Mental health and telephone triage

So when you are triaging somebody with a mental health problem and they probably can not describe what is happening to them or they do not want to talk, how would you get over that?

Obviously, mental health calls make up a big part of our workload, particularly in the out-of-hours period and it is usually because the patient, who is probably known to mental health services, can not access the appropriate care in the out-of-hours period, so we do get a lot of these. The important thing, Mark, is to treat this patient like every other patient, allow them to speak. It may be that they are that emotional and agitated that you need to reassure them, calm them down, let them know that you are taking everything seriously and you want to be there to help them but you need to understand what the main problem is this evening. It needs to be based on basically what is the risk, the perceived risk, during that consultation. Are they at risk of harming themselves? Do they have a plan, like a suicidal ideology? Are they doing any self-harm, take an overdose? Have they wounded themselves? If there is any suggestion of any self-harm or overdose, then obviously, they need to be seen in the emergency department. It may be that the patient responds to you during the consultation and you may be able to speak to appropriate services.

Again, it is a huge skill to master because you are not physically looking at them. It is not the same as I am in the consulting room doing a face-to-face consultation. So it does take a lot of skill. What we say is treat the mental health patient the same as every other patient. Make sure you get as much information. It is always good to find out what kind of medications they are on because it can... And the dose as well. It can give you an indicator of how their condition is being managed and what stage it is at. But you just treat them the same as every other patient, to be honest, Mark.

You are asking questions but you are getting no answers but the patient is clearly on the other end of the line but just not talking.

Again, coming back to the perceived risk at that time. If you think the patient has got a plan to commit suicide and the line has suddenly gone dead, then you would need to escalate this to the emergency service, initially to the ambulance service and pass this call to them as a mental health patient, potential suicide in progress and then they will probably involve the police as well. What you would also need to do after this call is to submit an incident report about a vulnerable adult and probably do a safeguard and referral to the local safeguarding board as well.