Exclusion Criteria for Adults (anyone over 18)

Read alongside

Safeguarding Children Policy

Protection of Vulnerable Adults Policy

1.0 Introduction

1.1 This policy and procedure sets out which patients are not suitable for Clinical Partners care.

2.0 Purpose

2.1 The purpose of this document is to ensure that any patient who may pose a risk to themselves or others does not receive treatment from Clinical Partners when we are not as an independent mental health outpatient service provider positioned to provide the appropriate or safe level of care.

3.0 Scope

3.1 This policy and procedure is to be followed by all staff and Partners.

4.0 Duties and responsibilities

4.1 The CEO is responsible for ensuring that the exclusion criteria is applied.

4.2 These criteria set out which patients the Clinical Partners triage team may or may not accept. The triage team are not authorised to accept any patient who meets the exclusion criteria.

4.3 Each clinician is separately responsible for which patients they do or do not accept as a referral from Clinical Partners. There is no obligation whatsoever for a clinician to accept a referral from us.

4.4 All our Clinical Partners should ensure that they are aware of the exclusion criteria.

4.5 All Clinical Partners staff are responsible for making sure that they understand and adhere to this policy. If you are unsure about any aspect, then please discuss it with the Head of Triage or your Line Manager.

5.0 Policy for patient exclusions

5.1 As an outpatient mental health service it is our policy not to offer care to patients who require a higher level of care or who are in crisis, or who may pose an excessive risk to themselves or others.

5.2 The exclusion criteria may be in respect of a condition that we do not treat e.g.  Primary substance misuse. The exclusion criteria may be because immediate escalation is required for e.g. A&E or potentially psychiatric hospitalisation or the condition is too severe for an outpatient care plan.

5.3 Patients and their referrers will sometimes not be entirely overt about the severity of the situation, so you must consider more subtle cues that suggest greater severity than is being disclosed and seek senior advice before booking.

5.4 Patients will periodically move in and out of wellness, and may become unsuitable. If this happens then they should be carefully managed into the correct level of care by the Clinical Partner who is looking after them. The triage person who arranged their treatment is usually able to support this process.

5.5 All Clinical Partners triage staff have training and supervision, and it is for them to use their best judgement to establish the level of risk that an individual patient may pose. If they are ever unsure what to do then they should discuss the case with the Head of Triage or their deputy before doing anything.

5.6 For patients with whom we have no personal contact, it may be a 2^nd/3^rd party referrer who makes the administrative booking; we must have a confirmatory conversation.

6.0 Assessment process

For the triage team:

6.1 All private patients will be triaged before being offered an appointment.

6.2 Ratings:

Green rating - if there are no grounds for concern about the patient, and it’s felt that they will be suitable for an outpatient appointment.

Amber rating - if you are aware of low to moderate risk relating to this patient but where Clinical Partners is considered the correct service for them.

Red rating - if there is moderate to high risk but not sufficient to exclude them at point of triage. In these cases we need to request supplementary information, ensure they have a support structure in place, if the patient has local support we can be part of their established care not offering our services in isolation. Red will always require some form of supplementary information (e.g. GP letter, recent report following medical treatment, telephonic discussion with GP) gathered before making a decision to provide a service or not. 

Exclude - if it’s felt that Clinical Partners is not going to be suitable for the patient. This should be because they fulfil one of our exclusion criteria or because you have any other grounds that make you feel they may not be safe to be seen as an outpatient. If you are unsure then consult your manager.

6.3 Any concerns must be passed to the clinician prior to the appointment.

6.4 If you receive a call from an individual who tells you that they or the person on whose behalf they are arranging treatment fit any of the above possible exclusion criteria then you should explore the issues in more detail until you are satisfied that the patient is suitable or not. If you are still not sure, then let the patient know you will need to speak with your manager (Head of Triage) to check that we can help.

6.5 If its decided that Clinical Partners is not the correct service and this exclusion policy applies you may suggest that they contact their NHS GP, CMHT, solicitor, or other appropriate person or body.

6.6 Where exclusion criteria apply then you should notify your manager for them to monitor levels of unsuitable enquiries. This should be recorded for evaluation purposes and reporting at the Clinical Governance meeting.

For clinicians if you feel the exclusion criteria apply:

6.7 Safe management must be collaborative between yourself and Clinical Partners. Clinical Partners will seek to apply the exclusion criteria and inform you of any concerns raised during the triage process but you are under no obligation to take any patient we offer you.

6.8 The above are the exclusion criteria that the triage team are trained to work to and aimed to ensure that only patients suitable for the setting we can offer will be passed to you. However, patients do not always fully disclose when they book appointments. If you ever have any concern about the safety of any person connected with Clinical Partners then you should let us know immediately by contacting any member of Clinical Partners staff.

7.0 Exclusion Criteria

Patients who for purposes of risk to self:

• present a current risk of harm to others or themselves

• have severe eating disorders – especially anorexia with BMI 16 or under

• are actively intoxicated or under the influence of narcotics

• are verbally abusive on the telephone (OK to hang up)

• are currently self-harming to an extent that is more than superficial cutting or burning

• are currently under a section of the Mental Health Act

• have current or recent convictions for violence, sexual offences including abuse, or arson (except for medico legal / forensic)

• are very likely to be drug seeking, e.g. those demanding immediate prescriptions for controlled / mood altering drugs. We do not prescribe methadone.

Requests for assessments for specific reports regarding:

• Gun licenses

• Occupational clearance

• Driving

Needs to be discussed case by case

• Primary moderate or severe learning difficulty                                                                                                                                 

Possible exclusions (subject to further information): Patients who:

• those who have serious and enduring mental health needs who are likely to require long term care, possibly including periods as an inpatient. These patients are most likely best cared for by the NHS.

• those presenting with more complex diagnoses and personality disorders who may need the containment other than those we can provide as an outpatient mental health service.

• are actively considering or have had a suicidal attempt in the last three months or have a history of suicide intent. In all such cases we need to know how and when these / this attempt happened and make an informed decision about the current level of risk. Gather all information and do not make the decision to exclude on your own. Check with the Head of Triage or their deputy or the Registered Manager as to whether we will work with the new client.

• have recently been detained under the Mental Health Act (except for medico legal cases) – in these cases we need to know why they were detained, when, and to what extent their condition has improved since. The discharge summary from the most recent treating hospital should be sought by the family / patient / referrer.

• are actively being treated by the NHS. In these cases we should be wary of creating confusion and / or creating conflict with those who may already be giving very good care.

• patients who are currently in dispute with an NHS organisation or another health provider and who triage feel may become in dispute with us and we will not be able to resolve things for them.

• Severe abuse, sexual or other abuse where relevant statutory bodies have not been involved. These cases should be dealt with on a case by case basis and discussed with the Triage Manager. See the Clinical Partners Safeguarding Policy.

• are medico legal or in court proceedings where instruction / contact is not from a solicitor

• are aged under 18 and who do not have a parent or legal guardian involved in their care.

8.0 Process for monitoring compliance with the policy

8.1 Noncompliance with this policy will be monitored closely. Any incidents concerning inappropriate referrals, incidents in consulting rooms where the client turns out not to have the symptoms previously declared and are unsuitable to be treated in a non-urgent setting will be recorded as an Incident on the appropriate form. These forms are presented to the Clinical Governance meeting where all incidents are reviewed. Preventative action following an incident will be immediate if thought to affect client or clinician safety.

8.2 The Head of Private Triage will report to the Clinical Governance Committee on a quarterly basis if we are receiving larger than usual numbers of unsuitable enquiries, as this may have implications for our communications strategy.

9.0 References

 Code of practice: Mental Health Act 1983