Referrals to and Discharges from the Leicestershire Partnerships NHS Trust
Contents 1. Introduction... 3 2. Aims and Objectives of the Policy... 3 3. Referral Criteria... 3 4. Referral Procedure... 3 5. Discharge of patients from the... 5 6. Implementation... 5 Issue date: 16.01.06 2 of 5
1. Introduction The purpose of this document is to define the criteria and procedures for the referral of individuals to the Forensic Service; reference should be made to key documents that inform referral to other areas of the service i.e. Criminal Justice Services, Belvoir PICU and General Adult Psychiatry. Where appropriate there may be a need to refer to Trust polices and Procedures. 2. Aims and Objectives of the Policy The aims of the Referral pathway is to clarify the characteristics of individuals that may be suitable for referral or assessment and acceptance into the Service and to clarify the factors that decide readiness for discharge from the Service. The objectives are to facilitate appropriate referrals and to clarify the referral and discharge processes. 3. Referral Criteria 3.1 Patients considered suitable for referral to the will fulfil the following criteria, patients should not be referred on the basis of a singular criteria category, the criteria should be applied globally to the patient s presentation: a. Patients must have an identifiable mental illness including alcohol and substance related mental illness or dual diagnosis. Borderline Learning Disabilities and Organic Brain injury will only be considered where mental illness symptoms are clearly diagnosed in co-presentation, and where the referral is due to mental illness as the primary criteria. b. There is a significant serious risk to others as related to the criteria set out in 3.1 (a), and it cannot be safely managed without the intervention of a specialist forensic service. c. Patients will normally only be considered if they are within adult working age ranges usually 18-64. Individuals who fall outside of this range will be considered for assessment and advice by the service on a case by case basis. Patients referred between the ages of 16 18 will normally only be considered if they have left school or are living independently. d. Personality Disordered individuals who are offenders or have the propensity to offend and already have an ICD-10 diagnosis of personality disorder. Such individuals must show commitment to engage in treatment. e. If patients are offered specific psychological intervention then it does not mean that these patients will be care managed by the forensic services but might have to remain under the care of general adult services. 3.2 The Service reserves the right to decline acceptance of the referral at this where the individual does not meet the criteria. 3.3 A separate arrangement for child protection assessments are offered by forensic psychologists only. 4. Referral Procedure 4.1 The has given consideration to inclusion criteria for suitable referrals to the service. 4.2 The is a tertiary service for the Trust and for other agencies. Exceptionally we will accept patients referred from social services and probation. Issue date: 16.01.06 3 of 5
Referrals will not be accepted directly from GP s and must have been initially screened by the catchment area Psychiatrist. 4.3 Primary care services are required to refer in the first instance to their Locality Psychiatric Services who will assess if there is a major mental disorder and if a referral to this service is appropriate. 4.4 Referrers are encouraged to have informal discussions about cases with the service s Consultant Psychiatrists or any member of the team. 4.5 All referrals to the FMHS will be addressed to the Team Administrator, and will be acknowledged in writing on receipt and presented to the Referrals Forum, that meets twice monthly. 4.6 Receipt of referrals will be acknowledged in writing within three days, and will be accompanied by the referral pro-forma where necessary. It is essential that referrals include full details of the following information: Diagnosis Presenting history A full list of previous convictions, cautions and orders History of service involvement and details of previous treatment programmes undertaken Outcome data CPA Care Plans, Assessments and Risk Management Plans. Where criminal proceedings have occurred, referrals should also include: Full outline of the case Depositions and witness evidence All Indictments and relevant police evidence. 4.7 The Referrals Forum is multi-disciplinary and includes representation from all parts of the service. At this meeting, the panel discusses all referrals and each case is compared against the core service criteria. 4.8 At this point, the admissions panel can arrive at a decision regarding whether to proceed with an assessment. In the event that it is agreed to proceed with an assessment, the panel will identify and allocate the most suitable members of the service to undertake this and allocate the case to a co-ordinator. Updates on the outcomes of assessments will be provided to the referral panel as necessary. All decisions of the referrals panel are communicated to the referring agent in writing by the Service within 5 working days of the date of the discussion 4.9 Whilst the patient is undergoing the assessment including referral for specific psychological treatment medical, CPA, Care-Co-ordinator, and supervisory responsibilities will remain with the referring specialist or agency. If the treatment is considered suitable and the patient fulfils criteria, then the patient will be taken on by the service and medical and CPA responsibilities will be transferred at that time. 4.10 Once an assessment has been completed, the referrals panel will discuss the results and then communicate the decision to the referring agent. Before any cases are closed, the panel will ensure that all necessary written information has been collated and communicated to the referring agent. Issue date: 16.01.06 4 of 5
4.11 Where referral is based purely on risk in the absence on mental illness criteria, and is for psychology input only, Medical and CPA responsibility will remain with the referring specialist or team. 4.12 Patients who have been discharged and had no contact with the service will need to be referred as a new referral. An urgent assessment will be offered for those who have been discharged by the forensic services if required. 5. Discharge of patients from the Forensic Mental Health Service 5.1 Patients will be discharged from the Service when they no longer fulfil the criteria for acceptance as set out in 3.1 above. Some cases will be discharged directly into the community without follow up. 5.2 Patients will be discharged or transferred to other services when the care team identifies that the risk factors have been identified, addressed and treated and reduced to levels, which are considered by the Forensic and accepting Services to be acceptable, reasonable and manageable. In some cases it may be deemed suitable to refer the individual onto a more appropriate service instead of the original referrer. 5.3 There should be an awareness that some patients referred to the service and accepted may initially be deemed treatable but following extended assessment and treatment may prove otherwise, where identified the will exercise its right to discharge such cases back to locality services. 5.4 Referrers must understand that discharge of patients to referrers is as important as acceptance and referral to the Forensic Service, to ensure that individuals are not stigmatised or discriminated against on the basis of their status within mental health services. Therefore, referrers must undertake to accept back patients that are deemed to no longer require input from the forensic service once this has been agreed by all those involved in the care pathway. 5.5 The Forensic Service will actively advocate a discharge process that is nondiscriminatory and advocates for the patient in all aspects of social inclusion including education and employment regardless of race, culture, age, gender or social class. 6. Implementation The referrals and discharge criteria will be treated as an interim document until the consultation and ratification process is completed. Issue date: 16.01.06 5 of 5