Implementation of referral spells using MHSDS data
Referral Spell methodology
As part of the September 2024 performance publication in the Mental Health Services Monthly Statistics publication series, a new set of metrics will be introduced which utilise a new methodology which groups sets of individual referrals into a referral spell. Using this methodology, a spell is defined as starting at the point the first referral that is in scope is received by a provider. From this point, other referrals can form part of a referral spell where they are open concurrently or where the next referral opens within 5 days of the previous referral ending. A spell is closed when the last referral is recorded as closed (using the service discharge date).
Only referrals which fall within the inclusion and exclusion criteria will make up the referral spell. Where a person has other open referrals within the same provider that are not in scope for either of the two pathways, these referrals will not be included in the spell.
Data which utilises the referral spell methodology will be published in a separate CSV file in the Mental Health Monthly Statistics publication and also will be denoted by Metric IDs that begin with “MRS”.
From November 2024 data onwards, some small changes to the methodology have been introduced. These include:
- Incorporating Referral Rejection Date and Referral Closure Date in the referral-spell derivation section where Service Discharge Date is not available.
- Deprecated crisis team type codes have been excluded from the CYP metric, excluding historic referrals with a team type of either A03 (Crisis Resolution Team) or A04 (Home Treatment Service).
Clock stops
The Clinically led Review of Standards recommended a move away from ‘contact based’ metrics and towards understanding when meaningful activity has taken place, which is why we will be reporting on the wait from referral to help starting and not just the first or second contact that a patient has with a service. The full details of the clock stop criteria are found in the Exclusion and Inclusion criteria below but the clock stops are made up of a combination of a baseline outcome, care plan, intervention and assessment being recorded for the referral spell. Once all of these elements are recorded, the full clock stop is recorded.
The full clock stop is recorded for children and young and people once there has been 1 contact, a baseline outcome recorded and either a care plan, SNOMED intervention code, ADHD or ASD assessment SNOMED code recorded. For adult community waiting times, the full clock stop is recorded once a person has 2 contacts, a baseline outcome, a SNOMED assessment code and either a SNOMED intervention code or care plan recorded.
Inclusion and exclusion criteria for children and young peoples and adult community mental health waiting times metrics:
Children and young people
| Age | Age 0-17 | Only including referrals where at at start of referral was between 0 and 17. |
|---|---|---|
| Providers | Excluding digital providers | Excluding referrals with provider code DFC or S9X2N. |
| Inpatients | Non-inpatient only | Excluding any referrals with an associated hospital spell record. |
| Team Types | Excluding crisis care referrals | Exclude where team type is either: Crisis Resolution/Home Treatment Service (A02), Psychiatric Liaison Service (A11), 24/7 Crisis Response Line (A19), Health Based Place of Safety Service (A20), Crisis Café/Safe Haven/Sanctuary Service (A21), Walk-in Crisis Assessment Unit Service (A22), Psychiatric Decision Unit Service (A23), Acute Day Service (A24), Crisis House Service (A25), Paediatric Liaison Service (C05). Exclude where team type is Single Point of Access service (A18) AND Clinical response priority is recorded as either Emergency (1), Very Urgent (4) or Urgent/Serious (2). |
| Team Types |
Excluding referrals in-scope of |
Exclude where team type is Early Intervention in Psychosis (A14) AND primary reason for referral recorded as suspected first episode of psychosis (01). |
| Team Types |
Excluding referrals in-scope of |
Exclude where primary reason for referral is recorded as eating disorder (12), unless the team type is recorded as either SPA (A18) or MHST (F01). |
| Team Types | Exclude LD activity | Exclude where team type is either: Epilepsy/Neurological Service (E02), Specialist Parenting Service (E03), Enhanced/Intensive Support Service (E04). |
| Clock stops: contact | Child or young person is seen | Date of first care contact or indirect activity. Where care contact must be:
|
| Clock stop: baseline outcome |
An outcome or experience |
The date of the first valid outcome assessment submitted to either the MHS606 or MHS607 tables of the MHSDS. Includes any accepted assessment list in the MHSDS Technical Output Specification. No requirement for the person score to be valid. |
| Clock stop: Care Plan | Formulation/care plan | Either the date that a care plan was created or last updated, depending on which happened soonest with the referral-spell. Includes any care plan records submitted to the MHS008 table of the MHSDS, as long as they can be linked to a care plan agreement record in MHS009. |
| Clock stop: SNOMED interventions |
Advice/Signposting/Consultation/ |
Must have a relevant SNOMED code recorded in the MHS202 Care Activity or MHS204 Indirect activity tables of the MHSDS. Relevant SNOMED codes include any from the psychological therapies, psychosocial interventions, or medication and physical therapies groups of the reference set. Either the earliest care contact date or date of indirect activity is used as the clock stop. |
| Clock stop: SNOMED Assessment | Specific assessments | For CYP, SNOMED codes in the assessments group of the SNOMED reference set do not count as clock stop with the exception of:
Only these two assessment codes can count as interventions which stop the clock for CYP. |
Adult community mental health
| Age | Age 18+ | Only including referrals where at at start of referral was 18 and over. |
|---|---|---|
| Providers | Excluding digital providers | Excluding referrals with provider code DFC |
| Inpatients | Non-inpatient only | Excluding any referrals with an associated hospital spell record |
| Team types | Only including referrals to core community MH teams | Include where team type is either: Primary Care Mental Health Service (A05), Community Mental Health Team - Functional (A06), Assertive Outreach Team (A08), Community Rehabilitation Service (A09), Psychotherapy Service (A12), Psychological Therapy Service (non IAPT) (A13), Personality Disorder Service (A16), Community Eating Disorder Service (C10). |
| Clock stops: contact | Person is seen | Date of first care contact where:
|
| Clock stop: baseline outcome | A baseline outcome is recorded | The date of the first valid outcome assessment submitted to either the MHS606 or MHS607 tables of the MHSDS. Includes any accepted assessment list in the MHSDS Technical Output Specification. No requirement for the person score to be valid. |
| Clock stop: Care Plan | Co-produced personalised care plan completed | Either the date that a care plan was created or last updated, depending on which happened soonest with the referral-spell. Includes any care plan records submitted to the MHS008 table of the MHSDS, as long as they can be linked to a care plan agreement record in MHS009. |
| Clock stop: SNOMED interventions | Clinical or social intervention started |
Must have a relevant SNOMED code recorded in the MHS202 Care Activity or MHS204 Indirect activity tables of the MHSDS. Note - for adult CMH the codes for 'Signposting' and 'Consultation' do not count. |
| Clock stop: SNOMED Assessment | SNOMED assessments | All adult CMH waiting times must have at least one SNOMED code from the assessments group of the reference set recorded in order to stop the waiting time clock. But this only applies to referral-spells which started after 1st April 2024 - i.e. waiting time periods that started before 2024-25 and had a care contact recorded prior to 1 April 2024 do not have to have a SNOMED assessment recorded to stop the clock. If the spell started prior to 1 April 2024 and had no contact recorded prior to 1April 2024 would still need a SNOMED assessment to stop the clock. |
Last edited: 13 January 2025 1:44 pm