Brief Guidance on Mental Health Clustering

·  All patients must be clustered after a maximum of two community contacts or two occupied bed days.

·  Red Rules Plus- at Initial Cluster Assessment for patients new to services or those who are re-presenting to services you should ensure the patient scores in the red range specified for the cluster, and then in the orange range on key scales before assigning to the cluster. Red rules and transition review periods are available on the Trust intranet http://www.leicspart.nhs.uk/_KnowledgeDevelopment-PaymentbyResults.aspx

·  Cluster 5 and upwards will be in secondary care; clusters 1-4 generally to be in primary care. Typically, primary care IAPT services manage cluster 1-4 and secondary psychological therapies services manage cluster 4 upwards. There needs to be some discretion / flexibility at the boundary.

·  Patients only to be assigned to cluster 11 when they are in a period of recovery, experiencing full or near full functioning and are being prepared for discharge. Where there is disability with impact on role functioning then cluster 12 should be considered. (Patients can be discharged from any cluster)

·  Scheduled cluster review is not required until the maximum review period for the cluster is approaching. Do not change cluster at scheduled review if the patient is still receiving the care package / pathway for that cluster. And do not step patients down to a lower severity cluster unless they meet the entire step down criterion as stated in clustering booklet.

·  Patients discharged from inpatient unit may remain in their original cluster (i.e., at the time/prior to admission) but not necessarily so. A severely depressed patient e.g. cluster 5 may develop psychotic symptoms, step up to cluster 15 and an acute admission and then step down to cluster 3 at discharge. The key issue to consider relates to those who were in clusters 7, 8, 10, 16 or 17 pre acute admission when a strong case can be made to revert to those clusters at discharge as the step down criteria for the original cluster have yet to be met.

·  Inpatients generally will not be on cluster 1-4 and 11. For example clusters 3 and 4 can include mild or moderately depressed patients whose risk of serious self harm may trigger an admission.

·  Cluster 7 is only appropriate for patients with chronic, non psychotic presentations or those with bipolar disorder where the presentation is one of repeated episodes of depression.

FINAL clustering guidance

jg/gk/fb – 1.10.2013