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Recording the clinical response priority type

The Clinical Response Priority Type field is used to determine whether a referral is ‘routine’, ‘urgent’, ‘very urgent’ (added in v5.0 of the MHSDS) or ‘emergency’ (Table 3). This information is a crucial requirement for organising and monitoring response times in community-based crisis services.

Recording of this field was investigated as part of exploratory analysis. Of the 1,454,892 community crisis referrals in the MHSDS which started between 1st April 2020 and 31st March 2021, 76,754 (5.4%) had no Clinical Response Priority Type recorded. This represents a significant improvement on 2017 (around 22% not recorded). Further improvement is needed to support implementation and assurance of national policy, particularly in encouraging consistent interpretation and recording of the definitions of these priorities across all services.

Table 3: Extract from the Technical Output Specification; table MHS101 Referral

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

Table Data item name (Data Dict Element) IDB elementname Data item description National code National code definition 

MHS101

Referral
CLINICAL RESPONSE PRIORITY TYPE ClinRespPriorityType The clinical response priority of a SERVICE REQUEST. 1 Emergency
4 Added in MHSDS v5.0: Very Urgent
2 Urgent/serious
3 Routine

 

What needs to be done

The definition for each Clinical Response Priority Type code (i.e. the definition of the terms emergency, very urgent, urgent/serious and routine) varies depending on the care pathway and providers should reference national guidance for the pathway in question. For example, the term ‘urgent’ is currently used to describe a one week waiting time requirement in the context of eating disorder services.

This guidance seeks to define these terms in the context of community-based urgent and emergency mental health (crisis) services. This includes all teams providing the functions of urgent and emergency support, advice & triage and assessment (including a brief follow-up) for people of all ages.

The definitions in Table 4 have been provided by NHS England. These are aligned with the UK mental health triage scale, which many urgent mental health services already use. They were developed after 11 pilot sites field-tested the potential introduction of standards for urgent mental health care.

In line with national policy, all providers are required to implement the use of the clinical response priorities across all relevant departments.

It should be noted that by definition, all ‘urgent’ and ‘very urgent’ referrals should be followed by a face-to-face response, and this should be reflected in referrals with a face-to-face contact in the MHSDS. It is also likely that many ‘emergency’ referrals will also need to be followed by a face-to-face contact from a mental health service.

Table 4:Clinical response priority definitions for mental health crisis services

Clinical response priority and proposed national standards Definition/description of typical presentations – to be determined by the specialist urgent MH crisis service at triage (Based on the UK mental health triage scale) Likely % of referrals to an open access crisis service

Emergency

– immediate blue light 999/A&E
Immediate response – denotes emergency situations in which there is imminent risk to life or serious harm to themselves or others and will require a “999” response, potentially within minutes. This would require a response from the police or an ambulance but may also require rapid support or a joint response from an MH crisis service. 1-2%
Very urgent – face-to-face response from MH crisis service within 4 hours

For those who: present a risk of harm to themselves or others; present acute suicidal ideation with clear plan and intent; have a rapidly worsening mental state; do not require immediate physical health medical intervention; are

not threatening violence to others.

 

These referrals require a very urgent face-to-face assessment with a specialist mental health crisis practitioner within 4 hours.
2-5%
Urgent – face-to-face response from MH crisis service within 24 hours

Typical presentations in this category include: high risk behaviour due to mental health symptoms; new or increasing psychiatric symptoms that require timely face-to-

face intervention to prevent full relapse;

significantly impaired ability for completing activities of daily living; vulnerability due to mental illness; expressing suicidal ideation but no plan or clear intent.

 

These referrals require an urgent face-to-face assessment with a specialist mental health crisis practitioner within 24 hours.
5-10%
Routine / non-urgent

This term in the context of crisis care is to be used for all responses that do not require an urgent face-to-face intervention from a specialist NHS mental health crisis service.

 

There is a wide range of responses that could fall into this category: telephone advice and support from NHS or

VCS services; less urgent face-to-face appointments with a community mental health team; referral to GP or other primary care services; help with medications

and prescriptions over the phone; booking into a local sanctuary/haven; signposting to local authority services such as benefits advice.
65-85%

 


Recording the service or team type

To understand if people in scope for a mental health care pathway are accessing the recommended services, it is important to be able to identify the services with which they are in contact. At the highest level, it is necessary to understand which teams or services the person in scope has been referred to.

It is understood that teams or services with similar roles can have different names within provider organisations and they should be mapped to the most relevant national codes. The list of service or team types within the MHSDS has been designed to be age-agnostic, to prevent the unnecessary expansion of the code list (Table 5). Instead, where age- specific services are in place, this can be identified through the age of the patients.

Table 5: Extract from the Technical Output Specification; table MHS102 Service or Team Type Referred To.

Community-based mental health crisis services and liaison services are shown in blue text with grey highlight. Please always consult 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 
SERVICE OR TEAM TYPE REFERRED TO (MENTAL HEALTH) ServTeamT ypeRefToM H The type of service or team within a Mental Health Service that a patient was referred to A01 Day Care Service
      A02 Crisis Resolution Team/Home Treatment Service
      A03 Removed in MHSDS v5.0 - Crisis Resolution Team
      A04 Removed in MHSDS v5.0 - Home Treatment Service
      A05 Primary Care Mental Health Service
      A06 Community Mental Health Team - Functional
      A07 Community Mental Health Team - Organic
      A08 Assertive Outreach Team
      A09 Community Rehabilitation Service
      A10 General Psychiatry Service
      A11 Psychiatric Liaison Service
      A12 Psychotherapy Service
      A13 Psychological Therapy Service (non IAPT)
      A14 Early Intervention Team for Psychosis
      A15 Young Onset Dementia Team
      A16 Personality Disorder Service
      A17 Memory Services/Clinic/Drop in service
      A18 Single Point of Access Service
      A19 24/7 Crisis Response Line
      A20 Health Based Place Of Safety Service
      A21 Crisis Café/Safe Haven/Sanctuary Service
      A22 Walk-in Crisis Assessment Unit Service
      A23 Psychiatric Decision Unit Service
      A24 Acute Day Service
      A25 Crisis House Service
      B01 Forensic Mental Health Service
      B02 Forensic Learning Disability Service
      C01 Autism Service
      C02 Specialist Perinatal Mental Health Community Service
      C04 Neurodevelopment Team
      C05 Paediatric Liaison Service
      C06 Looked After Children Service
      C07 Youth Offending Service
      C08 Acquired Brain Injury Service
      C10 Community Eating Disorder Service
      D01 Substance Misuse Team
      D02 Criminal Justice Liaison and Diversion Service
      D03 Prison Psychiatric In reach Service  
      D04 Asylum Service
      D05 Individual Placement and Support Service
      D06 Mental Health In Education Service
      D07 Problem Gambling Service
      D08 Rough Sleeping Service
      E01 Community Team for Learning Disabilities
      E02 Epilepsy/Neurological Service
      E03 Specialist Parenting Service
      E04 Enhanced/Intensive Support Service
      F01 Added in MHSDS v5.0 - Mental Health Support Team
      F02 Added in MHSDS v5.0 - Maternal Mental Health Service
      F03 Added in MHSDS v5.0 - Mental Health Services for Deaf people
      F04 Added in MHSDS v5.0 - Veterans Complex Treatment Service
      F05 Added in MHSDS v5.0 - Enhanced care in care homes teams
      F06 Added in MHSDS v5.0 - Mental Health and Wellbeing Hubs
      Z01 Other Mental Health Service - in scope of National Tariff Payment System
      Z02 Other Mental Health Service - out of scope of National Tariff Payment System

 


Community-based urgent and acute mental health services

NHS-funded teams providing urgent and emergency mental health support, advice & triage and assessment should normally record one of following team types:

  • A02 - Crisis Resolution Team/Home Treatment Service
  • A18 - Single Point of Access Service
  • A19 - 24/7 Crisis Response Line
  • A20 - Health Based Place Of Safety Service
  • A21 - Crisis Café/Safe Haven/Sanctuary Service
  • A22 - Walk-in Crisis Assessment Unit Service
  • A23 - Psychiatric Decision Unit Service
  • A24 - Acute Day Service
  • A25 - Crisis House Service

For crisis lines, in particular for Children and Young People (CYP), the practitioner responding may be part of a community mental health team but function as part of the A19 - 24/7 Crisis Response, in which case the A19 code should be used in any referrals or Drop in Contact activity.

The relevant national code should be used based on the local team’s function, regardless of what the local team name or model is, or which age groups they support. Definitions of these team types, as set out in the MHSDS v5.0 user guidance, are provided in Appendix: Community-based crisis and acute care team type definitions and in future will be incorporated into the NHS Data Dictionary.

Note that the separate team type codes A03 - Crisis Resolution Team and A04 - Home Treatment Service are being retired in MHSDS v5.0. Where relevant, we encourage providers to switch to the combined A02 code at the earliest opportunity in preparation for that change. These codes are being retired as many providers combine these functions in a single team. That means national activity cannot be consistently separated out and so the individual codes are not adding sufficient value in the national dataset.

There are instances in which it is not possible to record a referral during a contact with open access triage services such as 24/7 urgent mental health lines, due to insufficient information being shared by the service user, challenges linked to the pathway into services or the type of contact with the service user. To support data collection of this activity, a Drop in Contact table has been added to the mental health services dataset, with guidance provided in section 5. of this document.


Recording of referrals to liaison psychiatry (or CYP teams providing equivalent functions)

When people attend A&E with mental health needs, they should be referred to mental health liaison services or CYP equivalent services (usually either paediatric liaison or CYP community mental health teams providing in-reach).

NHS England and Improvement have confirmed that the monitoring of activity in liaison mental health services will be undertaken using submissions to the MHSDS, and reports are now included in the national Urgent and Emergency Mental Health Dashboard – FutureNHS Collaboration Platform.

For adults and older adults

Teams that provide on-site specialist liaison mental health in general hospitals and who respond to referrals from either A&E or inpatient wards, should record team type A11 - Psychiatric Liaison Service. The referral source should be recorded for all referrals.

Adult crisis teams providing in-reach to general hospitals should not record themselves as psychiatric liaison. These teams should record team type A02 (as set out above), and ensure that the activity location type is recorded, for example where this is in A&E (refer to activity location section for more detail).

For children and young people

CYP liaison teams

Teams that provide dedicated specialist CYP mental health liaison based on-site in general hospitals, and which respond to either A&E or ward-based referrals, should use team type C05 - Paediatric Liaison Service. The referral source should be recorded for all referrals.

Crisis resolution and home treatment services

In v4.1 of the MHSDS, there are separate team types on crisis resolution (A03) and home treatment (A04), as well as the combined code (A02). In v5.0 of the MHSDS (implemented from the October 2021 reporting period onwards), only the combined code will be included. All teams delivering the following functions should use the combined code (A02) and ensure that activity location is recorded:

  • CYP teams that provide crisis response in community settings and/or in-reach to Emergency Departments (A&E) / general hospitals
  • CYP teams that provide an integrated crisis and liaison function combined with intensive home treatment

Recording of activity location

To understand what services are being delivered, it is important to know an assessment is taking place, in addition to knowing the service or team a person is referred to. Service providers should ensure accurate and full recording of the activity location type for any assessments undertaken as part of these pathways (Table 6). For example, this data will show when community-based crisis teams are providing crisis response to A&E departments.

Table 6 Extract from the Technical Output Specification; table MHS201 Care Contact.

Please always consult 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 
Activity location type code ActLocTypeCode The type of LOCATION for an ACTIVITY: • where PATIENTS are seen • where SERVICES are provided or • from which requests for SERVICES are sent A01 Patient's home
      A02 Carer's home
      A03 Patient's workplace
      A04 Other patient related location
      B01 Primary Care Health Centre
      B02 Polyclinic
      C01 General Medical Practitioner Practice
      C02 Dental Practice
      C03 Ophthalmic Medical Practitioner premises
      D01 Walk In Centre
      D02 Out of Hours Centre
      D03 Emergency Community Dental Service
      E01 Out-Patient Clinic
      E02 Ward
      E03 Day Hospital
      E04 Emergency Care Department or Minor Injuries Department
      E99 Other departments
      F01 Hospice
      G01 Care Home Without Nursing
      G02 Care Home With Nursing
      G03 Children’s Home
      G04 Integrated Care Home Without Nursing and Care Home With Nursing
      H01 Day centre
      Jo1 Resource centre
      K01 Sure Start Children’s Centre
      K02 Child Development Centre
      L01 School
      L02 Further Education College
      L03 University
      L04 Nursery premises
      L05 Other childcare premises
      L06 Training establishments
      L99 Other educational premises
      M01 Prison
      M02 Probation Service Premises
      M03 Police Station / Police Custody Suite
      M04 Young Offender Institution
      M06 Young Offender Institution(15 -17
      M07 Young Offender Institution (18-21)
      M05 Immigration Removal Centre
      N01 Street or other public open space
      N02 Other publicly accessible area or building
      N03 Voluntary or charitable agency premises
      N04 Dispensing Optician premises
      N05 Dispensing Pharmacy premises
      X01 Other locations not elsewhere classified

 


Recording of protected characteristics and other vulnerable groups

As part of recording referrals and registering patients, capturing data on protected characteristics and vulnerable groups is essential to enabling the identification, reporting and understanding of populations experiencing inequalities and supporting improvement in Urgent and emergency mental health care pathways: data quality guidance urgent mental health services. This is a priority to record for as many patients as possible, not only for urgent mental health team types, but for all service types.

Of particular priority is improved data on ethnicity, disability, sexual orientation and accommodation status, as data quality is low and these factors have a clear link to the support people need and assessment of equality across mental health services. For mental health services supporting children and young people, Looked After Child Indicator and Child Protection Plan Indication Code are required fields, which are also high priority for data improvement.

A new data item has been introduced for MHSDS v5.0 to better capture whether an inpatient is in scope of Transforming Care. For patient pathways that include specialist inpatient services for people with a learning disability and/or autism, it is required to complete the field Transforming Care Indicator in the table MHS501HospProvSpell. For more information, see ‘Appendix 11 Assuring Transformation’ in the MHSDS user guidance.  

Providers will also need to implement changes to the accommodation status and gender data items that are being introduced in MHSDS v5.0, with more detail provided in the MHSDS user guidance.  

To enhance system understanding of MHSDS data quality, NHS Digital have produced a publicly available data quality dashboard. This includes a section focused on data for protected characteristics and vulnerable groups.

Some guidance on collecting demographic data is already available. For example, the LGBT Foundation and NHS England have launched a new good practice guide to provide support for services to implement effective sexual orientation and trans status monitoring. If We're Not Counted, We Don't Count contains updated guidance, tips and case studies, and explains how monitoring plays an instrumental role in identifying and addressing inequalities. Further guidance and support for providers in collecting demographic data and understanding and advancing equality within services is being developed and will be shared via the Advancing Equality section of the Mental Health, Learning Disability and Autism Resource Hub – FutureNHS Collaboration Platform.

Further guidance and support for providers in collecting demographic data and understanding and advancing equality within services is being developed and will be shared via the Advancing Equality section of the Mental Health, Learning Disability and Autism Resource Hub – FutureNHS Collaboration Platform.


Recording referral start times and care contact times

NHS England have confirmed that the response time for urgent and emergency services should be measured in hours.

Table 7: Extract from the Technical Output Specification; tables MHS101 Referral and MHS201 Care Contact. Please always consult the published Technical Output Specification for any changes.

Table Data item name (data Dict element) IDB element name Data item description
MHS101 Referral REFERRAL REQUEST RECEIVED TIME ReferralRequestReceivedTime This records the time the REFERRAL REQUEST was received. This item is only required for urgent and emergency priority referrals into services with target waiting times measured in hours e.g. community-based crisis services or psychiatric / paediatric liaison
MHS201 Care Contact CARE CONTACT TIM CareContTime The time at which a Care Contact commenced.

Initial exploratory analysis investigated the times provided for the referral and care contact to check the accuracy of response times reporting. In order to determine if a person has received a contact within a certain number of hours, it is essential that the recording of both the referral time and the contact time must be precise to the number of minutes (Table 7). If it is not precise to that level, then some cases may be reported as receiving a contact within a certain number of hours when this was not the case.

The analysis identified a large amount of potential default reporting and rounding for both referral start times and contact times. For example, many cases are recorded as being on the hour or half past the hour. 


What needs to be done?

To provide accurate reporting of the true response times for these pathways, the recording of Referral Request Received Time and Care Contact Time must be as accurate and near as possible to the minute the activity took place.

Systems must not be configured to record a default time when the true time is not known. Anyone involved in the manual entry of times in administrative systems must not enter default times when the true value is not known. It may be beneficial for the importance of accurate recording of times to be highlighted to front line staff and others involved in data entry.

It is accepted that there will be factors that limit the accuracy of time recording in any administrative system. It is also acknowledged that a certain level of accuracy is required to enable sufficiently robust analysis.

Last edited: 7 December 2021 5:48 pm