- Keep in mind that these appointments should be ‘patient led’ → i.e., always ask the patient if they feel comfortable/safe to wait for appointments/callbacks and listen to what they are asking. It will be easier to identify the right help if you can grasp the true nature of the call, first.
- Continuity of care is important. It is often easier for a patient to talk to someone whom they have seen before and who is aware of their history, so they don’t have to keep recounting a painful issue. Therefore, if a patient has seen one of our clinicians previously for the same or similar mental health issue, call handlers should try to arrange urgent appointments with that same clinician, provided the patient is able to wait to see that particular person.
Determine the Urgency
The first step in this process is to determine just how urgent the need is. The urgency can be determined by asking the caller the following three questions:
- “Do you currently feel unsafe?”
- “Are you (or the person you are calling on behalf of) having any suicidal thoughts that you feel you (they) may act on?”
- “Do you think you (or the person you are calling on behalf of) may cause yourself (themself) harm or hurt anyone else?”
In the case of someone calling on behalf of another person, you can ask: “Are you worried about their safety or your own in their presence?”
🚨 Urgent Help
Callers who have answered Yes or Unsure/Don’t know to any of the above questions are considered potentially in crisis or high risk.
In this situation, the call handler needs to identify → is the patient known to any specific clinician regarding their mental health?
You can check the patient’s notes to see if they’ve previously been seen by any clinicians for their mental health.
Patient KNOWN to a clinician
In a case where the patient is known to a clinician regarding mental health, try to maintain continuity of care by booking with the same clinician. Let the patient know that you will to try to find an urgent appointment with the clinician that they have previously seen.
- Identify the next available red slot with the known clinician → offer the slot to the patient, asking the patient if they “feel safe to wait until then to see that clinician?”
✅ If the patient says that they feel safe to wait → book the appointment
⛔ If the patient says that they do NOT feel safe to wait for the known clinician → follow procedure for Patient NOT known to any previous clinician below ⬇️
Patient NOT known to a clinician
- Offer the patient the earliest red slot with ANY GP/MHN and ask if they “feel safe to wait until then to see someone?”
- Offer the patient a callback from the duty doctor sometime on the same day (morning or afternoon) and ask again if they “feel safe to wait until then to speak to someone?”
- Let them know that it appears that their needs are really urgent and the only way to get immediate help is to call 999. Ask them if they “feel able to call 999 themself once you are finished with the call?”
- send them crisis line information on Accurx
- write the conversation and outcome in the patient notes
- if you have any further concerns → raise them with your lead
✅ If the patient says that they feel safe to wait → book the appointment
⛔ If the patient says that they do NOT feel safe to wait for the appointment with ANY GP/MHN → go to step 2. ⬇️
✅ If the patient says that they feel safe to wait → add the patient to the duty doctor list
⛔ If the patient says that they do NOT feel safe to wait for the callback → go to step 3. ⬇️
✅ If YES they will make the call themselves →
⛔ If they can NOT make the call themselves → once again, offer them a callback sometime on the same day (morning or afternoon) from one of the duty doctors.
N.B. Remember to ask the patient where they are currently and for a contact number so that we know where to send emergency services.
👉 Routine Help
While a routine appointment is less urgent, it is important to get the right type of slot with an appropriate clinician. Start by asking the patient if they have been seen before for this issue and check EMIS for patient history.
Patient has been seen before
After talking with the patient and checking EMIS notes, ask the patient what they need to arrange. The answer is likely to be one of three options:
- Medication review →
- If seen by GP/MHN within the last 6 months → offer medication review appointment with pharmacist.
- If > 6 months since last review → offer routine review with MHN/GP (ideally with the same clinician as patient has seen before).
- Standard follow-up → check previous notes to see whom the patient has seen before for this issue and book with same clinician where possible. If the patient feels that the wait for that specific clinician is too long, they can opt to see a different clinician sooner.
- Annual review → are only regularly carried out for patients with Severe Mental Illness (SMI). Follow the process detailed on this page to book with the appropriate clinician.
Patients with a ‘new’ or first mental health issue
This is for patients who have never previously attended for any mental health issue. The general process is that for any issue:
- Offer a new patient appointment with either the MHN (F2F where possible) or a routine GP appointment.
- Once the appointment is booked, send the appropriate form via Accurx to the patient, making it clear that the form should be completed before the appointment:
- for ADHD concerns → send ADHD Adult Self-Report Scale (ASRS) questionnaire
- for other mental health issues → PHQ-9 (for depression) and GAD-7 (for anxiety) questionnaires
- Send patient IAPT referral information (via Accurx).
Flowcharts
🚨 Urgent Help
👉 Routine Help