New Craigs Hospital (Guidelines)

 “To provide treatment when a person’s illness cannot be managed in the community, and where the situation is so severe that specialist care is required in a safe and therapeutic space. Admissions should be purposeful, integrated with other services, as open and transparent as possible and as local and as short as possible.[i]”

New Craigs provides a focused, time-limited assessment, care and treatment service for patients with suspected/known severe mental disorder (as defined by the Mental Health (Scotland) Act, 2003) whose needs cannot be met at home. To work towards discharge to a less intensive setting as safely, quickly and effectively as possible[ii][iii] will be the aim of the admission.

[i] Commission to review the provision of acute inpatient psychiatric care for adults in England (2016). Old Problems; New Solutions: Improving acute psychiatric care for adults in England.

[ii] Scottish Government (2016). Health and Social Care Delivery Plan.

[iii]Scottish Government (2017).  Mental health strategy 2017-2027.

What patients can expect

The Health professionals will conduct an initial assessment of the patients need by means of a clinical interview and review of all available information. Every attempt will be made to build a therapeutic relationship from the earliest possible stage.  The assessment process will be as collaborative as possible, aiming for effective involvement of other professionals in the multidisciplinary team, the patient and relevant others.

Confidentiality and its limits will be discussed at the earliest possible opportunity, together with discussion around how information is held and shared[i]. 

Before admission every reasonable effort to identify and utilise any relevant documentation including advanced statements, previous assessments and any existing management or action plans. For example, crisis self management plans, wellness recovery action plans (WRAP) and Care Programme Approach (CPA) plans.

On arrival for assessment the Mental Health Assessment Unit nurse or doctor will explore the purpose, potential benefits and risks of admission, together with the purpose, potential benefits and risks of choosing alternative care and treatment options.

[i]General Medical Council (2009). Confidentiality

Before any admission assessment of risk and development of a risk management plan will be started.  It is important to identify the risks associated with hospital admission and discuss with the patient and relevant others[i]. 

The role, purpose and limitations of an acute inpatient setting should be discussed and understood by the Mental Health assessment Unit, the patient and relevant others.

There may be occasions when there is disagreement between the patient, relevant others and the assessors around whether hospital admission is the most appropriate care and treatment option.  If this is the case careful documentation of the disagreement should be made and discussion with senior colleagues will be sought with the aim of obtaining a pragmatic solution.

[i] General  Medical Council (2008). Consent: patients and doctors making decisions together.

The main indications for admission to New Craigs Hospital are:

• Assessment of suspected/known severe mental disorder which cannot be carried out in a less intensive setting.
• Treatment – to initiate or change treatment suspected/known severe mental disorder which cannot be carried out in a less intensive setting.
• Management of acute risks to self and/or others- related to the suspected/known severe mental disorder which cannot be carried out in a less intensive setting.

At the point of admission, the possible diagnoses, outline care and treatment plan will be discussed with the patient and relevant others.   In addition an outline plan of likely post-discharge care and treatment arrangements will be discussed including an Estimated Date of Discharge.  If the diagnosis is unclear the most likely working diagnosis should be documented.

A full assessment of any co-morbid physical disorder will be made at the point of admission.

All patients will be reviewed by a consultant psychiatrist within 24hrs of admission.  This will be a multi-disciplinary review where possible.

Care and treatment plans will take into account any relevant local and national guidelines and any variance from these guidelines will be documented together with the rationale.

Members of the multidisciplinary team including the Responsible Medical Officer will be clearly identified during the admission process or as soon as is reasonable and practicable.

Admission to hospital is a potentially distressing and possibly even traumatic experience for the patient, carer and relevant others. All staff involved in the admission process should be aware of this potential and should provide appropriate orientation, information and support for the patient, relatives and carers during the admission. The first 72 hours of admission are particularly important in this regard.

If the Mental Health assessment unit and/or your consultant have arranged admission to New Craigs you will be shown to the ward and introduced to the nursing team and other staff.

The main aim of the care and treatment in New Craigs is to help you recover and return home as soon as possible. You can expect the Doctor in charge of your care to estimate how long it is expected for you to remain in hospital and set an expected date for you to return home.

Your signs and symptoms will be assessed, including a physical examination and routine investigations, e.g. blood tests and ECG,   and together with the information provided by you and your relatives/carers the doctor in charge of your care will make a preliminary diagnosis according to the current to the International Classification of Disease.

This will direct the treatment you will then receive. All specific treatments in New Craigs follow the best available evidence contained in the guidelines from;-

• NICE ( National Institute of Clinical Excellence)
• SIGN (Scottish Intercollegiate Guidelines Network)
• Maudsley Guidelines
• British Association of Pharmacology

Following a period of treatment if you are recovering as anticipated we will plan with you for your discharge home and if required, community based follow up.

If, however, there has been no or minimal recovery the diagnosis will be reviewed and a trial of alternative treatment will be considered.

Reviews with the professionals involved in your care normally take place a minimum of once weekly.

We will treat information about your problems and life experience in strictest confidence.  It is important to understand, however, that the Mental Health Service aims to work in partnership with other people and services involved in your care, in order to deliver care and treatment which is as effective as possible.  To ensure effective joint working, information about you will be shared between members of the Mental Health Service and other professionals involved in your care and treatment, including your general practitioner.  Some of your personal details, including your name, address, date of birth, gender and diagnosis will be entered on a computer database.  This database is password protected and is covered by the Data Protection Act.

The principle of confidentiality has limits - in very exceptional cases the health professional may decide that it is necessary to share information and “break” confidentiality. These include situations involving serious risk to the safety of the patient or others, or child protection issues, or where there is a risk of a serious crime being committed, or where there is a legal duty such as a court order requiring sharing of information.  For example, if a patient discloses information that indicates that a person’s life is at risk unless preventative action is taken then the health professional would be duty bound to act on this information and, if necessary, share information even if the patient did not wish this to happen.  In this kind of circumstance the health professional would, if possible, explain to the patient the reasons for sharing information beforedoing so.

If you have any further queries about confidentiality, please do not hesitate to speak to the health professional when you meet with them.

Confidentiality and Mental Health service form (NHS Highland intranet access required)

Crisis self-management plan (NHS Highland intranet access required)