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Current chapter – Recording and improving community based crisis care activity


Using the new Drop in Contact table for recording open access crisis line and SPA triage activity

Every area has now developed 24/7, open access, urgent NHS mental health lines for people of all ages. In some areas the team type providing this service is referred to locally as a single point of access (SPA) or in others it may be called a 24/7 crisis line (or these terms are sometimes used interchangeably).

Ideally, all services should record all activity coming into these services as referrals in the MHSDS. However, it is recognised that in many places with current data systems, it is not proportional or possible to open referrals for simple, quick calls with patients. The table ‘MHS302 Mental Health Drop in Contact’ was added in MHSDS v5.0 to provide an alternative option to record and recognise this activity in a way that can still provide key insights to local and national teams.

As this table is a new concept in the MHSDS, only the service types specified in the service type data item (see Table 1) are currently in scope to flow the data. This will allow for evaluation and adjustment if needed, before it is used for further service types.

it has particular relevance to service models such as 24/7 urgent mental health lines as:

  • it enables activity submissions without needing to be linked to a referral and identified patient, for example when a service user remains anonymous
  • It provides an alternative where the configurations and workflows of a data system and/or service present challenges to recording a referral for every new call that a crisis line or SPA might receive

The Drop in Contact table aims to enable better collection of overall activity from these services in the national dataset with minimised burden, while retaining the ability to understand the wider patient pathway wherever possible. Data submitted through the Drop in Contact table should not duplicate any contacts submitted via the Care Contact table

It is essential at a national level to understand the total demand/activity being undertaken by crisis lines/SPAs. As one of the few open access mental health service types, they provide an invaluable indicator of population demand trends.

This drop in table and guidance on recording and submitting data can also be applied to activity from new models of ‘crisis alternative’ services such as crisis cafés/sanctuary/havens. Similarly for these services, it is important to record the volumes of activity going through the services and some key detail on the people using them, but they may not be set up to record referrals in the MHSDS easily.

Table 1: Extract from the Technical Output Specification; table MHSS032 mental health drop in contact.

Please always contact the published Technical Output Specification for any changes.  


Data item name (data dictionary element) IDB element name Data item description National code National code definition 
MENTAL HEALTH DROP IN CONTACT IDENTIFIER MHDropInContactId The Mental Health DROP IN CONTACT IDENTIFIER is used to uniquely identify the Mental Health DROP IN CONTACT within the Health Care Provider. It would normally be automatically generated by the local system upon recording a new Drop in Contact, although could be manually assigned.      
CARE CONTACT DATE (MENTAL HEALTH DROP CareContactDateMHDropInContact The date that a Drop in Contact took place, or was scheduled to take place    
MENTAL HEALTH DROP IN CONTACT SERVICE TYPE MHDropInContactServiceType The type of SERVICE where the Mental Health Drop in Contact took place. A17 Memory Services/Clinic/Drop In Service
A19 24/7 Crisis Response Line
A21 Crisis Café/Safe Haven/Sanctuary Service
START TIME (MENTAL HEALTH DROP IN CONTACT) StartTimeDropInContact The Start Time of the Mental Health Drop in Contact as reported by the Care Professional    
END TIME (MENTAL HEALTH DROP IN CONTACT) EndTimeDropInContact The End Time of the Mental Health Drop in Contact as reported by the Care Professional.    
LOCAL PATIENT IDENTIFIER (EXTENDED) LocalPatientId This is a number used to identify a PATIENT uniquely within a Health Care Provider. It may be different from the PATIENT's case note number and may be assigned automatically by the computer system    
NHS NUMBER NHSNumber A number used to identify a PATIENT uniquely within the NHS in England and Wales    
PERSON BIRTH DATE PersonBirthDate The date on which a PERSON was born or is officially deemed to have been born    
GENDER IDENTITY CODE GENDER IDENTITY CODE The gender identity of a PERSON as stated by the PERSON 1 Male (including trans man)
2 Female (including trans woman)
3 Non-binary
4 Other (not listed)
X Not Known (not recorded)
Z Not Stated (patient asked but declined to provide a response)
GENDER IDENTITY SAME AT BIRTH INDICATOR GenderSameAtBirth An indication of whether the patient's gender identity is the same as their gender assigned at birth. Y Yes - the person's gender identity is the same as their gender assigned at birth
N No - the person's gender identity is not the same as their gender assigned at birth
X Not Known (not recorded)
Z Not Stated (person asked but declined to provide a response)
ETHNIC CATEGORY EthnicCategory The ethnicity of a PERSON, as specified by the PERSON. A White- British
B White-Irish
C White any other white background
D Mixed - White and Black Caribbean
E Mixed - White and Black African
F Mixed - White and Asian 
G Mixed - Any other mixed background
H Asian or Asian British - Indian
J Asian or Asian British - Pakistan
K Asian or Asian British - Bangladeshi
L Asian or Asian British - Any other Asian background
M Black or Black British - Caribbean
N Black or Black British - African
P Black or Black British - Any other Black background
R Other Ethnic Groups - Chinese
S Other Ethnic Groups - Any other ethnic group
Z Not stated
99  Not known 
ETHNIC CATEGORY 2021 EthnicCategory2021 Placeholder data item to accommodate the 2021 census when it goes live    
CONSULTATION MECHANISM (MENTAL HEALTH) ConsMechanismMH The communication mechanism used to relay information between the CARE PROFESSIONAL and the PERSON who is the subject of the consultation, during a CARE CONTACT. A non-face to face consultation should directly support diagnosis and care planning and must replace a face to face OutpPatient Attendance Consultant, Clinic Attendance Nurse or Clinic Attendance Midwife, or other types of CARE CONTACT. A record of the consultation must be retained in the PATIENT's records. Contact with PATIENTS solely for the purpose of informing them of the outcome of Diagnostic Test results, with no other clinical interaction, are not classified as CARE CONTACTS 01 Face to face
02 Telephone
04 Talk type for a person unable to speak
05 Email
09

Text Message

(Asynchronous)

10 Instant messaging (Synchronous)
11 Video consultation 
12 Message Board (Asynchronous)
13 Chat Room (Synchronous)
98 Other (not listed)
CARE PROFESSIONAL LOCAL IDENTIFIER CareProfLocalId A unique local CARE PROFESSIONAL IDENTIFIER within a Health Care Provider which may be assigned automatically by the computer system    
MENTAL HEALTH DROP IN CONTACT OUTCOME MHDropInContactOutcome The outcome of the Mental Health Drop in Contact as reported by the Care Professional. 01 Caller Disconnected
02 Advice on call only
03 Signposted to other non-NHS services / sources of support
04 Non-urgent referral to other NHS service
05 other NHS service 05 Urgent referral for face to face assessment
06 Emergency Service(s) notified
98 Other (not listed)
ORGANISATION IDENTIFIER (RECEIVING) OrgIDReceiving ORGANISATION IDENTIFIER (RECEIVING) is the ORGANISATION IDENTIFIER of the ORGANISATION that is receiving the contact with the PATIENT. This field should be used to identify the organisation in cases where the service is subcontracted and the activity from that service is being submitted by the contracting organisation    

Submission requirements for the Mental Health Drop in Contact table

Contacts recorded via this table do not need to be linked to a referral. But providers can only submit this table if it is included in a submission that also includes the mandatory referral data tables within the submission. The referral data does not need to be linked to the data in the Drop in Contact table but is needed to pass the validations built into the MHSDS submission portal.

In some cases a trust or CCG will be contracting/subcontracting relevant services, such as a crisis line service or crisis café, to an organisation that does not currently submit referrals to the MHSDS. Where this is the case, agreements will need to be in place for the Drop in Contact data to be submitted to the MHSDS by an organisation that is submitting full referral information (e.g. the relevant NHS trust). The subcontracting organisation will need to submit the data as part of their MHSDS submission under their own organisation code. The subcontracted organisation delivering the service should be identified within the Drop in Contact table using their Organisation Data Service code be identified within the Drop in Contact table using their Organisation Data Service code submitted in the field “ORGANISATION IDENTIFIER (RECEIVING)”.

Mandatory data items

The Mental Health Drop in Contact table should include details of all Mental Health Drop in Contacts occurring within the reporting period. This table is not linked to the rest of the dataset at patient level but includes data items that will allow some linkage during analysis.

To enable the flexibility needed to record the range of contact types received by open access crisis line and SPA triage services, there are only two mandatory data items within the “Drop in Contact” table:

  • MENTAL HEALTH DROP IN CONTACT IDENTIFIER: a unique ID for each distinct contact with the service
  • CARE CONTACT DATE (MENTAL HEALTH DROP IN CONTACT): the date on which the contact took place

Wherever possible, services should aim to collect further demographic and administrative information set out in the sections below, which may be best facilitated by registering patients accessing these services on provider record systems. This will enable key identifiers to be obtained, including an NHS number.

Alongside this guidance we will be engaging with services to identify and share case studies of how this activity is being recorded. This will include looking at how record systems can be adapted to record these contacts without the need to open a referral as we know that can be more challenging in certain systems.

When is it relevant to record Drop in Contacts versus referrals?

The primary route to recording contacts across mental health services remains via the full recording of a referral. The Drop in Contact table has been established to enable the recording of activity only from specific functions, such as all age 24/7 crisis lines. The table aims to support data recording where service users are sometimes partially or entirely anonymous and it is more challenging and/or less proportionate to capture referrals for brief contacts.

Drop in contacts submitted to the MHSDS should not double count activity associated with a referral. Where a contact with a service such as a crisis line is recorded in the Care Contact table as part of a referral, there is no additional requirement to also submit a Drop in Contact.

Where further NHS care is required for a patient following a contact with a service such as a crisis line, the services involved would still always be expected to record a referral for that person as per the standard processes. This includes situations where the follow-up NHS care required will be provided by the same person or team that received the initial contact via a function such as a crisis line.

Where no further NHS care is required following a contact with a patient via these service types, and where a referral can be opened and recorded, then the referral should be discharged once the contact with that person is completed.


Recording information about the drop in contact

For each contact (for example each call), providers should record the following administrative information, ideally completed automatically by contact and record systems:

Time and date of the contact (i.e. the call)

The type of service being run

  • memory services/clinic/drop in service
  • 24/7 crisis response line
  • crisis cafe/safe haven/sanctuary service

The consultation mechanism (for example telephone)

And where the systems and pathways enable it. 

  • duration (via start and end time data items)
  • care professional identified (i.e. the professional the contact was with) 

Where the service delivering a single 24/7, open access, urgent NHS mental health line for people of all ages is referred to locally as a Single Point of Access Service, the 24/7 crisis line service type should be selected.


No service types beyond the three listed above should use the Drop in Contact table because it is a new concept in the MHSDS that will need to be evaluated.

Recording outcomes of the drop in contact

Wherever possible, providers should record a unique local patient identifier (M302110) and an NHS number as part of records captured from these services so that activity submitted via the Drop in Contact table can be linked to other activity occurring across the system.

The NHS Spine should be used to identify NHS numbers where they aren’t already held within the electronic patient record held by the organisation. See guidance on accessing and using the NHS Spine for more information.

If an NHS number and local patient identifier can be provided, no other demographic data items in the Drop in Contact table are necessary, although this information can still be submitted for those contacts. Wherever possible, linkage in the national datasets will be used to pull in demographic information rather than services collecting and submitting it as part of each Drop in Contact.

For instances where NHS numbers can’t be assigned, the demographic data items in the Drop in Contact table should be completed whenever the situation allows it and the service user is content to share it.

Proxy contacts

Contacts with a patient proxy who is a representative of the patient, such as a parent or carer, should be recorded in the same way as a direct contact with a service user. Any unique identifiers or demographic information submitted should relate to the patient.

Anonymous contacts

Contacts with service users that remain anonymous should still be recorded. No local patient identifier or NHS number would be required but any demographic information that can be collected should be submitted.

Contacts with health professionals and other professionals

 When a professional contacts a relevant service and is not acting as a proxy for a patient, then the activity should not be recorded and submitted to the national dataset as a Drop in Contact. Only direct activity with a patient or proxy is in scope for the Drop in Contact table.


Recording outcomes of the Drop in Contact

High level outcomes of the contacts should be captured using the options in data item M302150, Mental Health Drop in Contact Outcome. Where the Drop in Contact table is being used for a face-to-face service, such as a crisis café, providers may find it helpful to use the code list with adjusted descriptions of the codes (Table 2) within local teams so that they align with the medium of communication.

Table 2: definitions of the mental health drop in contact outcomes

Drop in contact outcomes code and description Definition 
01 - Caller disconnected

Contact ended by the patient, deliberately or unintentionally, before what the responsible professional deemed to be the end of the conversation.

 

This can be applied to contact made via any consultation mechanism not just those made by phone.
02 - Advice on call only

Advice was given during the contact and was the primary support provided to the service user.

 

Further NHS or non-NHS support may be discussed but direct referral or signposting to services is not the key outcome required to support the service user.

 

This can be applied to contacts made via any consultation mechanism not just those made by phone.
03 - Signposted to other non-NHS services / sources of support

Further non-NHS support, such as to social care or benefit support, is the key outcome required to support the service user.

 

This could also include signposting to non-NHS commissioned voluntary care sector support.
04 - Non-urgent referral to other NHS service

Further non-NHS support, such as to social care or benefit support, is the key outcome required to support the service user.

 

This could also include signposting to non-NHS commissioned voluntary care sector support.
05 - Urgent referral for face to face assessment An urgent referral to any NHS service is required, for example to a Crisis Resolution and Home Treatment Team.

 

This aligns with the urgent or very urgent crisis referral response priorities assigned to the referral.

This could include a referral into the same team that provides the crisis line function.

06 - Emergency Service(s) notified One or more emergency services were notified to provide an emergency response to support the service user.

If the service user requires further NHS support then a referral and all associated information should be opened and submitted to the MHSDS by the relevant provider.

Last edited: 31 January 2022 9:01 am