The Royal College of Psychiatrists in collaboration with NHS England/Improvement have published guidance for clinicians and other healthcare professionals working in community and inpatient services.
The guidance includes specific reference to a community mental health clinical decision framework for allocation of resources recognising that clinicians and other health professionals might need to work collaboratively in mental health services. There are also other guidance notes which will be of interest to healthcare professionals caring for mental health patients in different settings which we highlight.
What does the decision framework for allocation of resources cover
It includes details of a new clinical decision tool to enable the allocation of care and treatment for community mental health patients/patients based on need. It covers the following key areas:
- Define patient groups by hierarchy of need
- Consider need by diagnosis;
- Consider the impact of medication: patients on high risk medications;
- Consider the potential susceptibility to the virus for certain groups of patients;
- Complete RAG rating assessment/zoning;
- Review caseloads at least weekly for community mental health teams and daily for home treatment teams; and
- Consider whether there are local clinical or ethics advisory groups in place to provide advice on local policy and practice if helpful.
- Managing care pathways with limited staffing resources to sustain continuity of treatment. Key to this is finding local solutions for your area. The framework highlights that priority should be for delivering interventions that prevent crises, with the aim of lessening the impact upon acute services. Consideration should also be given to whether face to face contact is needed or whether for some patients this can be managed over the telephone or via other visual technologies. Local areas are also encouraged to assess mental state on the telephone but consideration should be given to those who may not be able to access technology or hear well over the telephone.
Residential care and nursing homes for people with learning disabilities, mental health and/or other disabilities
The guidance sets out what residential care homes should do, if a resident has symptoms of COVID-19.
Key steps include:
- Isolating the resident in the same manner as if they had the flu. If they require full isolation their own room can be used.
- Staff should take steps to minimise the risk of transmission by using PPE for activities that bring them into close personal contact with the resident.
- If neither the resident or staff member is symptomatic then PPE is not required. However good hygiene practices should continue and there should be consideration of increased cleaning to reduce the risk of the virus being present.
Supported living placements
Providers are advised to
- Review their client list and the level of support available to individuals;
- Work with local authorities to identify those who fund their own care and help determine the support available;
- Map all local authority-commissioned care and support plans;
- Work with local authorities to establish mutual aid plans for sharing workforces across other providers, home care and health service providers;
- Increase general interventions such as cleaning activities.
Hostels and day centres
Hostels and day centres do not yet need to close. However, they should ensure frequent cleaning and disinfecting communal areas. If a resident becomes unwell, they should stay in their room. If staff become unwell they should be sent home.
If an individual is in a day centre and they do not have a home or room to self-isolate, the centre should create an area within the centre to temporarily isolate the individual and contact the local authority.
How do you manage a mental health in-patient ward environment?
The guidance acknowledges that whilst it may be counter-productive to stop all activities, they should be adjusted to meet national guidance. Ward groups, ward rounds, mealtimes and visiting times should be reviewed to allow for as little contact as possible.
Ensure communication between staff and patients is as good as possible, whether this is through the use of notice boards, written communication, smaller group or individual meetings. Meetings can still take place as long as personal contact is avoided and there is adequate distancing between individuals.
Staff should also look to include patients as much as possible in assisting in the restricting of the ward routines and activities.
Visitors are asked to limit their visits and look at how else they can keep in touch with patients. Visitors must be immediate family members or carers. Visitors should be limited to one per patient in most cases.
The guidance also covers some additional areas, such as IAPT, outpatients and day patient services, for example.
The Act received Royal Assent on 25 March, having been fast tracked through Parliament. There are no substantive changes to Schedule 8 of the Act concerning temporary changes to the Mental Health Act as against the Bill. We still await the Explanatory Notes which provide details on enactment.
If you have any queries or would like support in relation to coronavirus policies or the guidance, please do not hesitate to contact a member of our team.