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Children and young people’s mental health service (CAMHS) out of hours service procedure

Contents

  1. Aim
  2. Scope
  3. Link to overarching policy
  4. Procedure
  5. Links to associated document
  6. References
  7. Appendices

1 Aim

This procedure is designed to ensure all children and young people have timely access to mental health assessments out of office hours where the urgent criteria is met across the care group localities (Rotherham, Doncaster, and North Lincolnshire).

Out of hours is defined as 8pm to 8am every day.

2 Scope

The out of hours service is provided for all children and young people (under 18 years of age) across the trust that require an urgent mental health assessment out of hours.

Referrals will be accepted from the following:

  • accident and emergency departments (A and E), also referred to ‘urgent, emergency care centre’ in Rotherham
  • paediatric wards (or any other ward with a 0 to 18 year old admitted)
  • section 136 suite
  • police via section 136 or A and E

This procedure is for use by all child and adolescent mental health service (CAMHS), approved mental health practitioners (AMHPs) and for information for all agencies listed above who refer to the out of hours CAMHS mental health service and adult liaison teams in acute trust (for their understanding of the processes for those under 18 years of age).

3 Link to overarching policy

This procedure should be read in conjunction with the clinical risk assessment and management policy.

4 Procedure

Out of hours assessments will take place in general hospitals (urgent or emergency care services) and in-patient wards, including adult mental health. No home visits will take place out of hours due to safe lone working. See the lone working policy and paragraph 4.10 for further information. Police have access to a police surgeon and liaison and diversion service (locality specific) in the first instance if a young person is in custody but where they have mental health concerns or feel that a young person requires a hospital bed, then they can access out of hours clinicians for advice.

The on call clinician will not be expected to make phone calls to patients at home or to children’s homes to offer support. In exceptional circumstances, calls may be made where this has been previously agreed for a time limited period identified within a care plan and shared with CAMHS practitioners in advance.

4.1 Referral process

Referring agencies (A and E and wards) will contact single point of access (SPA) who will contact the Tickhill Road Hospital switchboard in the first instance on 01302 566999, who will then contact the on call clinician. CAMHS clinicians will contact the referrer and triage the referral by telephone to determine suitability and necessity to attend the ward or A and E to undertake an assessment.

CAMHS clinicians will assess all young people up to the age of 18 years who meet the urgent criteria (see 4.2). Assessments may be face to face or via telephone. Telephone assessments may be based on the referral information, presentation and risks identified and it may be in the best interest of the young person or family to reduce length of time in urgent or emergency care centre environment.

For young people aged 17 years and 6 months and above will be given the choice of CAMHS or adult services.

4.2 Criteria for urgent referral

Clinicians will assess either in person or via the telephone if the following conditions are present:

  • following an episode of self-harm
  • where a young person has attended A and E following an episode of self-harm where there was suicidal intent, and they are refusing to be admitted to the paediatric ward
  • if a young person presents in A and E or on the ward and has expressed suicidal thoughts and has an active plan for suicide but have not currently self-harmed, for young people under 16 years old an admission to paediatric ward should be considered
  • where there is evidence of major thought disturbance suggestive of a psychotic episode

To undertake a comprehensive assessment and discharge plan a parent or carer will be required to be present; in the case of children in care, this may be a social worker, foster carer or residential worker.

If the clinician conducts a telephone triage and deems that it is an inappropriate referral, then the referring clinician should make a referral to the appropriate agency such as social care. It is not the responsibility of the out of hours CAMHS clinicians to forward on inappropriate referrals.

4.3 Options for referrers

  • A young person may be discharged from A and E without a CAMHS assessment with the agreement that the CAMHS Crisis team contact the family or young person the next working day and triage as per referral process, this may include arranging an urgent assessment, routine follow up or signposting and discharge. The referrer needs to contact the CAMHS Crisis team as per paragraph 4.6 to inform of the circumstances of presentation and to discuss immediate safety planning.
  • A young person may be admitted to a paediatric ward without a CAMHS assessment, this should always be with the support and supervision of a parent or carer unless there are safeguarding issues, or the parent or carer is increasing the risk. When considering admission, the clinician should refer to the NICE guidance for self-harm NG225 (2022) (opens in new window).
  • The young person will then be assessed when they are fit for assessment the following day by the CAMHS crisis team.
  • Consent to care and treatment and discharge should be considered, see trust policy.

4.4 Outcomes from assessment

Following assessment there are a range of alternative options, dependent on the presentation and risk management plans, these may include:

  • discharge home with a safety plan and follow up contact agreed
  • referral to social care, where there are safeguarding concerns or specific concerns about parent or carers ability to safely care for a young person
  • where there are no mental disorders identified by the CAMHS practitioner and this is recorded in the in-patient or A and E patient records and information passed to the named worker or department who will follow up as necessary
  • admission or continued admission to an inpatient ward with agreed re-assessment or follow up

4.4.1 Tier 4 admissions

If the outcome of a CAMHS out of hours assessment is that a young person requires a tier 4 bed, attempts should be made to ensure the young person is kept in the least restrictive environment possible and kept safe with risks to self or others managed or agreed with whoever is responsible for their safety. Mental health wards should be used as a last resort where there is an acute onset of a severe mental illness or there is imminent risk to self or others, this is a decision made in conjunction with senior managers on call.

Tier 4 admissions are processed as per NHS England operating handbook protocol and completion of the referral form to access tier 4 (formerly referred to as ‘form 1’).

For South Yorkshire residents:

  • in the first instance a referral form to access tier 4 is completed, and contact made with the on call psychiatrist for the Becton centre via 0114 271 7000 to discuss and email the detail to scn-tr.becton.centre@nhs.net and copied to the local NHS England case manager

For North Lincolnshire residents:

4.5 Record Keeping

Where CAMHS Crisis team practitioners attend a ward or department, they will input assessment summary and risk management and discharge plan in the hospital, patient notes or records.

The CAMHS on call report on SystmOne should be completed for all out of hours contacts, including those where the young person has not been assessed.

A FACE risk assessment and detailed contact or session note should be completed on all assessed young people. Please see appendix I recording of referrals and activity on SystmOne for detail of how to register a patient not known to CAMHS on SystmOne. The CAMHS Crisis team must be informed of any assessment the following working day. Correspondence to general practitioners (GPs), patient, family or carers will be followed up by the CAMHS crisis team or the locality team (if the person is open to them) and not by the assessing out of hours clinician.

Patients that have been open to CAMHS prior to November 2017, their Silverlink records can be accessed via the ‘stalis’ archive facility in SystmOne.

4.6 Handing over cases or information

Following an assessment, the clinician who has completed the out of hours assessment is responsible for handing over the information to the relevant team via SystmOne task and where urgency requires, telephone contact is made with the service to ensure that the case is followed up with urgency.

For those individuals who are already open to CAMHS, the CAMHS crisis team should hand over all details relating to the presentation and discharge plans along with any requirements for their follow-up.

Please see contact information below for all 3 CAMHS services and the community eating disorder service.

4.6.1 Rotherham

4.6.2 Doncaster

4.6.3 North Lincolnshire (NL)

4.6.4 Eating disorders

If staff believe that psychiatric medical assessment is required, make this clear within the handover of the case, further information may be required from the appropriate psychiatrist.

4.7 Out of area patients

Where a young person has presented to a local hospital out of hours, the CAMHS Crisis team will hand over the information to the CAMHS team where the young person resides or is registered with a GP. Young people and families need to be made aware that follow up arrangements may be different to those expected within RDaSH services.

4.8 Gillick competency or mental capacity

If a young person under 16 is deemed to be Gillick competent or is aged 16 or over and has mental capacity and able to consent to admission and treatment, an assessment can be completed without an adult present. If staff, make the decision that a young person is Gillick competent or has mental capacity to make the decision this needs to be clearly recorded in your record keeping and how that decision has been reached. However, it is acknowledged that on discharge from A and E or the ward, there is a vital safeguarding role and responsibility for the parents or carers. This should be explained to A and E and ward staff with the suggestion that it would be advantageous to wait until the next working day where there is no responsible adult present so that the locality team can assess and liaise with family and appropriate services. If there are any concerns or suspicions that there may be safeguarding issues, then the local out of hours safeguarding team should be contacted for checks to be made and also possible advice on any recommendations or interventions. If safeguarding concerns are highlighted these need to be handed over to the locality teams. Staff may consider possibly discussing in safeguarding supervision to support reflection. See consent to care and treatment policy for more detail around capacity and lack of capacity in relation to consent.

4.9 Staff capability

CAMHS staff undertaking out of hours assessments should be band 6 and above clinical staff.

No clinician will be put on the out of hours rota until they have completed the capability framework (appendix G).

4.10 Lone working

All assessments will be conducted within a contained, staffed environment, generally either within A and E or on the paediatric ward or general adult ward. Whilst assessments may be undertaken alone, there will be access to other health professionals and support from crisis services if necessary.

Appendix H key contact details contains the details of the three general hospitals and other useful contact details.

If a clinician is called out, they should contact the CAMHS on call manager to inform them of the need to travel and should agree arrangements for ‘reporting in’ arrangements to them when they have returned home following an assessment to ensure that they have returned home safely. Staff should have completed a Lone worker risk assessment that reflects their need to undertake this work.

4.11 Transport

If called out, staff claim (via on-line e-expenses) the distance being identified to and from home address, identifying that this was outside usual duty hours. If staff require access to taxi services due to medical, fatigue or ability reasons, this will or can be arranged via Tickhill Road switchboard (on 03000 213 000).

4.12 Claiming time back, rest periods, payment

When called out (either in person or telephone) to complete an assessment, the time taken (from leaving to returning home, telephone liaison and record keeping) can be claimed. This is done by confirming the time of the call, venue and duration. This should be shared with the clinician’s team manager for processing at the end of each month.

On call during the week may mean that staff are expected within their work environment the next day. If the clinician is unable to safely attend for work the next day, they will inform the team manager of this, with an expected time of attendance and provide feedback in relation to the case.

Whilst there is no formal requirement to provide any additional rest time when call outs have been less than 5 hours in duration during the week (11 hours of ‘rest’), the team managers can provide flexibility in working hours to ensure that staff have appropriate rest and are capable of returning to work safely and effectively.

Following being on call the clinician will designate time to administration or on-line training to avoid the potential need to cancel patients, this is supported by team managers.

CAMHS clinicians can claim back time or additional overtime payment for a callout, they will inform the CAMHS service manager of the following:

  • date of the call
  • location called to (Rotherham, Doncaster or Scunthorpe)
  • duration of the call out, time from leaving home to returning, including administrative time

On occasions, the processing of payments for interventions can be provided over the telephone, this would include assessments and formulation of cases where it was not possible or relevant to attend the location. As with all other clinical interventions these will be recorded on SystmOne.

Full time CAMHS Clinicians are expected to provide a minimum of 2 slots in a month period, dependent on the number of shifts required to be covered and the availability of staff. The on-call allowance paid for staff is calculated by sessions, the maximum number required is 1 in 9. Out of Hours CAMHS managers are expected to provide 4 to 5 slots in a month (with weekend or bank holiday days being counted as 2 slots). Both clinicians and managers are responsible for providing additional cover if any clinical activity is arranged for the following day. If the rota has been amended to provide cover, then the manager of the rota needs to update the switchboard, to update their rota. If the rota manager is unavailable the clinician will need to do this. The switchboard is contactable on:

Managers and clinicians are required to update the switchboard when changes have been made to contact telephone numbers.

4.13 Bank holidays

Clinicians on call on a bank holiday are entitled to time back to reflect the time on call (irrespective of if they are called out). The team manager will authorise the additional time owing following a bank holiday and add the time to annual leave entitlement.

4.14 On call manager

In addition to an on call clinician, there is an ‘on call CAMHS manager’, which is either a senior clinician, pathway lead or CAMHS manager. The on call manager is contacted via the Tickhill Road switchboard 03000 213 000).

If the on call clinician has made arrangements to go out and assess a child or young person they need to contact the out of hours manager to make them aware of the arrangements, and particularly the time they intend to go out. Following the assessment, the clinician will need to contact the on-call manager to make them aware they have completed the assessment and are back home safe. Failure to contact the on-call manager following an assessment will result in the manager contacting the last known location or next of kin to ascertain the safety and whereabouts of the clinician.

The on call clinician can also contact the on-call manager for advice and assistance surrounding the assessment process and the management of risk. The on call manager will not be expected to attend any assessment. Any advice or instructions that are passed to the clinician from the manager will be done so on the information that they have received from the clinician.

The on call manager can be contacted to support any professional differences with other agencies if required and they can support with the liaison between services.

The on call manager can be contacted to discuss any case, for support in decision making and access to tier 4 beds or any other planned admission. In the event of a young person requiring access to an adult mental health bed or further organisational advice and support, they can contact the director on call via switchboard.

In exceptional circumstances where the on-call clinician is not available and there is a scenario where a young person is at risk, the on call manager will undertake any activities to support the welfare of a young person; this includes liaison and support to other services or escalating concerns to senior managers.

4.15 Rota for on call

The rota will be available for staff at least 4 weeks in advance of the start date. Prior to this staff will be asked for details of availability or non-availability within a set period of time for the rota to be developed.

6 References

7 Appendices

Please see admission, transfer and discharge manual including patient flow and out of hours (OOH) procedures webpage for appendices attached to this procedure.

  • Appendix G Capability framework for on call CAMHS clinicians
  • Appendix H Key contact details
  • Appendix I Recording of referrals and activity on SystmOne

Document control

  • Version: 4.1.
  • Unique reference number: 250.
  • Date ratified: 20 February 2024.
  • Ratified by: Clinical policies review and approval group.
  • Name of originator: CAMHS Crisis team manager and nurse consultant.
  • Name of responsible individual: Director or nursing and allied health professionals.
  • Date issued: 26 February 2024.
  • Review date: 31 December 2026.
  • Target audience: All clinical staff in children’s care group CAMHS service.

Page last reviewed: April 23, 2024
Next review due: April 23, 2025

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