The broad objective of the MHAU is to support patients to effectively self-manage their lives and health, thereby reducing distress and improving functioning. MHAU aims to achieve this objective by providing a single point of access to an integrated, community assest-based approach to care, facilitating an efficient journey through mental health services. Meeting this objective can include:

• A detailed mental health assessment, including mental health risk assessment, with appropriate treatment and follow-up arrangements. Clinical contact can be in person, by telephone or by video consultation platforms.
• MHAU crisis intervention would be normally up to 72hrs for those patients assessed as being appropriately managed in the community with intensive support to manage current illness and to enable community based alternatives to hospital care.
• Maintaining a recovery focus in all approaches and making appropriate use of each patient’s personal resources and strengths in every care and treatment plan
• Recognising the continuum of mental health and developing crisis and relapse prevention plans with each patient at the earliest appropriate stage in the care and treatment process
• Working with the patient’s own social system in assessment, crisis resolution and longer-term care and treatment when appropriate and effective
• Making appropriate and effective use of community resources in care and treatment plans Liaising with other statutory and non-statutory service providers as appropriate in order to deliver an integrated service
• Providing a range of interventions which reflect the patients’ needs and preferences, and based upon best available evidence of effectiveness
• Promoting the principles of recovery, personal responsibility, autonomy, and self-management
• Avoiding contributing to harmful dependency on services by promoting autonomy and independence through a strengths-based approach and positive risk management.
• Engaging with members of the patient’s social system assessing their need for support as appropriate.
• Undertaking mental health assessments referred from A&E departments (once any relevant physical health assessment and interventions have been completed) Mental health assessment will not be delayed when the patient has capacity to participate and where medical investigation results are pending which will not impact on decisions relating to medical admission or are likely to be negative.
• Enabling police and ambulance to have direct access to mental health professionals where appropriate and in line with agreed processes
• Ensuring local provision for access to emergency mental health assessment is maintained across the 24 hour period 
• Undertaking a specific role within the New Craigs bed management SOP for General Adult admission beds, with staff on duty taking on the tasks from the SOP relevant to the team when this is required. (See departmental standard operating procedures)
• Ensuring that all referrals for admission to New Craigs Hospital must have input from the MHAU and / or the flow co-ordinator to ensure all viable alternatives to admission are considered. These discussions will take place at the daily site run downs where there will be representation from the multi-disciplinary teams who can assist with the decision making process.

Data collection and monitoring

The MHAU / Mental Health Services will collate information on referral sources and assessment outcomes which will be broken down to individual referring services. The aim is to utilise this for a data analysis for service development / governance and feedback to the Scottish Government as part of unscheduled care.

The service is primarily intended for people experiencing an acute mental health presentation and / or who are in crisis, who potentially require immediate mental health treatment and / or admission to New Craigs.

The greater part of assessments are nurse led undertaken by specialist mental health nurse practitioners.

Section 297 assessments are conducted in conjunction with medical colleagues. 

Medical input to the MHAU will be provided by the junior duty doctor system that is in place within New Craig’s Hospital. Consultation and advice to the MHAU will be provided by the consultant psychiatrist on call. The point of contact for all other agency or services will be the MHAU who can liaise with the consultant psychiatrist as necessary. The consultant psychiatrist on call cannot provide direct consultation to other agencies or services without escalation to an appropriate level of seniority within that agency or service eg consultant physician or Police Inspector.

Following completion of an assessment, MHAU staff will complete an SBAR which will be made available on SCI Store. The service can dispense medication where required, with this being documented in the SBAR as per staff guidance. This option will predominantly apply to patients who do not require admission, prescribing will be time limited with ongoing prescribing remaining the responsibility of the GP / locality team.

Patients with dementia, Learning Disability, acquired brain injury or CAMHS are not appropriate for the MHAU.

• Specialist Mental Health Nurses work on a rota basis covering a 24 hour period.
• There are 3 paramedics with additional mental health training who sit within the team.
• There will be administrative support provided during working hours.
• When staffing is reduced to below safe staffing numbers then the Police and SAS will be notified that
  there will be a delay in responses to their triage calls.
• The duty doctor and duty consultant psychiatrist will be called upon to support the team with emergency assessments.

• GP’s
• General Adult CMHT
• Older Adult CMHT
• Drug and Alcohol Recovery Service Police Scotland
• Scottish Ambulance Service (SAS)
• Forensic Medical Examiner (FME)
• A&E within General Hospitals

Given the high risks associated with the patient group, referrals to MHAU will not be accepted without an in person or video consultation assessment by the referrer.

The MHAU staff will complete the MHAU referral form, gathering information over the phone in order to start the assessment process, including risk assessment, prior to the patient attending the MHAU.
(See departmental standard operating procedures)

MHAU can only offer a service to patients experiencing an acute mental health presentation
potentially requiring immediate mental health treatment and / or admission to New Craigs. Patients
who do not meet these criteria should follow the relevant alternative care and treatment pathway.

Police Scotland triage referral to MHAU (for patients who would otherwise have required to be transferred to A&E)

• Police Scotland, from within NHS Highland geographical area (excluding Argyll and Bute), can make a referral to the MHAU following an initial in person contact with the patient if police staff have significant concerns for the patient’s safety or wellbeing so long as the person has not been charge with an offence Patients must be able to participate in the triage process. Patients cannot be referred or triaged where there is significant impairment due to alcohol or drug consumption that impacts their ability to participate meaningfully in the assessment
• The police must remain with the patient until a decision is made that it is safe for officers to leave
• In cases where there is evidence of a significant acute physical health condition, this should be reviewed at A&E before any referral to MHAU
• If the MHAU determine, following triage, that an in person assessment at the unit is required then the Police will escort referrals to the MHAU. Police and the MHAU will carry out a joint risk assessment as to the requirement to remain with the patient until the outcome of the assessment
• If following discussion and agreement with nursing staff there is no requirement for continued Police presence, Police can leave the unit. However, if nursing staff request Police presence they should remain until outcome of the assessment is known
• Police may also prioritise their presence if there are already sufficient Police Officers in the MHAU to  ensure the safety of the patient and others within
• Where patients do not wish to transfer to MHAU but following telephone triage with the MHAU an assessment is indicated, this would need to be escalated to GP, MHO service or the relevant mental health professional if the patient is involved with services
• For section 297 assessments arrangements will continue as at present, with contact being made from Police Scotland with the MHAU as per relevant pathway.

• SAS from within NHS Highland geographical area (excluding Argyll and Bute) can make a referral to the MHAU following an initial in person contact with the patient if SAS staff have significant concerns for the patient’s safety or wellbeing.
• Patients must be able to participate in triage process. Patients cannot be referred or triaged where there is significant impairment due to alcohol or drug consumption that impacts on their ability to participate meaningfully in the assessment.
• The SAS must remain with the patient until a decision is made that it is safe for SAS staff to leave.
• In cases where there is evidence of a significant acute physical health condition, this should be reviewed at A&E before any referral to MHAU.
• If the MHAU determine, following triage, that an in person assessment at the unit is required then the SAS, where appropriate, will either escort referrals to the MHAU or the patient can make their own way there.
• SAS staff should not leave New Craigs until the patient has been transferred into the care of MHAU.
• Where patients do not wish to transfer to MHAU but following telephone triage with the MHAU an assessment is indicated, this would need to be escalated to GP, MHO service or the relevant mental health professional if the patient is involved with services.

• All patients referred to MHAU must have a completed telephone referral to provide details to the MHAU as outlined above.
• Patients must be able to participate in the assessment process. Medical staff in A&E will be available for guidance and advice if the patient’s physical state deteriorates during the assessment period in the MHAU.
• Medical investigation results which may be relevant to the mental health assessment should be completed and available prior to assessment
• Mental health assessment should not be delayed when the patient has capacity to participate and where medical investigation results are pending which will not impact on decisions relating to medical admission or are likely to be negative.
• The Mental Health Liaison Team (MHLT) based at Raigmore are not currently part of the MHAU and will continue to operate daily between 9am and 5pm. The MHLT will assess patients whilst they are at Raigmore following presentation to A&E. Outside of their working hours, referrals for emergency assessment will be directed to the MHAU. The MHAU have no input into the general wards but can offer support and professional advice to clinicians

There are 3 mental health paramedics that sit within the MHAU.

Operational hours:

• Monday: 18:00 to 04:30
• Tuesday to Thursday: 18:00 to 06:00 
• Friday to Sunday:  24 hour cover

The MHPRU respond to people who have contacted 999 for Ambulance support for a mental health need. The vehicles are dispatched by Ambulance Control Centres and are staffed by a Paramedic with additional mental health training.

The specialist nurses within MHAU provide enhanced professional support to the paramedics and can, if appropriate, attend alongside the paramedic.

• Referrals for consideration for admission for clients on CMHT caseload’s should be discussed with the sector RMO and in their absence the duty consultant and ADS completed and sent to the flow coordinator or in their absence the MHAU. 
• The flow coordinator, or MHAU in their absence, will send a link to the referrer to join one of the twice daily New Craigs site run down (Monday to Friday) on Microsoft Teams to discuss the referral and a decision to be made.

To support alternatives to admission

• High risk patients requiring specific clinical interventions over a weekend or public holiday can be referred via the twice daily New Craigs site run down (Monday to Friday) on Microsoft Teams. MHAU can be contacted to provide the details of how to access the meeting. The SBAR and relevant risk assessment should be made available via SCI store prior to the site run down.
• MHAU crisis intervention would be normally up to 72hrs over a weekend or public holiday. The associated documentation for this intervention would be uploaded on to SCI via an SBAR format for the community teams to access.
• NHS24 OOH’s CPN are accessed by clients calling 111

NHS24 mental health calls are embedded within MHAU.

The MHLT respond to NHS24 calls on the weekend and public holidays between 09:00 to 17:00.