NSFT Integrated Delivery Teams
Recovery Forum
Graham Abbott
June 2017
Mental Health Payment by Results
‘Clustering’
Organic
Psychotic
Disorder
Very Severe and Complex
Common Mental Health
Problems (Non-Psychotic)
Mild/ Moderate & Severe Common
Mental Health Problems (NonPsychotic)
Mental Health Clustering
Plain text
Cluster 1
This group has definite but minor problems of depressed mood, anxiety or other
Common Mental Health
Problems (Low Severity)
disorder but they do not present with any distressing psychotic symptoms
Cluster 2
This group has definite but minor problems of depressed mood, anxiety or other
disorder but they do not present with any distressing psychotic symptoms.
Common Mental Health
Problems (Low Severity with
Greater Need)
Cluster 3
Non-Psychotic (Moderate
Severity)
Cluster 4
Non-Psychotic (Severe)
Moderate problems involving depressed mood, anxiety or other disorders (not
including psychosis).
This group has definite but minor problems of depressed mood, anxiety or other
disorder but they do not present with any distressing psychotic symptoms.
Cluster 5
Non-Psychotic Disorders (Very
Severe)
Cluster 6
Non-Psychotic Disorders of
Over-valued Ideas
Cluster 7
Enduring Non-Psychotic
Disorders (High Disability)
Cluster 8
Non-Psychotic Chaotic and
Challenging Disorders
This group will be severely depressed and/or anxious and/or other. They will not
present with distressing hallucinations or delusions but may have some unreasonable
beliefs. They may often be at high risk for suicide and they may present safeguarding
issues and have severe disruption to everyday living.
Moderate to very severe disorders that are difficult to treat. This may include treatment
resistant eating disorder, OCD, where extreme beliefs are strongly held, some
personality disorders and enduring depression.
This group suffers from moderate to severe disorders that are very disabling. They will
have received treatment for a number of years and although they may have
improvement in positive symptoms considerable disability remains that is likely to
affect role functioning in many ways.
This group will have a wide range of symptoms and chaotic and challenging lifestyles.
They are characterised by moderate to very severe repeat deliberate self-harm and/or
other impulsive behaviour and chaotic, over dependent engagement and often hostile
with services.
Cluster 10
First Episode Psychosis
This group will be presenting to the service for the first time
with mild to severe psychotic phenomena. They may also
have depressed mood and/or anxiety or other behaviours.
Ongoing or Recurrent Psychosis
Cluster 11
Ongoing Recurrent Psychosis (Low Symptoms)
Cluster 12
Ongoing or Recurrent Psychosis (High Disability)
Cluster 13
Ongoing or Recurrent Psychosis (High Symptom
and Disability)
This group has a history of psychotic symptoms that are
currently controlled and causing minor problems if any at all.
They are currently experiencing a period of recovery where
they are capable of full or near functioning. However, there
may be impairment in self-esteem and efficacy and
vulnerability to life.
This group have a history of psychotic symptoms with a
significant disability with major impact on role functioning.
They are likely to be vulnerable to abuse or exploitation.
This group will have a history of psychotic symptoms which
are not controlled. They will present with severe to very
severe psychotic symptoms and some anxiety or depression.
They have a significant disability with major impact on role
functioning.
Psychotic Crisis
Cluster 14
Psychotic Crisis
Cluster 15
Severe Psychotic Depression
They will be experiencing an acute psychotic episode with
severe symptoms that cause severe disruption to role
functioning. They may present as vulnerable and a risk to
others or themselves.
This group will be suffering from an acute episode of
moderate to severe depressive symptoms. Hallucinations
and delusions will be present. It is likely that this group will
present a risk of suicide and have disruption in many areas
of their lives.
Very Severe Psychosis with Poor Engagement
Cluster 16
Dual Diagnosis
Cluster 17
Psychosis and Affective Disorder - Difficult to
Engage
This group has enduring, moderate to severe psychotic or
affective symptoms with unstable, chaotic lifestyles and
coexisting substance misuse. They may present a risk to self
and others and engage poorly with services. Role functioning
is often globally impaired.
This group has moderate to severe psychotic symptoms with
unstable, chaotic lifestyles. There may be some problems
with drugs or alcohol not severe enough to warrant dual
diagnosis care. This group have a history of non
concordance, are vulnerable & engage poorly with services.
Cluster 18
Cognitive Impairment (Low Need)
Cluster 19
Cognitive Impairment or Dementia
Complicated (Moderate Need)
Cluster 20
Cognitive Impairment or Dementia
Complicated (High Need)
The person in this cluster will have mild cognitive impairment or early
stage dementia or organic brain disorder.
The person in this cluster will have problems with their memory and/or
other aspects of cognitive functionality resulting in moderate problems
in their daily living and coping skills.
The person in this cluster may have significant problems looking after
themself & may have a risk of self-neglect/harm to others.
The person may have high levels of anxiety, depression or psychotic
symptoms and their behaviour may pose serious challenges to others.
They may be at risk of their care arrangements breaking down.
Cluster 21
Cognitive Impairment or Dementia
(High Physical or Engagement)
The person in this cluster will have significant problems looking after
themselves and may have a risk of self-neglect/harm to others.
The person’s physical health may be very poor possibly resulting in
frailty. Their behaviour may significantly challenge others and they may
be at risk of their care arrangements breaking down.
Children and families pathway
• This pathway is primarily for children aged 13 and under,
and their parents or carers.
It places emphasis on the prevention of future mental
health problems by addressing
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parenting difficulties,
attachment problems,
mental health problems and
neurodevelopmental difficulties in early childhood.
Young People’s Pathway
• Young people with emerging and severe mental health
problems who are aged between 14 and 25 years, on
the basis of severity and reduction of function, in
context of emerging, acute or chronic illness.
• Adult - Clusters 5-17
Adult Pathway
• The adult pathway is for people aged 25 and over whose mental
health needs are more severe than can be met by the Wellbeing
service (Cluster 5-17).
• It includes adults over the age of 65 who do not have dementia
or complexities associated with ageing and individuals who have
mild learning disabilities with a coexisting Mental Health
Problem.
• It incorporates assertive outreach and early intervention in
psychosis for those adults who have a first episode aged 25 or
older.
Enhanced community pathway
• This is in addition to the existing Suffolk Wellbeing Service,
offering a broader social inclusion approach, aiming to make
links with local resources to reduce isolation and stigma.
• This pathway is for people with moderate depression or
anxiety, people with personality disorders and people who
have a psychotic illness but are stable.
Complexity in Later Life
• This pathway is for people of all ages with dementia and
people with mental health problems who also have
complexities associated with ageing.
Neuro-developmental Pathway
• This pathway is for people aged 14 and over with
mental health problems and/or challenging behaviour
and severe, profound and multiple learning disabilities,
autistic spectrum disorders or attention deficit
hyperactivity disorder.
Eating-Disorder Pathway
• This pathway is for individuals presenting with anorexia
nervosa, bulimia nervosa, binge eating disorder and
related diagnoses.
• There is an under 18’s team and a separate smaller
adult team.
Services for people likely to go into, or
who are leaving hospital
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Step-up care
Home Treatment
Alternative to admission Beds
Acute Admission
NSFT Dual Diagnosis Policy Quote (p8)
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Mental Health: Drug and alcohol use can often make mental health
assessment difficult – but not impossible, therefore intoxication and/or
recent use of alcohol/drugs is not a contraindication for mental health
assessment.
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Mental health and substance misuse practitioners should, wherever
possible and with the consent of the service user, discuss the case prior to
making a referral to their partner service.
Areas considered may include:
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The extent of the mental health difficulty
The extent of the drug and/or alcohol misuse
Current risks and needs
Current care-plan
History
Current presentation
Service user aims for treatment