Factors Influencing Triage Decisions in Mental Health Services

By Grigg, Margaret; Herrman, Helen et al. | Australian Health Review, May 2007 | Go to article overview

Factors Influencing Triage Decisions in Mental Health Services


Grigg, Margaret, Herrman, Helen, Harvey, Carol, Endacott, Ruth, Australian Health Review


Abstract

The aim of the study was to identify the factors influencing the timing of an assessment after contact with a triage program in a community-based area mental health service in Australia. Triage decisions apparently were influenced by several groups of factors: patient characteristics; the source and mode of the contact with triage; and to a large extent by mental health service factors including the training, supervision and support of triage workers and the perceived availability of an assessment. While demand factors such as patient characteristics influenced the triage decision, supply factors also played an important role.

Aust Health Rev 2007: 31(2): 239-245

TRIAGE INCORPORATES rapid assessment, problem identification, determination of acuity and the deployment of the required resources to respond to the person's health needs. It aims to identify emergent or life-threatening disorders, regulate the flow of patients through a service and use resources efficiently. It may be provided face-to-face, over the telephone, or through the use of technology such as the Internet. Triage is used in a range of health settings that require the accurate prioritisation and categorisation of patient treatment.

The use of triage in access to mental health care has had limited study. Patient characteristics, general medical practice and the psychiatric system may all influence the triage decision.1'2 Emergency psychiatric services have evolved in some service settings to ensure that the people in urgent need can gain access to mental health care quickly. While emergency models can be effective,3 their effectiveness also appears to be influenced by the overall mental health system within which they are located.4

Triage programs have their origins in emergency medicine. More recently, they have been used in primary care5 and managed care.6 The evaluation of NHS Direct, a 24-hour general health triage service staffed by nurses, demonstrated that telephone triage is widely used, callers mostly follow the triage advice, and there are few adverse outcomes. However, it had little impact on the utilisation of other health services or overall cost.7"9

Mental health services in Australia are relatively well resourced10 and the national mental health policy and plan are acknowledged globally as providing leadership in community-based care and integration with general health care.11'12 Nonetheless, the demand for treatment from mental health services exceeds the available supply,13'14 and there is substantial unmet need for mental health care more generally.15 While there has been much debate about how mental health resources should be allocated, and calls for increased funding to expand services,16 there has been limited exploration of the processes used by mental health services to respond to demand.

Mental health treatment in Australia is provided mainly by general practitioners with public sector mental health services (MHS) providing consultation, and direct treatment and care for those with more serious and complex problems. Entry to a specialist MHS in Australia relies on a triage process that decides on the priority of referrals, directs programs to manage emergencies quickly, and reduces the unnecessary use of resources.17 Triage typically involves a patient or other person in a face-to-face or telephone contact with a mental health professional that determines whether and how quickly a person will receive a mental health assessment.

This study was conducted in Victoria where MHS are part of mainstream acute health services organised in geographically defined catchment areas. Access to the MHS, including acute inpatient care, case management and rehabilitation programs, relies on successfully negotiating a triage process. The aim of this study was to identify the factors that influenced whether, and how quickly, an assessment is provided after contact by or about a patient with a mental health triage program. …

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