Question for professionals...

[elementofsurprise]

What on earth is the criteria for access to the CMHT?

And is it possible to get hold of it somehow?

I know it differs a bit by area, but what is your local policy/what would be a general policy? I just can't seem to work it out, and if I ask I get confusing replies that don't actually make sense (and further undefined things like "serious mental illness"). But so many people seem to be told they "don't meet the criteria" without a hint why that is!

I suspect the policy is highly discriminatory so they can't make it public...

Hope I'm wrong.

I had PND and got seen within 2 weeks. I mainly had anxiety really.

What do you mean by highly discriminatory? Because they do discriminate between those with serious MH problems and those without...

I suspect they do as most health services and divide referrals into 'urgent' or 'routine' based on the severity of symptoms.

In our Trust it's decided on a case by case basis by a MDT triage process.
As far as I know there's no set criteria.

I know I can be discharged from CMHT between bouts of being unwell as long as I'm fairly functional (the bar is pretty low) and have insight and am complying etc so maybe the reverse helps form the criteria in my area?

The definition of severe mental illness is
taken from “Mental Health Policy Implementation Guide: Community Mental Health Teams.” DOH:
2002 and is outlined below:
Individuals who present with:
 Severe and persistent mental disorders associated with significant disability,
predominately psychosis such as schizophrenia and bipolar disorder.
 Longer-term disorders of lesser severity but which are characterized by poor treatment
adherence requiring proactive follow up.
 Any disorder where there is significant risk of self-harm or harm to others (e.g. acute
depression) or where the level of support required exceeds that which a primary care
team could offer.
 Disorders requiring skilled or intensive treatments (e.g. vocational rehabilitation,
medication maintenance requiring blood tests) not available in primary care.
 Complex problems of management and engagement such as presented by patients
requiring interventions under the MHA (1983).
 Severe disorders of personality where these can be shown to benefit by continued
contact and support.

It does vary from trust to trust, and there will be some people who don't necessarily meet the Department of Health's criteria, but the team discuss and decide to work with the person for a particular reason

A GP can refer you to a CMHT, and a Crisis Team could also start off a referral, although again this may vary between trusts.

Basically, if someone has a health need, caused by their mental illness, which cannot be managed by primary health services like the GP, this would be considered as an appropriate referral to a CMHT following a team discussion.

It's the same as physical health - it's based on clinical need. If a GP thinks a patient needs to be seen by a specialist then they will refer. With mental health it's the same - the GP refers to a psychiatrist or CMHT if there is a need. If you think you should be referred then you need to talk to your GP about this. Our surgery has a mental health nurse attached to the practice.

In the cmht where I used to work, gp referrals were discussed in an mdt meeting each week to decide if the patient needed cmht input (rather than gp/ primary care psychology/ another psychiatric service). There wasn't a written criteria as far as I was aware (except patients who weren't suitable for cmht as needed another specialist service), it was case by case consideration.

If you mean for on going care coordination by the cmht (having a long term care coordinator), I think the general criteria was patients with severe needs in multiple areas of life, e.g. mental health, housing, finances etc. 'Severe' obviously depended on the resources available, more patients wanted this level of support than there were resources available.

Thanks for the replies, especially Rubberduckies

msrisotto By "highly discriminatory" I meant based on prejudices of CMHT staff rather than a set criteria. It does actually seem that this may happen if things are done "case by case" rather than a specific criteria.

I have been referred several times but they have asked my GP not to refer me again - he has, but they reject the referral.

I know I'm not the only one who has been baffled by the mystery criteria and not being able to access any help.

I am quietly and calmly heading to a very dark place and trying to check if there is anywhere to turn at all.

Gu What about patients who needed ongoing support/therapy but not help in all areas? (eg. once settled in a flat with benefits being paid so no urgent need in that area.)

Also you mention "if the patient needed cmht input (rather than gp/ primary care psychology/ another psychiatric service)" - what if primary care psychology (is this IAPT?) won't take the person and says they need CMHT/more intense/longer term help?