LOCATION:

Caherina House, Strand Street, Tralee, Co Kerry

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THE PROBLEM:

The Specialist Mental Health Assessment HUB was developed initially in response to the pandemic. Mental health patients were presenting to an overburdened Emergency Department. They were at risk of contracting Covid while awaiting assessment. The waiting time for patients increased and lead to high levels of “Did not Waits” for mental health patients leading to higher risks of suicide, self-harm and mental health relapse. 60% of ED Mental Health assessments occur out of hours. These assessments are performed by NCHDs who often have no or very limited experience in crisis psychiatry. This is a significant clinical governance issue as the patients who are at highest risk in the service are being managed by the practitioners with the least amount of experience in managing this risk.

It was recognised at service level that having 5 separate community mental health teams accepting referrals from primary care with differing thresholds of acceptance did not offer a streamlined pathway to service users accessing services.

THE SOLUTION:

To redirect Mental Health patients from the Emergency Department to a single point of access. A referrals system was developed for General Practitioners to directly refer into Adult Mental Services in Kerry. The first aim was to develop a service which provided triage and signposting, ensuring service users received the right service at the right time, in the right place. This resulted in a reduction in Mental Health patients attending ED, reduced waiting times, improved patient experience times, reduced waiting lists improved service KPIs and improved capacity.

BENEFITS:

Results from the service show that waiting times have been dramatically reduced. In the first year (2020) of opening the Specialist Mental Health Assessment HUB received approximately 1,200 referrals and forwarded 150 referrals onto the CMHTs with the remainder being signposted to other services. 

The second aim of the project was to support the CMHTs become focused on treatment and management of major mental health disorder.

From January 2021 up to and including August 2024 there were a total of 5027 referrals into the SMHA Hub. These figures are broken down as follows:

2021 - 1,250 Referrals, 2022 - 1,256 Referrals, 2023 - 1,509 Referrals & 2024 - 1,012 until end of August.

Of these 5,027 referrals, 3,917 were accepted to the SMHA Hub meaning that 1,110 were redirected/signposted back to primary care and/or community supports.  The acceptance figures are broken down as follows:

2021 – 1,024, 2022 - 1031, 2023 – 1,182 & 2024- 680 until end of August.

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• SMHA hub total ref Vs Total accepted

• SMHA hub ref X risk rating (Red, amber, Green)

• SMHA hub referral waiting time in days (including weekend) X risk rating (red, amber, green).

• SMHA DNA X % of appointments lost due to DNA