What is Mental Health (MH) Disorder: Unspecified?
- significant changes in thinking, emotion and/or behaviour.
- distress and/or problems functioning in social, work or family activities.
The mental distress that a patient is experiencing does not always fit neatly into one of the categories of MH Disorders found in the Mental Health Nurse Handbook.
When a patient is experiencing symptoms of mental health disorder that have a great deal of overlap between categories, or have not been described as fitting into one particular category, then it is termed Unspecified.
For example, while a low/depressed/anxious mood when a person experiences bereavement may be quite normal, if that altered mood continues to cause distress or gets in the way of normal functioning (e.g., not sleeping or eating properly), professional care may be required. Yet, the diagnosis may be hard to pinpoint because depression, anxiety, bereavement, sleeplessness, eating disorder or any combination of all could apply.
Whether we are able to be precise in our diagnoses or not, it must be kept in mind that we can still help people with MH Disorders. Many of these conditions are treatable, and improvement is possible, even if we can’t find the specific term for it.
90% of people with MH Disorders are cared for in primary care (including SMI).
50% of MH Disorders are established by age 14; 75% by age 24.
Diagnosing Mental Health Disorder: Unspecified
Penrose Health Action Plan
We aim to keep the number of Mental Health Nurse visits to a maximum of 6 per patient in any given episode. See Schedule of Reviews below for more specific/detailed guidance.
⚠️ Safety netting
If at any time a patient presents:
- with a significant change in risk status; or
- if there is a commencement/change in medication
The visit count resets back to the beginning (i.e. First review)
Secondary and External services may be better placed to help/support patients than we are.
- Secondary services offer psychological treatments (e.g., interpersonal/psychodynamic therapies, CBT)
- External services in the community offer many options for social and psychological help through relationships with the wider service network (e.g. Social Prescriber, Befriender, Care Coordinator, Therapist, Lifestyle Coach, etc.)
We do not provide any form of psychotherapy within our surgeries.
Patient Journey - Determining Schedule of Reviews
Click toggle for a schematic of the action plan/treatment policy for all Penrose Health Surgeries, or follow the guidance below.
If patient is showing symptoms that overlap in MH Categories or do not fit into any one category → select appropriate symptom code(s) in Consultation.
Ensure full review of EMIS for any previous diagnoses, codes or secondary care to help determine current diagnosis and consider discussing with MHN team/lead → review in 2-6 weeks.
If appropriate, please consider:
- social prescribing and/or signposting to community services if major social stressors (see Booking a Care Coordinator Appointmentand Social Prescribing for more information).
- giving advice regarding general healthy lifestyle (e.g. exercise, sleeping well).
- If a patient is actively managed by another mental health provider → liaise with services as required and conclude routine MHN appointments.
- If rejected by secondary services and patient is at high risk → review again in <1-2 weeks.
If patient is stabilised/improving → conclude routine MHN appointments.
If patient has issues ongoing or worsening → discuss with another professional (e.g., GP or at Clinical Meeting) for clinical impression.
- if clinical impression changes → rebook and follow that pathway.
- if still unclear → book for clinical review with GP
Referring/Signposting Onward
Below are some services to which you can signpost/refer patients. More services can be found on the Penrose Portal in Mental Health Services Database.