Older People’s Mental Health-MidLothian

Referral Priority

• Urgent referrals: assessment within 72 hours.

We ask that GPs call the OPMH Duty Nurse (07483926392) to discuss the referral to enable appropriate triaging, and then subsequently submit a SCI Gateway referral.

For an acute change in mental health, please arrange investigations to exclude delirium prior to referral – the delirium primary care management page gives more detail.

Situations indicating that an urgent mental health assessment is needed include acute mental health presentations such as severe depression, psychosis or suicidal ideation with immediate risk factors identified.

Please consider a referral to Social Work through Single Point of Access in the first instance if the concerns are primarily about social issues (becoming lost in the community, care needs not being met, significant carer stress).

• ‘Soon’ referrals: assessment within 2 weeks.
• Routine referrals: assessment within 12 weeks.

Patients requiring assessment outwith normal working hours

The process depends on whether the person has dementia or not.

After hours assessment for mental health issues or for patients who do not have dementia:

• 5pm to midnight: GP ideally carries out face-to-face physical examination. If physical causes for presentation are excluded and mental health presentation is suspected, GP liaises directly with Intensive Home Treatment Team (IHTT) 07976842093 or office number is 0131 285 9624 (both numbers are for use by health professionals only). Patient is assessed at Midlothian Community Hospital (MCH) or Royal Edinburgh Building (REB) if risk is present. 
• After midnight: GP ideally assesses for physical health causes for presentation and, if these are excluded, GP liaises with Mental Health Assessment Service (MHAS) 0131 286 8128. Patient is assessed at REB or RIE if medical issues are identified. 
• If the mental health assessment can wait to be carried out within working hours, GP to email urgent referral to loth.midlothianopmh@nhs.scot. Our Duty Nurse will arrange for a mental health assessment within working hours.  

After hours assessment for patients with dementia:

• Liaise with on call consultant through REB switchboard 0131 537 6000 – there is not a separate an out of hours assessment service for Dementia.  The on-call Consultant will offer advice to the GP who has made an assessment.

Examination and Investigation prior to referral

• Please complete an appropriate physical examination and investigation where dementia is suspected within a month of referral. Please see guidance on RefHelp’s dementia page for investigations required.
• For an acute or subacute change in mental health or presentation, where delirium needs to be excluded, please arrange investigations within a week of referral. Please see delirium guidance.

• ECGs and CT head scans do not need to be done in advance. The service will arrange these if appropriate. 

Please note that the mental health service will hold any referrals and contact the practice to request that the appropriate investigations have been completed. This is particularly important when there is an acute or subacute change in presentation and delirium needs to be excluded first.

Who can refer:

• Referrals are welcome from all health care professionals after appropriate treatments have been tried in primary care.
• Where indicated, GPs are asked to complete capacity assessments. The mental health team will provide a second opinion when required. 
• Patients can self-refer:
  • patients with a diagnosis of dementia, and their carers, can contact the Midlothian Older People’s Mental Health Team directly even after they have been discharged.
  • Patients with mood and psychotic illnesses can contact the team directly for a self-referral within a year of the discharge date.

Who to refer:

• Adults aged 65 or older with mental illness including depression, anxiety, psychosis, bipolar affective disorder who require specialist input.
• Adults aged 65 or older with cognitive changes who require a dementia assessment.
• Patients of any age where cognitive impairment is the primary issue in the clear absence of depression, anxiety or substance misuse.  We will offer an initial assessment in this circumstance.
• Patients of any age who have a diagnosis of dementia and are displaying behavioural and psychological symptoms of dementia which require specialist input.

Who not to refer:

• Patients with an acute change in mental state where a delirium has not been excluded.

These patients should be fully investigated from a physical perspective and the underlying cause of the delirium treated before referral – please see delirium advice.

• Patients where the primary problem is alcohol or substance misuse including alcohol-related brain damage with no other psychiatric illness.

These patients should be referred to the Substance Misuse Service located at Number 11, St Andrew Street, Dalkeith, EH22 1AL. Telephone: 0131 660 6822.

• Patients where the primary problem is behavioural or psychological disturbance secondary to head injury with no underlying psychiatric or cognitive disorder.

These patients should be referred to Neuropsychiatry via SCI gateway for specialist assessment/ management.

How to refer:

• Referrals from general practice should be submitted through SCI Gateway(Midlothian – Psychiatry of Old Age).
• For clinicians without access to SCI Gateway, please email referral details to loth.oapadmin@nhs.scot.

• Self Referral:
  • The Midlothian team encourages patients with a diagnosis of dementia, and their carers, to contact the Midlothian Older People’s Mental Health Team directly even after they have been discharged.
  • Patients with mood and psychotic illnesses can contact the team directly for a self-referral within a year of the discharge date.

Clinical guidelines:

NICE guideline NG97: Dementia: assessment, management and support for people living with dementia and their carers

https://www.nice.org.uk/guidance/ng97

SIGN guideline 157: Risk reduction and management of delirium, quick reference guide

https://www.sign.ac.uk/media/1425/sign157_qrg.pdf

NICE guideline CG90: Depression in adults: recognition and management

https://www.nice.org.uk/guidance/cg90

Lothian Joint Formulary: Psychotropic medication under ‘Central Nervous System’

https://formulary.nhs.scot/east/medicinecategories/

Patient resources:

Midspace: Local Midlothian resources and information for mental health and wellbeing:  https://midspace.co.uk/

Health in mind: patient information leaflets on mental health issues:  https://www.health-in-mind.org.uk/

Dementia Service:

• https://www.midlothian.gov.uk/info/1350/getting_care_and_support/185/dementia_support
• Midlothian Adult Social Care (ACCT): 0131 271 3900
• Emergency Out of Hours Social Work: 0131 200 2324
• Voices of Carer Across Lothian (VOCAL): 0131 663 6869 www.vocal.org.uk
• Alzheimer Scotland: 24h dementia helpline 0808 8083000 https://www.alzscot.org/

There are generic resources on other RefHelp pages – see the RESOURCES & LINKS sections:

• DEPRESSION – see Depression (Adults) (nhslothian.scot)
• ANXIETY – see Anxiety, Panic & Phobias (Adults) (nhslothian.scot)
• STRESS – see Stress (nhslothian.scot)

PSYCHOLOGICAL THERAPIES – Mental Health Psychology and Other Services