Older Peoples Mental Health-Edinburgh

Referrals are categorised at triage using the following priorities based around imminent or serious risk to the patient or others (e.g. self harm, violence / aggression, challenging behaviour, neglect):

• Emergency – 24hr response from receipt of referral. This is facilitated by the RRT – please see separate RRT guidance (telephone discussion required with RRT)
• Urgent –   response within 5 working days (CMHTOP is a Monday – Friday service) – telephone discussion needed with the relevant Single Point of Referral
• Routine – at least / minimum 4 weeks (2 weeks for EBSS)

The aim of the triage process is to obtain sufficient information from the person making the referral to:

• Determine whether the person requires a mental health service intervention;
• Direct each referred person to the team likely to meet the identified need for further assessment or treatment;
• Determine the level of risk or distress;
• Initiate emergency response where the need is identified;
• Identify the service most likely to meet the needs of the person, when a mental health service intervention is not required;
• Identify local community services and other relevant services;
• Give the referrer clear and concise information about the services available and options for further assessment or treatment;

Referrers should note that patients are triaged to a range of appropriate professionals depending on their needs. Referrers can request that the patient be seen by a particular discipline, but this request may not be fulfilled. Patients should be aware of this when being referred.

Who can refer:

Referrals are accepted from:

• GP clinical teams
• Care Homes within Edinburgh for residents with dementia and/or other mental health problems

And specialist services too:

• Rapid Response Team (RRT).
• Hospital clinicians
• REAS Older People Mental Health Inpatient Wards
• Adult Mental Health Consultants
• Mental Health Assessment Service (MHAS)
• Cognitive Disorders Clinic at Anne Rowling Clinic (to facilitate CMHTOP follow up for early onset dementia).

Who to refer:

All patients referred to the CMHT must be registered (or due to register) with a GP within the Edinburgh boundary and appropriate to the over-65 service (except in the case of early onset dementia). They should have an organic or functional mental health condition with at least one of the following:

• Require assessment of mental state and diagnosis
• History of frequent relapses or hospital admissions
• Acute disruptive, disturbing or threatening behaviours to self or others (related to mental state)
• At serious risk of neglect, or in a position of vulnerability (due to acute mental health problems), which social care are unable to support
• Require advice and management of pharmacological treatment
• Requiring assessment for diagnosis of dementia – please ensure that recent blood screening results & relevant brief cognitive testing scores are included in the referral – see RefHelp dementia page for guidance
• Require ongoing support due to severity of mental health condition
• Require other specialist treatments such as non-pharmacological treatment including psychological therapies
• Capacity assessments when the presentation is complex, and the GP requires a psychiatric opinion – see the Capacity Assessment page for more information
• Require follow-up after discharge from hospital regarding above

Please note that referrals as an alternative to hospital admission would require input from the RRT.  

Please consider and investigate for delirium if changes in mental state and or behaviour are acute in onset prior to referral, and see the delirium page for further guidance.

Who not to refer:

Patients under 65 with cognitive concerns

People under 65 years of age with cognitive impairment should be referred to general adult community psychiatric services (CMHT) to assess for reversible psychiatric causes of cognitive impairment such as anxiety and depression.

Patients under 65 years old with cognitive impairment who have been reviewed by General Adult psychiatry and have had depression and or anxiety symptoms optimised should be referred by the specialist to neurology (those with a high suspicion of neurodegenerative dementia may be seen at the Cognitive Disorders Clinic at the Anne Rowling Clinic).  

Patients under 65 years old with cognitive impairment with a strong family history of heritable neurocognitive disorders, and or with co-morbid neurological symptoms please refer to Neurology.

How to refer:

 Single Point of Referral

There is a Single Point of Referral for the North & the South for referrals to the CMHTOP, MATS & EBSS (see below regarding referrals to RRT).

GPs should refer using SCI Gateway:

• Edinburgh – Psychiatry of Old Age – North
• Edinburgh – Psychiatry of Old Age – South.

Please see HSCP boundaries.

• North Edinburgh Team: 0131 553 8411 – loth.northteamreferrals@nhs.scot
• South Edinburgh Team: 0131 537 6616 – loth.southteamreferrals@nhs.scot

Please note office hours for both North and South teams are 9am to 5pm Monday to Friday.

For those without SCI Gateway, please use the referral form

Rapid Response Team – please see separate RRT page.

If a patient does not meet the criteria for CMHT Older People involvement, then please can the referrer consider the options on the Resources and Links page.

HSCP Boundaries Older People’s Mental Health Edinburgh

Social Care Direct    0131 200-2324

Referrals for:

• Personal care including bathing or showering
• Meal preparation
• Prompting with medication
• Aids and adaptations such as handrails and bath chairs
• Respite care
• Long term care
• Day care
• Telecare

Crisis/Counselling

Mental Health Assessment Team

Edinburgh Crisis Centre                            0808 801 0414 (open 24hrs) 

Samaritans                                                         0131 221 9999 / 08457 909090

Cruse Bereavement Care                          0845 600 2227

Crossreach Counselling                             0131 552 8901

Dementia

24 Hour Dementia Helpline Freephone 0808 808 3000

Alzheimer Scotland, Action on Dementia – Provide advice and support 24 hours a day, Have wide range of printed booklets free for carers and people with dementia. Same number as above.

Post Diagnostic Support Link Worker- tel 0131 551 9350 – for people with diagnosis of dementia after April 2013 (referral from professional required)

Carer Support

VOCAL – 0131 622 6666 – support, advice and information for carers across Lothian – Also run dementia specific courses for carers.

Edinburgh Carer Support Team – 0131 536 3371 (NHS and CEC joint service) – self referral or by professional.

Benefits

Attendance Allowance Claim Pack- Tel- 0345 605 6055.

Transport

Blue Badge and/or Taxicard – 0131 469 3891 (City of Edinburgh Council).