RCP-SoPW 2019 – Vital role of word triggers in flagging up mental health cases

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by Rachel Pugh 

Knowledge of the correct trigger words is vital in ensuring that a patient with suspected psychiatric symptoms is seen by a mental health professional.

Consultant psychiatrist at the Princess of Wales Hospital, Bridgend, Dr Robert Colgate underlined to physicians the importance not only of knowing the red flags in mental health, but also of using the right language to seek referrals to colleagues in another specialty, in his presentation at the joint conference in Cardiff of the Royal College of Physicians/Society of Physicians in Wales.

Dr Colgate said: “Using the right words makes a great difference in talking to other medical specialities.”

He emphasised that specialist advice should always be sought if a medical practitioner is faced with a patient displaying any of the following red flag symptoms:

* Elevated or grandiose mood

*  Suicidal thoughts or preparation

*  Psychosis - particularly linked with aggressive command hallucinations or orders.

It is also important to understand the workings of the mental health triage system or referral algorithms in operation. Colgate made reference to the Australia Mental Health Triage Scale, with its five-point colour-coded structure, now labelled category B to F, with additional categories - Category A equating to immediate current actions endangering self or others and Category G being for advice or information only.

Natisha Sands and Stephen Epsom have worked to develop key competencies and decision algorithms at the University of Melbourne with a focus on adult mental health services. (1)

In the old age psychiatry department of the Princess of Wales Hospital, Bridgend, where Colgate works, a referral coordination pathway was set up in 2002, which operates 9-5, Monday to Friday and with services  focused around a referral algorithm using three categories of triage plus advice, risk assessment at the point of referral and a decision led by the clinical referral coordinator.

The system of referral into Bridgend has improved thanks to an extensive programme of training at all levels, beginning by improving and developing rapport including telephone triage techniques. The triage categories use an adapted hybrid scale based on the Australian Mental Health Triage scale and Old Age psychiatry algorithms.

Literature supports the use of robust guidelines to aid decision-making during triage in health and mental health settings in order to establish consistency and clarity in responding to callers. (2) Without such guidelines, First Responders report feeling overwhelmed, stressed and unsure of the accuracy of their decision-making during triage. (3)

Using triage scales inevitably produces decisions which will affect service staff activity and the decisions depend on the individual processing a physician’s referral. Colgate underlined the need to respect the decision made in a time of crisis and to concentrate of swift assessment with feedback left until later.