thoughts,
plans/action,
preventative
measures?
Yes* / No* /
Not known
Yes / No
Drug Alcohol?
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Details
Frequency and amount?
Evidence of SelfHarm:
Nature and
Frequency?
Yes* / No* /
Not known
Yes / No
Evidence of
psychosis?
Yes* / No* /
Not known
Yes / No
Evidence of self
neglect including
wandering.
Yes* / No* /
Not known
Yes / No
Symptoms?
Name: …………………………………… Profession: ……………………………………
Signature: ………………………………
Date: …………………………………………..
Please include any additional information on a separate sheet.
Please return this referral form either via post to: Calderdale SPA Office, Willowdale, The
Dales, Calderdale Royal Hospital, Salterhebble, Halifax HX3 0PW
Or phone
Or Fax to
01422 222888
01422 222881
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5. RANGE OF SPECIALIST MENTAL HEALTH SERVICES
PROVIDED BY SWYPFT
Services for adults of working age with moderate to severe mental
health problems
From 2nd April 2012, Calderdale’s community services (Working Age Adults)
will be remodelled into two community teams.
The roles and functions of the community mental health teams will merge with
psychology and inclusion support (day services) to form one team. One of the
specialist teams (Assertive Outreach Team or Insight, Early Intervention in
Psychosis) will be based within each of the teams.
Community Mental Health Teams
Provide a community-based service for working-age adults who are
experiencing moderate to severe mental health problems, including:
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Bipolar disorder
Severe anxiety, depression or obsessive compulsive disorder where
there may be risk and where there is an inability to use a cognitive
behavioural psychological approach
Schizophrenia which is symptomatic or in need of continued services in
order to prevent relapse, and to maintain and improve functioning
Emotional instability which is debilitating and where the individual is not
able to engage in individual or group work offered by the psychological
therapies department
Dual Diagnosis provides a service for people who have complex
mental health needs and who have co existing problematic substance
misuse.
Early Intervention in Psychosis
Provides a person centred service for people aged 14-35 who are
experiencing a psychotic illness for the first time, or who are experiencing
prodromal symptoms of a psychotic disorder and therefore deemed having an
at risk mental state. To support their treatment and recovery and maintain well
being outside of the mainstream mental health system.
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Assertive Outreach Team
The Assertive Outreach Team is a specialist multi-disciplinary team, offering a
comprehensive package of care which covers the holistic needs of a small but
significant group of the most severely mentally ill population, who have a
documented history of non-engagement with services, invariably noncompliance with medication, and have a significant history of risk behaviour in
terms of risk to themselves or the public; this will also include exploitation by
others and vulnerability to self neglect. The service aims to establish robust
links with people in the community, offering intensive treatment and working
towards a strengths model of care. We see people in their own homes or
elsewhere in the community. When hospital admission is required we hope to
facilitate this ourselves and offer regular in-reach to clients in hospital, whilst
working collaboratively with the ward staff. The team works with a number of
different agencies from the statutory sector and voluntary sector. We operate
Monday-Friday 9-5, and offer a service to people between the ages of 18-65,
taking into consideration the graduate policy.
Calderdale Inclusion Support Service
Calderdale Inclusion Support Services (CISS) provides individual and group
work to promote social inclusion and vocational activity for adults 18-65.
The service is provided utilizing mainstream activities and facilities in the
Calderdale area
Referrals are taken from CMHT for people on Standard CPA and CPA. The
service uses the Recovery Star to assess and care plan with the service user.
CISS team is made up of Occupational Therapists, Day Service Workers and
Support Workers. The team deliver therapeutic interventions, for example,
anxiety management, confidence building, activities that promote social
inclusion and reduce social isolation. The Vocational team focus supporting
people to retain employment and developing the skills for work.
Secondary Care Specialist Adult Psychological Therapies Service
The Services described are for adults who are in a position to engage in an
active Psychological Therapy (age 18 upwards).
APTS treat people who are experiencing SEVERE AND PERSISTENT NonPsychotic Mental Health Problems including:
Depression
Anxiety disorders
PTSD
Eating Disorder
OCD
Disorders arising from Sexual/Physical /Emotional Abuse in childhood.
Pervasive Interpersonal Problems: Pervasive conflicts and difficulties in
establishing and maintaining relationships (not marital/partnership breakdown
suitable for RELATE).
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Somatoform Disorders: Somatisation and body dysmorphic disorder.
Complex Adjustment Disorders: complex and enduring grief reactions
(persistent and not resolving with the passage of time).
Personality Disorders: characteriological issues requiring specialist
assessment and treatment.
Severe and Complex Disorders involving co-morbidity where specialist
assessment and consultation is required to provide a second opinion and/or
where formulation will help to indicate appropriate intervention and/or
management.
SEVERE and COMPLEX is characterised by:
Persistent episode.
Recurrent episodes.
Causing significant disruption in everyday functioning.
Increased likelihood of significant risk, e.g. suicidal ideation but no active
plans.
Using self harm as a coping mechanism.
Complex picture with co-morbidity.
Not responsive to previous lower tiered interventions (such as psychoeducational groups, and up to 20 sessions of cognitive-behavioural therapy).
Complicating underpinning personality based issues.
The Psychological Therapies Lead (WAA) for the Calderdale Locality is
Christine Marklow, The Dales Unit, The Calderdale Royal Hospital,
Salterhebble, Halifax HX3 OPW. Telephone No. 01422 222733.
ACUTE PATHWAY
Assessment and Home Based Treatment (AHBT)
The service provides assessment and short-term treatment to those services
users aged 18 – 65 experiencing the onset or relapse of severe mental illness
/ disorder / distress where a breakdown in normal coping mechanisms or a
change in circumstances necessitates a rapid, flexible and intensive
approach. The service offers a rapid assessment within 4 hours and intensive
home based treatment as an alternative to hospital admission. The Service is
available 365 days a year between the hours of 08:00h and 23:00h; outside of
these hours an in-reach assessment service is available to attend the A&E
department at CRH.
A referral for AHBT will usually be characterised by one or more of the
following:
 Imminent risk of harm to self or others by a service user experiencing
mental health problems.
 A mental health crisis likely to necessitate psychiatric inpatient
admission.
 Acute onset of a suspected psychiatric illness.
 Risk of service users self neglect or exploitation of a service user with
mental health problems.
 A person in A & E or a general medical ward thought to have a serious
mental health illness.
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Interventions offered are intended to:
 Provide a timely and effective response to metal health crisis and
provide intensive home based treatment where this will meet the needs
of those in crisis.
 Contribute toward a Gate-keeping role to inpatient services,
signposting service users to appropriate services and
facilitating/coordinating admission to hospital where necessary
 Reduce frequency and duration of hospital admissions.
 Facilitate the timely discharge from hospital of those service users
requiring admission
 Promote recovery and prevent relapse.
In-Patient Services
Provide assessment and treatment for people whose mental health needs
cannot safely be met in the community.
Elmdale (Adults) – Dales Unit, Calderdale Royal Hospital, Halifax
Beechdale ( Older People Service) – Dales Unit, Calderdale Royal
Hospital, Halifax
REHABILITATION PATHWAY
Lyndhurst
Lyndhurst is a mixed sex in patient unit for people with serious mental health
problems who require assessment, treatment and rehabilitation back into the
community. The service is based in the community providing 14 in-patient
beds. Patients admitted to Lyndhurst have usually already been in hospital,
on an acute ward or in a more secure hospital environment. Patients can be
admitted informally or detained under the restrictions of the Mental Health Act;
they will always be already on CPA at the point of referral. Referrals should be
discussed with the manager and are managed via Residential Panel.
Wells House
Wells House is an 18 placement service with the ability to provide 12
residential beds and 6 places supporting people in their own homes. The
service is delivered within a supported tenancy framework. Support from
health and social care staff enables ongoing recovery and integration into
community living. The service uses the outcome focused Recovery Wheel to
assess and care plan and review individual needs. Referrals are managed
via the Residential Panel. Wells House works closely with Lyndhurst to
provide transition to independent community living.
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SHARE
Providing accommodation for people with mental health problems for either
crisis support, respite or short term rehabilitation. Supporting the delivery of
effective care plan as part of the CPA.
The aim of the rehabilitation service is to provide short term accommodation
for people leaving hospital that offers intensive support and structure to help
deal with issues and problems that might otherwise prevent or hinder
successful resettlement in the community.
The aim of the respite service is to support people in maintaining as
independent a lifestyle as possible whilst continuing to live in the community
The aim of the crisis beds is to help service users or their carers to prevent or
manage a crisis as an alternative to hospital admissions where home
treatment is not indicated
Referrals from Bed Management, Elmdale or Residential Panel.
Share facilitates and supports community based treatment options such
as Clozapine initiation and Out patient ECT. This is managed by the
Assessment Home Based Treatment Team
Union Housing
Union Housing provides residential support to people experiencing long term
mental health problems. The service promotes the recovery of mental health
service users whose needs still cannot be wholly met by the range of acute,
community and short-term residential services.
The Scheme aims to offer accommodation and staff support, providing safe
environments in which health and risk issues can be monitored and daily
living skills/recreational & vocational activities/goals of increased
independence can be identified, promoted and achieved in a collaborative
manner.
Referrals are by the Residential Panel.
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Calderdale Older People Services
Community Mental Health Teams
Provide a community-based service for older adults who are experiencing
moderate to severe mental health problems, including:
 Bipolar disorder
 Severe anxiety, depression or obsessive compulsive disorder where
there may be risk and where there is an inability to use a cognitive
behavioural psychological approach
 Schizophrenia which is symptomatic or in need of continued services in
order to prevent relapse, and to maintain and improve functioning
 Emotional instability which is debilitating and where the individual is not
able to engage in individual or group work offered by the psychological
therapies department.
 First episode of psychosis
 Dementia which requires ongoing monitoring and support
Care Home Liaison Team.
The team supports older people with mental health problems who live in
care homes in Calderdale. A typical user of the service would be an older
person experiencing dementia or severe and enduring mental health
issues. They may have difficulties with accepting help from care staff and
behave in ways that care staff can find difficult to understand and manage.
The team will assess individuals (nursing and dietetic staff) and help care
staff develop plans of care. The team facilitates reviews of medication and
liaises with primary care teams. The team will provide mental health
nursing assessments for social workers and the PCT.
The team will also provide ad hoc training and education sessions for care
staff having facilitated over 100 staff in the past 12 months. The team is
supported by medical staff from the older people’s mental health service.
The team also carries out funded nursing care and continuing health care
assessments for the PCT.
Acute Hospital Liaison Team
Works closely with the Calderdale and Huddersfield NHS Foundation Trust to
ensure that the mental health needs of older people admitted to an acute
hospital setting are recognised and met.
The team cover both hospitals and participate in the Virtual ward and provide
a Dementia matron service to all areas
This document compiled by:
Andrew Donato CPA/Risk Manager/Safeguarding Lead
Irene Stephenson Support Services Manager
23rd September 2011
Updated by Janice Wootton Community Manager Mental Health 21/3/12
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