Protocol for managing Child & Adolescent Mental Health (CAMHS) out-of-hours referrals in Greater Glasgow & Clyde

The Nurse in Charge at Skye House will take initial responsibility for managing referrals of young people up to age 17 years (inclusive), except for paediatric inpatients in the Royal Hospital for Children.

Paediatric inpatient facilities will have direct access to the 2^nd on-call in Child and Adolescent Psychiatry whatever the age of the patient.

The Nurse in Charge will be able to offer advice to referrers, and where appropriate, signposting to alternative support services.

For young people requiring emergency mental health assessment, the Nurse in Charge can arrange this via the following options:

• Joint assessment by Nurse in Charge and 1^st on call doctor at local psychiatric hospital sites

• CAMHS Crisis Service (providing nursing assessment in Emergency departments across NHSGGC)
• Assessment by 2^nd on call doctor for under 12 year olds, presenting outwith hours of CAMHS Crisis Service. Patients presenting at Emergency Department will be seen by the Crisis Service initially.   

The Nurse in Charge, 1^st on-call doctor and Crisis Service, will have access to additional support and supervision from:

• 2^nd on call (higher trainee) in Child and Adolescent Psychiatry
• 3^rd on call Consultant in Child and Adolescent Psychiatry in Greater Glasgow and Clyde
• On-call Charge Nurse (for practical support during peaks in assessment activity)
• On call Senior Managers

Patients from other Health Board areas are generally not accepted unless presenting to a Greater Glasgow and Clyde Emergency Department or as a current inpatient. Referrers of patients resident in Glasgow and Clyde who present at sites in other Health Board areas should be advised to contact the CAMH Service for that area.

Referrals from other Health Boards may be considered if the referrer is a Consultant Child and Adolescent Psychiatrist seeking inpatient admission of a child or young person in an emergency. Inpatient units are hosted on behalf of national and regional commissioners. Consideration for admission to the inpatient units would depend upon the bed status and the nature of the referral and such referrals should be discussed with the on-call Consultant Child and Adolescent Psychiatrist for Greater Glasgow and Clyde.

In the event that no age appropriate bed is available within CAMHS in-patient units, consideration should be given to the most appropriate placement of the child or young person. Where appropriate (based on the patients age), the Nurse in Charge should make efforts to locate a bed within adult mental health services in the patient’s local board area. For younger children, who cannot safely be accommodated in an adult bed, discussion with the Senior Manager on call should take place, to discuss sourcing a bed in other young person’s units in Dundee or Edinburgh. Consideration must also be given to availability of staff to facilitate escort arrangements.

• Self referrals are not accepted.
• Referrals from staff at secure units are not accepted. Secure units should refer to GEMS.

Please note that we do not offer an Out-of-Hours service to Argyll and Bute patients but we will see any patient who presents to Inverclyde Royal Hospital Emergency Department Out-of-Hours.

The Royal Hospital for Children Switchboard will differentiate between under 12’s and 12-17 year olds; (i) redirecting under 12’s in NHSGGC to Royal Hospital for Children and (ii) directing calls relating to 12-17 year olds in NHSGGC to Nurse in Charge at Skye House.

During hours of Monday – Sunday 8pm-8am, patients will be assessed at presenting Emergency Department by the CAMHS Crisis Service. 

Outwith these hours, a safe and effective system to transfer patients between sites has been agreed:

*Patients with a Vale of Leven postcode will be assessed at Gartnavel Royal Hospital by the non-resident 1^st on call for General Adult psychiatry for Vale of Leven hospital. All other patients who are transferred to Gartnavel Royal Hospital for assessment will be seen by 1^st on call in General Psychiatry for Gartnavel Royal

The young person/carer will be told where to present to if a telephone call is made prior to presenting. Patients presenting with families or carers will be asked to make their own arrangements to travel to the appropriate site, unless there are clinical reasons to indicate that a Nurse escort is required. This is the responsibility of the referring clinician to determine.

For young people presenting alone who need to be transferred, the NIC from Skye House should be phoned and will take responsibility for organising Nursing staff to collect and accompany the young person to the appropriate site (only if the young person is agreeable to the transfer, is compliant with the assessment process and is not presenting with a known or suspected risk of violence or aggression). This service is for transfer only and is not for the purpose of providing a level of enhanced nursing observations for the young person once they have arrived at site of transfer. The transfer will be by taxi and will be accessed through either Ward 4, Royal Hospital for Children or Skye House budget code.

Detained patients will require a Registered Mental Health Nurse (RMN) escort for transfer and this will be organised by the NIC at Skye House

Sky House Nurse in Charge Out of Hours Protocol

If admission is required, the NIC at Skye House will identify available beds. In the first instance, a bed will be sought at Skye House or Ward 4, Royal Hospital for Children, dependent on the age of the child or young person. If a bed is not available (including pass beds), a bed should be sought in locality Adult Mental Health ward, or if no local bed available, appropriate contact should be made with one of the other two Young Person’s Units in Scotland.

The Consultant on call should contact the CAMHS Manager on call (via switchboard) for verbal agreement to admit a patient to a bed within a psychiatric hospital outwith NHSGGC. Out-of-Area Referral Form to be completed and submitted to the Clinical Director and Head of Service on the following working day.

The CAMHS Bed Manager should be updated the following morning by the NIC.

Out of Area Referral Application Form (Word document)

The Following process should be followed for patients presenting with Self Harm:

Some units within Greater Glasgow and Clyde where the young person will be assessed also provide services to adult psychiatric patients. It is important to assure the safety and protection of any young people who will attend an assessment at these sites.

Confirmation of suitability for assessment for young people from the sites has been obtained.

Royal Hospital for Children colleagues in medical paediatrics or the Emergency Department may be asked for urgent medical support for Ward 4 patients when the Higher Trainee is already committed to another task and medical input is required. If there is a psychiatric emergency and the 2nd on-call is not available, the 3rd on-call will be called.

It is the responsibility of the hospital to which the patient has been admitted to organise Nursing cover (principle set out in NHSGGC Psychiatric Emergency Plan) unless the patient has been transferred to the hospital by Skye House in which case the responsibility will lie with Skye House.

It would be expected that a psychiatric assessment by the 2nd on call would be made in the first instance to determine the level of nursing input required, unless this has been arranged in advance. If there are difficulties getting access to appropriate nursing input the On Call manager for GGC CAMHS should be contacted.

If psychiatric nursing support for a child or young person admitted to a ward in district general hospitals is required it is the responsibility of the hospital to which the patient has been admitted to organise Nursing cover (principle set out in NHSGGC Psychiatric Emergency Plan), unless the patient has been transferred to the hospital by Skye House in which case the responsibility will lie with Skye House.

It would be expected that a psychiatric assessment by the 2nd on call would be made in the first instance to determine the level of nursing input required, unless this has been arranged in advance. If there are difficulties getting access to appropriate nursing input, the on call manager for GGC CAMHS should be contacted.

Please follow the NHSGGC Policy on Lone Working (follow Hyperlink below to HR Connect).

NHSGGC : Lone Working

Nurse in Charge at Skye House can be the point of contact for CAMHS clinicians working out of hours. 

1^st   and 2^nd  on-call doctors, NIC and Crisis Service nurses should make sure that details of any clinical contact from the on-call period are given to the appropriate CAMHS team the next working day. This should include (i) a full mental state assessment, (ii) risk assessment and safety plan.  The NIC on duty at Skye House on the following day can co-ordinate this handover.

The CAMHS Bed Manager should be informed of any Out of Hours child and adolescent admissions.

Following an out of hours contact, the band 6 NIC will ensure there is an appropriate handover to the duty person in the Locality CAMHS team the following morning. Clinical notes should be entered directly into EMIS wherever possible, however if EMIS access is not available to the assessing clinician, written clinical notes can be scanned and e-mailed to the NIC e-mail account using a secure e-mail address. The NIC will then upload these to EMIS.

All CAMHS teams operate a duty rota, where a member of staff is available to deal with urgent referrals.

The band 6 NIC will, when required, contact and handover to the Intensive Community and Homebased CAMHS Service (ICAMHS) to pick up should this intervention, alongside Community CAMHS referral, be required. ICAMHS referrals should be emailed to ICAMHS administration support and copied to ICAMHS team lead and discussed further with the ICAMHS duty nurse at 9am.

Self Harm cases should be referred to ICAMHS or to their local Tier 3 CAMHS team (if they are open to them) who should make contact with the patient the following day.

The Paediatric Liaison Team based in the Royal Hospital for Children will see any young person admitted to RHC for psychiatric review.

The NIC will not be expected to create a new EMIS record if one has not already been created. New cases will be scanned and emailed to the relevant Duty person

The Nurse in Charge must gather the information below before making arrangements for assessment.

Many of the Out of Hours assessments can be completed by CAMHS Crisis Service at the Emergency departments where they initially present.

For referrals which require assessment at locality adult psychiatric hospitals, the NIC should ensure that the young person is directed to the appropriate hospital, depending on their postcode, and obtain the following information:

1. NAME
2. AGE
3. DATE OF BIRTH
4. ADDRESS
5. POST CODE
6. NAME OF REFERRER
7. CONTACT NUMBERS OF PATIENT AND REFERRER
8. OUTLINE OF PRESENTING PROBLEMS
9. DEGREE OF URGENCY
10. WHETHER KNOWN TO CAMHS
11. WHETHER KNOWN TO SOCIAL SERVICES

EMERGENCY ADMISSIONS: a referral form is required. Please also refer to the Out-of-Hours referral flow chart in the NIC Out-of-Hours Protocol. All potential admissions should be discussed with the consultant on call.

This number is only for use in an emergency where any of the following events are about to or have taken place and a Mental Health Officer is required:

• Emergency Detention Certificate
• Short Term Detention Certificate
• The nurses holding power has been applied

This service provides an emergency social care service for the 13 Local Authorities in the West of Scotland and provides such a service for all care groups, predominantly child care/child protection, mental health and frail adults, along with a number of other duties.

When requesting a Mental Health Officer from the service, the senior manager on shift will make the decision to release a Mental Health Officer whilst considering other statutory competing priorities and the expectation would be that an estimate of response time would be given.

It will be the duty of the Mental Health Officer from Standby, in the case of a detention having been made, or otherwise, to advise the relevant Social Work Area Office when office hours are resumed, of the intervention in each case and resulting outcome and requirement for further action. This information will be sent to the relevant Operations Manager for Mental Health in the relevant Area Team for Glasgow, and to the local office in the case of the other 12 Local Authorities.

In Glasgow the community sector child and adolescent teams all operate a Duty System whereby there is an available clinician on duty during office hours to take emergency phone calls. If required the Duty Worker will access the team consultant and if they are not available then there is a Greater Glasgow integrated child and adolescent day time rota which can be accessed by the community teams.

The CAMHS Tier 4 hub and Paediatric Liaison have internal duty systems relating to their own specialist group of patients.

CAMHS Daytime On-Call Protocol