Publication - Advice and guidance

Mental Health in Scotland: Improving the Physical Health and Well Being of those Experiencing Mental Illness

Published: 3 December 2008
Topic: Health and social care
ISBN: 9780455973323

Annex C Guidance for QOF mental health indicators - NHSGG&C

EXAMPLE GUIDANCE FOR QUALITY AND OUTCOMES FRAMEWORK MENTAL HEALTH INDICATORS (FOR GPS IN NHS GREATER GLASGOW AND CLYDE 2007)

Suggested Actions	Potential Responses
SUGGESTED HEALTH PROMOTION and PREVENTION ADVICE (MH9)
1.Note CVD medical history, family history and systems enquiry (Chronic Disease Register Status)	1.Pursue any suspicious symptoms identified on systems enquiry
2. Health related behaviours Smoking; record if current smoker (quantity), ex-smoker or never smoked Diet; record if problematic Physical activity; ask if thinking about becoming more active COMPLETE HEART HEALTH RISK SCORE	2. Health related behaviours-intervention advice If wishes to discontinue offer referral, e.g.; local groups, community pharmacies Offer general dietary advice Aim to accumulate 30mins or more of moderate intensity physical activity over the course of most days per week. Can offer referral to Live Active or GCVS if appropriate
3. Risk behaviours Alcohol; record details and pattern of consumption Illicit drugs	3. Risk behaviours If suspect hazardous drinking offer advice/referral If suspect hazardous illicit drug use discuss liaising with CMHT or CAT
4. Check if additional health promotion activity required flu /pneumococcal vac, sexual health including cervical smear and contraception, eye screening, dental check, etc	4. Additional health promotion Discuss arrangements where indicated
5. Height/Weight/ BMI Record details Plus waist circumference	5. Height/Weight/ BMI If BMI is 25-30 (overweight) - offer advice If BMI > 30 (obese) - discuss referral to local weight management services
6. Pulse and blood pressure Record rate and regularity of pulse Record blood pressure	6. Pulse and blood pressure If irregularly irregular refer to *AF Guidelines* If systolic >140 or diastolic >90 refer to *hypertension guidelines* and consider adding to the *hypertension register*
7. Investigations Glucose - it is good practice to check if; diagnosis in schizophrenia spectrum, or on any antipsychotic medication (cross check prescription with BNF), and no measurement recorded in the past 12 months (fasting lab sample preferred) CVD medication assessed Lipids - It is good practice to check if; on any antipsychotic medication (check BNF) and no measurement recorded in past 12 months. Total Cholesterol, High Density Lipids and Low Density Lipids.	7. Investigations Repeat and/or refer to diabetes diagnostic criteria and *diabetes MCN referral guidelines* if abnormal result obtained Repeat and/or refer to *cholesterol guidelines* for management if abnormal result obtained and set cholesterol screening interval to annually.
MEDICATION MANAGEMENT (MH9, MH4, MH5)
8. Prescribing accuracy Check if prescribed and taken medication matches recent CMHT communication Note any significant side effects Note willingness to continue on prescribed medication 9. If on Lithium; Check level if no record of level in therapeutic range in past 6 months Check serum creatinine and TSH if no result recorded in past 15 months	8. Prescribing accuracy Liaise with CMHT if significant problems identified 9. Action if levels/creatinine/ TSH result unsatisfactory when on Lithium
CARE PLANNING AND CO-ORDINATION WITH SECONDARY CARE (MH6, MH7) (refer to CPA and ICP documentation if in existence)
10. Determine current social care and occupational needs 11. Review CMHT/voluntary sector/family input and co- ordination arrangements 12. Discuss early warning signs (relapse signature) and action to be taken in the event of relapse Signposting and Referral Information Recorded	10. Discuss liaison with CMHT if significant problems identified 11. Discuss liaison with CMHT/voluntary sector/family if significant problems identified 12. Discuss liaison with CMHT/voluntary sector/family if significant problems identified
PROACTIVE FOLLOW UP (MH7)
13. Recall within 14 days if fail to attend review appt.	13. If fail to attend three appts liaise with CMHT (if under their care) or send a fourth invite.

Suggested Actions

Potential Responses

SUGGESTED HEALTH PROMOTION and PREVENTION ADVICE (MH9)

1.Note CVD medical history, family history and systems enquiry (Chronic Disease Register Status)

1.Pursue any suspicious symptoms identified on systems enquiry

2. Health related behaviours

Smoking; record if current smoker (quantity), ex-smoker or never smoked
Diet; record if problematic
Physical activity; ask if thinking about becoming more active

COMPLETE HEART HEALTH RISK SCORE

2. Health related behaviours-intervention advice

If wishes to discontinue offer referral, e.g.; local groups, community pharmacies
Offer general dietary advice
Aim to accumulate 30mins or more of moderate intensity physical activity over the course of most days per week. Can offer referral to Live Active or GCVS if appropriate

3. Risk behaviours

Alcohol; record details and pattern of consumption
Illicit drugs

3. Risk behaviours

If suspect hazardous drinking offer advice/referral
If suspect hazardous illicit drug use discuss liaising with CMHT or CAT

4. Check if additional health promotion activity required

flu /pneumococcal vac, sexual health including cervical smear and contraception, eye screening, dental check, etc

4. Additional health promotion

Discuss arrangements where indicated

5. Height/Weight/ BMI

Record details

Plus waist circumference

5. Height/Weight/ BMI

If BMI is 25-30 (overweight) - offer advice
If BMI > 30 (obese) - discuss referral to local weight management services

6. Pulse and blood pressure

Record rate and regularity of pulse
Record blood pressure

6. Pulse and blood pressure

If irregularly irregular refer to AF Guidelines
If systolic >140 or diastolic >90 refer to hypertension guidelines and consider adding to the hypertension register

7. Investigations

Glucose - it is good practice to check if;

diagnosis in schizophrenia spectrum, or on any antipsychotic medication (cross check prescription with BNF), and no measurement recorded in the past 12 months (fasting lab sample preferred)

CVD medication assessed

Lipids - It is good practice to check if; on any antipsychotic medication (check BNF) and no measurement recorded in past 12 months. Total Cholesterol, High Density Lipids and Low Density Lipids.

7. Investigations

Repeat and/or refer to diabetes diagnostic criteria and diabetes MCN referral guidelines if abnormal result obtained
Repeat and/or refer to cholesterol guidelines for management if abnormal result obtained and set cholesterol screening interval to annually.

MEDICATION MANAGEMENT (MH9, MH4, MH5)

8. Prescribing accuracy

Check if prescribed and taken medication matches recent CMHT communication
Note any significant side effects
Note willingness to continue on prescribed medication

9. If on Lithium;

Check level if no record of level in therapeutic range in past 6 months
Check serum creatinine and TSH if no result recorded in past 15 months

8. Prescribing accuracy

Liaise with CMHT if significant problems identified

9. Action if levels/creatinine/ TSH result unsatisfactory when on Lithium

CARE PLANNING AND CO-ORDINATION WITH SECONDARY CARE (MH6, MH7)
(refer to CPA and ICP documentation if in existence)

10. Determine current social care and occupational needs

11. Review CMHT/voluntary sector/family input and co- ordination arrangements

12. Discuss early warning signs (relapse signature) and action to be taken in the event of relapse

Signposting and Referral Information Recorded

10. Discuss liaison with CMHT if significant problems identified

11. Discuss liaison with CMHT/voluntary sector/family if significant problems identified

12. Discuss liaison with CMHT/voluntary sector/family if significant problems identified

PROACTIVE FOLLOW UP (MH7)

13. Recall within 14 days if fail to attend review appt.

13. If fail to attend three appts liaise with CMHT (if under their care) or send a fourth invite.

Abbreviations

CMHT*	=	Community Mental Health Team
CAT	=	Community Addictions Team
CPA	=	Care Programming Team
ICP	=	Integrated Care Pathway
SW	=	Social Worker
AF	=	Atrial Fibrillation
BNF	=	British National Formulary
MCN	=	Managed Clinical Network
GCVS	=	Glasgow Council for Voluntary Services
MH	=	Mental Health Clinical Indicator Number from QOF

* Some CMHTs may not have an integrated Social Work team. In these circumstances liaison with Social Work colleagues may have to be done separately.

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