Roshani Prematunga

Identifying the core competencies of mental health telephone triage.

AIMS AND OBJECTIVES The primary aim of this study was to identify the core competencies of mental health telephone triage, including key role tasks, skills, knowledge and responsibilities, in which clinicians are required to be competent to perform safe and effective triage. BACKGROUND Recent global trends indicate an increased reliance on telephone-based health services to facilitate access to health care across large populations. The trend towards telephone-based health services has also extended to mental health settings, evidenced by the growing number of mental health telephone triage services providing 24-hour access to specialist mental health assessment and treatment. Mental health telephone triage services are critical to the early identification of mental health problems and the provision of timely, appropriate interventions. In spite of the rapid growth in mental health telephone triage and the important role these services play in the assessment and management of mental illness and related risks, there has been very little research investigating this area of practice. DESIGN An observational design was employed to address the research aims. METHODS Structured observations (using dual wireless headphones) were undertaken on 197 occasions of mental health telephone triage over a three-month period from January to March 2011. RESULTS The research identified seven core areas of mental health telephone triage practice in which clinicians are required to be competent in to perform effective mental health telephone triage, including opening the call; performing mental status examination; risk assessment; planning and action; termination of call; referral and reporting; and documentation. CONCLUSIONS The findings of this research contribute to the evidence base for mental health telephone triage by articulating the core competencies for practice. RELEVANCE TO CLINICAL PRACTICE The mental health telephone triage competencies identified in this research may be used to define an evidence-based framework for mental health telephone triage practice that aims to improve the quality, consistency and accuracy of telephone-based mental health triage assessment.

Feasibility and need for violence risk screening at triage: an exploration of clinical processes and public perceptions in one Australian emergency department

Background Research on patient aggression in hospital emergency departments supports the development of a systematic process for identifying individuals at risk of becoming violent. The feasibility and community acceptance of this approach is unknown. In this study, we determine the feasibility and explore the need for a violence risk screening process in one Australian emergency department. Method We used a descriptive exploratory design that involved semistructured interviews and observations of practice. The setting was an adult tertiary referral hospital and major trauma centre located in Melbourne, Australia. A convenience sample of nine triage nurses were observed assessing patients to explore how risk screening was undertaken in practice. Semistructured interviews were conducted with emergency department (ED) service users (N=19) to explore community perspectives on the process of violence risk screening. Results Observations of practice revealed that nurses used observed and reported information to screen for potential risk of violence rather than employing a direct questioning approach. Interviews with community members in the emergency department waiting room highlighted a public expectation that nurses screen and accurately identify patients at risk of violence on arrival to the ED. Conclusions Consistent with local prevalence data, public expectations of emergency care supported the need to adopt a uniform approach to identifying people at risk of becoming violent on arrival to hospital. Observations of triage nurses interactions with patients revealed that the existing violence risk screening approach was not being consistently used by triage nurses. An integrated approach to determining violence risk during triage assessment is recommended.

Mental health consumers' perceptions of quality of life and mental health care.

Research spanning the past decade consistently reports that people with severe mental illnesses experience lower quality of life than the general population, however, little is known about what “quality of life” means to consumers, or how quality of life can be promoted in mental health care. This study measured the Quality of Life of mental health consumers receiving care from a Mental Health Nurse Incentive Program, and examined consumer perceptions of quality of life. The study used an exploratory design incorporating the WHOQOL-bref survey and four additional qualitative questions for data collection. Data were analysed using descriptive and correlational statistics. Participants (n = 49) reported lower quality of life scores on all four domains of the WHOQOL-bref and lower overall ratings for “quality of life” than the general population. Having basic needs met, good relationships with family and friends, regular support, and improved social connectedness were identified by consumers as important to their quality of life.

Evaluation of a multifaceted intervention on documentation of vital signs at triage: A before‐and‐after study

Triage systems provide a centralised safety mechanism where all patients are assessed for clinical urgency at point of entry to the ED.

Development and interrater reliability of the UK Mental Health Triage Scale.

Mental health triage scales are clinical tools used at point of entry to specialist mental health service to provide a systematic way of categorizing the urgency of clinical presentations, and determining an appropriate service response and an optimal timeframe for intervention. The aim of the present study was to test the interrater reliability of a mental health triage scale developed for use in UK mental health triage and crisis services. An interrater reliability study was undertaken. Triage clinicians from England and Wales (n = 66) used the UK Mental Health Triage Scale (UK MHTS) to rate the urgency of 21 validated mental health triage scenarios derived from real occasions of triage. Interrater reliability was calculated using Kendalls coefficient of concordance (w) and intraclass correlation coefficient (ICC) statistics. The average ICC was 0.997 (95% confidence interval (CI): 0.996-0.999 (F (20, 1300) = 394.762, P < 0.001). The single measure ICC was 0.856 (95% CI: 0.776-0.926 (F (20, 1300) = 394.762, P < 0.001). The overall Kendalls w was 0.88 (P < 0.001). The UK MHTS shows substantial levels of interrater reliability. Reliable mental health triage scales employed within effective mental health triage systems offer possibilities for not only improved patient outcomes and experiences, but also for efficient use of finite specialist mental health services.

Investigating the predictive validity of an emergency department mental health triage tool

Emergency department mental health triage is a complex clinical task for which the evidence base is minimal. Research in the past decade has consistently identified issues associated with the accuracy and consistency of mental health triage assessment. In this study, we investigated the predictive validity of the clinical descriptors in the Victorian Emergency Department Mental Health Triage Tool. Using a naturalistic, retrospective study design, an audit of the emergency department triage database was undertaken on 12 months of continuous data for all mental health presentations (n = 1718). The main outcome measure was urgency categorization. The study findings indicate that triage nurses can accurately identify the urgency of mental health presentations using defined clinical criteria. A significant finding was that patients with acute psychotic symptoms were more likely to be triaged as high urgency (code 2); however, the Australasian Triage Scale, in use in all Australian and many international emergency departments, provides no mental health-specific descriptors in high-urgency categories (1 and 2).

Workplace violence in mental health: a Victorian mental health workforce survey

Paper abstract: Australian College of Mental Health Nurses 40th International Mental Health Nursing Conference Honouring the Past, Shaping the Future, 7-9 October 2014, Melbourne, Vic Australia. Disciplines Medicine and Health Sciences | Social and Behavioral Sciences Publication Details Douglas, A., Patterson, C., Watson, S., Gruber, E. & Gagan, A. (2014). Active engagement of consumers in a healthy lifestyle program: outcomes of a multidisciplinary pilot project in a mental health rehabilitation unit. International Journal of Mental Health Nursing, 23 (Suppl. 1), 9-9. This journal article is available at Research Online: http://ro.uow.edu.au/smhpapers/2282 ACTIVE ENGAGEMENT OF CONSUMERS IN A HEALTHY LIFESTYLE PROGRAM: OUTCOMES OF A MULTIDISCIPLINARY PILOT PROJECT IN A MENTAL HEALTH REHABILITATION UNIT Angela Douglas , Christopher Patterson , Elise Gruber , Sarah Watson 2b and Alex Gagan 2b Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia; 2 Illawarra Shoalhaven Local Health District, NSW Australia ( The Wollongong Hospital, b Shellharbour Mental Health Rehabilitation Unit) The National Mental Health Commission identifies the physical health of those living with a mental illness as worse than the general community on just about every measure. This paper presents the results of a pilot healthy lifestyle program aimed at engaging consumers with targeted and individualised health activities within a recovery-orientated rehabilitation unit. The ACTive program ran for 18 weeks in 2013, delivered by a team of mental health staff, dietitian, exercise physiologist, academic, and nursing and allied health students. Approval to evaluate the program was received through the Joint UOW/ISLHD Health and Medical HREC. Evaluation targeted quantitative physical health measures for consumers, and qualitative measures for consumers, staff and students. Preliminary results show a grouped average weight loss of 1.1kg, which has clinical significance given the weight-gain challenges associated with serious mental illness. Statistical comparison with a control group is currently underway. Consumers also improved in functional exercise capacity, with 80-metre average increase for the 6-Minute Walk Test, and 2.6 repetition increase in the Sit-to-Stand test for functional leg strength. Feedback provided has identified a number of key challenges to the sustainability and management of this type of program within current mental health service provision environments. Targeted and individualised health programs integrated into mental health services have great potential to reduce the existing disparity in physical health. However, the capacity for collaborative involvement of multidisciplinary health professionals is critical. Furthermore, programs that foster allied health student placement may enhance vocational scope for allied health within mental health services.