CMH Discharge / Transfer3

VISIT INFORMATION

Dear Colleague,

Thank you for continuing the care of [text name default=""] who was recently discharged from Community Mental Health. I am writing to update you on this patients mental health status and current functioning.

On [textarea cols=40 rows=1 default="date"], [text name default="NAME"] was admitted to our service, for [select value="voluntary|involuntary"] outpatient treatment of: [checkbox value="Neurodevelopmental Disorder|Schizophrenia Spectrum Disorder|Bipolar Disorder|Depressive Disorder|Anxiety Disorder|Obsessive-Compulsive Disorder|Trauma and Stress Related Disorder|Dissociative Disorder|Somatic Complaint Disorder|Feeding and Eating disorder|Elimination Disorder|Sleep-wake Disorder|Sexual Dysfunction|Conduct Disorder|Substance Abuse Disorder|Neuro-Cognitive Disorder|Personality Disorder|Paraphilic Disorder"].

-- Other concerns identified at initial assessment --

[checkbox value="nil|symptoms associated with a mental illness|intrusive negative thoughts|physical illness|death of friend|death in the family|death of a partner|coping with poor health|coping with partners poor health|adjusting to stage of life|withdrawing from substances|personal upheaval|divorce|separation from partner|relationship problems|imprisonment|poverty|personal injury|marrital discord|dismissal from work|marital reconciliation|retirement|change in health of a family member|pregnancy|sexual difficulties|gain a new family member|business readjustment|change in financial status|arguments with others|mortgage|debt|work stress|child leaving home|trouble with in-laws|lack of achievement|partner's employment status|school starting|school ending|change in living conditions|revision of personal habits|trouble with the boss|trouble with parents|change in work hours|change in work conditions|change in residence|change in school|church|religion|change in social activities|money worries|change in sleep habits|change in family structure|change in eating habits|vacation|Holiday stress|legal problems|problems with the weather|academic underachievement|target of bullying|discord with teachers|stressful work schedule|under-employment|hazardous work conditions|exposure to toxins|inadequate housing|homelessness|discord with lodgers|discord with neighbours|discord with landlord|insufficient welfare support|low self-esteem|physical abuse|sexual abuse|emotional abuse|a traumatic experience|parental pressure|unusual parenting practices|discord with healthcare professional|legal problems|victim of crime|immigrant status|minority status|marginalisation|social withdrawal and isolation|unable to make friends"][textarea cols=80 rows=10 default=""]

As a patient of Community Mental Health, [text name default="NAME"] was provided with [checkbox value="psychiatric medication|case management|community treatment order|clozapine management|diagnostic clarification|psychological assessment|psychotherapy|liasing with medical services|education around substance misuse|liasing with legal justice services|responsing to patient crisis|mental state monitoring|welfare checks|coordinating multiple services|carer support and education|psychoeducation|encouraging D&A services|psychosocial support referral|peer support|referral to rehab services|NDIS application|housing support|employment support|support with specialist medical service|supportive counselling|carer support|group therapy|safeside counselling referral|Pt advocacy|liaising with trustee and guardian|treatment planning"] [textarea default=""]. 

Clinical Impression:

On discharge, the severity of [textarea cols=40 rows=1 default="diagnosis"] was assessed as: [select value="not at all ill|almost fully recovered|mildly ill|moderately ill|markedly ill|severely ill|among the most extremely ill patients"]; which, compared to the patient's condition on admission, I rate as: [select value="very much improved|much improved|minimally improved|no change|minimally worse|much worse|very much worse|unable to be assessed"].

RISK ASSESSMENT on DISCHARGE

-- Suicide --

The patients suicide risk state is [checkbox value="higher than|similar to|lower than"] their usual baseline of risk. 

The patients risk status is [checkbox value="higher than|similar to|lower than"] the general population, and [checkbox value="higher than|similar to|lower than"] other patients in our service setting.

Foreseeable changes in suicide risk: 

[textarea default="Nil"]

Available risk resources accessible to the Pt: 

[textarea default="Help line numbers, Acute Care Team, PRN meds, Friends, Family, Counsellor, Community Mental Health Clinician, Disability Support Worker, NGO Caseworker, Distraction strategies"]

-- Other Risk Concerns --

[textarea default="Nil"]

Discharge Medications: [textarea cols=80 rows=40 default=""].
 
Discharge plan: [checkbox value="provided patient the details of the expected time and date of discharge|established carer’s capability and willingness to assist|arranged for sufficient quantities of medication to last until the next consultation|checked that the patient understands the purpose, dosage, frequency and side-effects of the medication|discussed the expected recovery path and confirmed understanding|confirmed necessary follow-up appointments with the patient's healthcare provider|arranged travel assistance|provided details of the patient's medical follow-up appointments|provided contact details for community mental health services and follow up arrangements|provided contact details for private mental health services and follow up arrangements|educated the patient about signs of possible relapse and what to do|provided the patient with emergency contact numbers|provided the patient with a self-management plan (including coping strategies)|provided the patient with a crisis management plan|confirmed community support arrangements including referrals to other services / programs"]
[textarea cols=80 rows=40 default=""]

If you have any questions regarding this patient, please feel free to contact me.

Kind Regards,


CLINICIAN
ROLE
Community Mental health
TELEPHONE
 
SUMMARY of CARE

[checkbox value="psychiatric medication|case management|community treatment order|clozapine management|diagnostic clarification|psychological assessment|psychotherapy|liasing with medical services|education around substance misuse|liasing with legal justice services|responsing to patient crisis|mental state monitoring|welfare checks|coordinating multiple services|carer support and education|psychoeducation|encouraging D&A services|psychosocial support referral|peer support|referral to rehab services|NDIS application|housing support|employment support|support with specialist medical service|supportive counselling|carer support|group therapy|safeside counselling referral|Pt advocacy|liaising with trustee and guardian|treatment planning"] [textarea default=""]

FORMULATION

[text default="The patient"] is a [text default="age"] year-old [select value="female|male"] who lives [checkbox value="alone|with friends|with partner|with family|with strangers|with other patients"] in [checkbox value="private rental accomodation|a share house|a privately owned house|a privately owned unit|government housing|supported accomodation|a SIL house|an NGO supported home|a transient rough-sleeping lifestyle"] in [text default="SUBURB"]. Pt was referred for treatment by [checkbox value="the adult inpatient mental health unit|the acute care team|a GP|a private psychiatrist|family"]. [text default="NAME"] has been a patient of Community Mental Health since [text default="DATE"].

[text default="The patient"] presents with a diagnosis of [checkbox value="Neurodevelopmental Disorder|Schizophrenia Spectrum Disorder|Bipolar Disorder|Depressive Disorder|Anxiety Disorder|Obsessive-Compulsive Disorder|Trauma and Stress Related Disorder|Dissociative Disorder|Somatic Complaint Disorder|Feeding and Eating disorder|Elimination Disorder|Sleep-wake Disorder|Sexual Dysfunction|Conduct Disorder|Substance Abuse Disorder|Neuro-Cognitive Disorder|Personality Disorder|Paraphilic Disorder"] that includes symptoms of [checkbox value="overactive, aggressive, disruptive or agitated behaviour|non-accidental self-injury|problem drinking or drug-taking|mania|cognitive problems|problems associated with hallucinations and delusions|problems with depressed mood|phobias|anxiety|obsessive-compulsive disturbance|stress|dissociative experiences|somatoform concerns|eating difficulties|sleep disturbance|sexual dysfunction|problems with relationships|problems with activities of daily living|problems with living conditions|problems with occupation and activities"] [textarea default=""]

[checkbox name="prosu" value="Progress towards discharge is promoted by:"][conditional field="prosu" condition="(prosu).is('Progress towards discharge is promoted by:')"] [checkbox value="treatment responsiveness|reduction of symptoms|increased autonomy|remission of illness|Pts active role in recovery|connectedness to friends and family|problem-solving skills|coping skills|ability to adapt to change|a sense of purpose or meaning in life|good social skills|ability to manage feelings of anger|motivation towards education|motivated to work|good overall health|access to mental and physical health care|healthy fear of risky behaviours and pain|hope for the future and optimism|sobriety|medical compliance|sense of the importance of health and wellness|impulse control|strong sense of self-worth|internal locus of control|access to a variety of clinical interventions|help seeking behaviours|resiliency|a supportive partner|a supportive family|being a parent|strong relationships, particularly with family members|opportunities to participate in and contribute|living in a reasonably safe and stable environment|sense of responsibility and duty to others|being a pet owner|intolerant attitude towards deviant behaviour|above average intelligence|having good academic grades|having a positive social orientation|having highly developed social skills|having the ability to plan ahead|having realistic expectations for the future|being religious|being connected to family|being connected to supportive adults outside the immediate family|ability to discuss problems with others|sharing activities with friends and family|having the consistent presence of a suportive other|involvement in pro-social activities|having positive role models|having affective relationships which are strong, close and prosocially oriented|being committed to learning and self improvement|being committed to work|having high needs for achievement|having non-deviant peers|having peer groups that do not condone antisocial behaviour|involvement in pro-social activities|exposure to positive parenting practices"][textarea cols=80 rows=5 default=""][/conditional].

RISKS

Suicide Risk State: [checkbox value="higher than|similar to|lower than"] the Pts usual baseline of risk.

Suicide Risk Status: [checkbox value="higher than|similar to|lower than"] the general population, and [checkbox value="higher than|similar to|lower than"] other Pts in the current service setting.

Foreseeable changes in suicide risk: 

[textarea default=""]

Available resources immediately accessible to the Pt: 

[textarea default="Help line numbers, Acute Care Team, PRN meds, Friends, Family, Counsellor, Community Mental Health Clinician, Disability Support Worker, NGO Caseworker"]

Other known risks to be aware of:

[textarea default="None foreseeable, self-harm, violence, vulnerablity, absconding, harm to children, other"]

Diagnosis: [checkbox value="Neurodevelopmental Disorder|Schizophrenia Spectrum Disorder|Bipolar Disorder|Depressive Disorder|Anxiety Disorder|Obsessive-Compulsive Disorder|Trauma and Stress Related Disorder|Dissociative Disorder|Somatic Complaint Disorder|Feeding and Eating disorder|Elimination Disorder|Sleep-wake Disorder|Sexual Dysfunction|Conduct Disorder|Substance Abuse Disorder|Neuro-Cognitive Disorder|Personality Disorder|Paraphilic Disorder"] that includes symptoms of [checkbox value="overactive, aggressive, disruptive or agitated behaviour|non-accidental self-injury|problem drinking or drug-taking|mania|cognitive problems|problems associated with hallucinations and delusions|problems with depressed mood|phobias|anxiety|obsessive-compulsive disturbance|stress|dissociative experiences|somatoform concerns|eating difficulties|sleep disturbance|sexual dysfunction|problems with relationships|problems with activities of daily living|problems with living conditions|problems with occupation and activities"] [textarea default=""]

ISSUES IDENTIFIED AT ASSESSMENT

[checkbox name="acaperf" value="Academic;"][conditional field="acaperf" condition="(acaperf).is('Academic;')"] in particular, the patient [checkbox value="frequently fails tests|struggles to keep up with peers|complains that the subject matter is too difficult|asserts that extracurricular activities are interfering with academic performance|lacks order and system in study|is disorganized and careless|lacks neatness|is rarely/never prepared|does not seek help when appropriate|copies from peers|engages in cheating/plagiarism|has poor attendance"] [textarea cols=80 rows=5 default=""][/conditional]

[checkbox name="sofac" value="Social;"][conditional field="sofac" condition="(sofac).is('Social;')"] in particular, the patient [checkbox value="is a loner|relates poorly to others|tends to isolate|does not fit in|feels excluded by others|is easily influenced and highly suggestible|engages in risky activities with peers|verbally criticizes peers|verbally criticizes caregivers|starts conflict without provocation|bullies and attempts to control others|does not respect rights and property of others|does not participate in group activities|interacts inappropriately with peers|is sexually inappropriate|is noncompliant with reasonable requests|frequently resists and disobeys authority|refuses to complete work assignments|does not follow rules and procedures|is socically disruptive|engages in attention seeking behaviours|is overly demanding of attention from others|has frequent tantrums in groups|frequently acts the clown|plays pranks on others|is overly dependent on others|timid/shy/dependent/anxiety-prone|is not accepted by others||does not sustain friendships|is an object of scorn/ridicule|is scapegoated/picked on|does not defend self when attacked|ostracized|social isolation|social withdrawal"] [textarea cols=80 rows=5 default=""][/conditional] 

[checkbox name="conduct" value="Conduct;"][conditional field="conduct" condition="(conduct).is('Conduct;')"] in particular, the patient [checkbox value="is verbally aggressive|frequently interrupts|starts fights|purposely agitates/disturbs/disrupts others|bullies and intimidates|frequently teases|attempts to manipulate|is overactive|is frequently inappropriate|cannot sit still and is generally restless|has numerous disciplinary offences|is malicious|is cold and calculating|lacks empathy and warmth|is cruel and punitive|has little respect for authority|is generally considered a troublemaker|is aggressive and generally violent|is destructive of own/others property|initiates physical fights|hits caregivers|is antagonistic|is frequently disobedient|is negativistic|is oppositional|is arguementative|talks back/mouthy|is defiant of authority|lies in regard to chores/homework/
house rules|complies only when threatened|is stubborn|is immature|demonstrates poor judgment|does not take responsibility for mistakes|does not own their behavior or consequences|demonstrates mutism|is prejudiced|is bigoted|insults others|vandalises|engages in hate crimes|lacks respect for authority|dares and provokes others|acts out|uses obscenities|has temper tantrums|falls to floor and tantrums|bangs head|has breath holding episodes|throws objects|screams|weeps|is generally destructive"]. [textarea cols=80 rows=5 default=""][/conditional]

[checkbox name="cogfac" value="Cognitive;"][conditional field="cogfac" condition="(cogfac).is('Cognitive;')"] in particular, the patient[checkbox value="is highly distractible|is hyperactive|is inattentive|handles novel situations poorly|lacks foresight|has low frustration tolerance|is easily confused|is unable to understand tasks|frequently daydreams|has poor concentration|is averse to change|is excessively concrete|has an inflexible and rigid thinking style|has unusual and extreme beliefs|appears intellectually delayed|is often confused and unable to accept guidance"]. [textarea cols=80 rows=5 default=""][/conditional]

[checkbox name="motdif" value="Motivational;"][conditional field="motdif" condition="(motdif).is('Motivational;')"] in particular, the patient [checkbox name="motdif" value="does not try hard with difficult tasks|generally makes little effort|is content to coast along|has the ability to do better work but lacks interest|generally shows no interest in the subject matter|does not persevere with most tasks|always needs great encouragement to complete work|gives up at first sign of difficulty|has low frustration tolerance|does not seem to pay attention|frequently daydreams|always seems preoccupied|is slow to respond|does not complete work assignments|does not make up for lost time|turns in assignments late|is careless with work|does not spend enough time on important tasks|copies from others|comes to class without necessary work materials|is frequently forgetful|misses excessive days|is known for frequent absenteeism|is always tardy|cuts classes|avoids work|is frequently truant|avoids school|refuses to attend school|refuses to attend work"] [textarea cols=80 rows=5 default=""][/conditional]

[checkbox name="becon" value="Behavioural;"][conditional field="becon" condition="(becon).is('Behavioural;')"] in particular, the patient [checkbox value="engages in alcohol/drug/substance abuse|has encopresis|has enuresis|engages in fire setting|engages in hypochondriasis|is frequently overactive and restless|engages in self injurious behaviour|hits others|bites others|engages in head banging|has a sexual preoccupation|engages in public masturbation|demonstrates inappropriate sexual behaviors|is frequently obscene|swears|makes sexualized gestures and remarks|exhibits genitals/disrobes/public nudity|wears provocative clothing|demonstrates molestation concerns|threatens others|touches others|fondles/rubs against others|engages in battery|has had forced sexual intercourse|is assaultative|has raped|threatens others|is slow moving|is slow to respond|lethargy|hypoactive|restless|fidgets|out of seat|impulsive|hyperactive/overactive|speech difficulties|thumb sucking|rocking|stereotyped movements|tics|noise or word productions|violence/aggression"] [textarea cols=80 rows=5 default=""][/conditional]

[checkbox name="afcon" value="Affect;"][conditional field="afcon" condition="(afcon).is('Affect;')"] in particular, the patient experiences [checkbox value="anxiety|fears|phobias|nervous habits|avoidance of particular certain things/actions/situations|anger|irritability|outbursts/rage/tantrums/meltdowns|tearfulness|sulking|whines|hurt feelings|low moods|feelings of  flatness|joyless|depressed|sad|unhappy|cries|feels hurt|has low energy|is easy fatigued|apathy|withdrawn|ashamed|guilty|suicidal|has limited range of emotions|expresses only high-intensity feelings|emotionally overactive|histrionic|dramatizes|plays the victim"] [textarea cols=80 rows=5 default="and other affect difficulties"][/conditional]

DISABILITY ISSUES

[checkbox name="comms" value="Understanding and Communicating"][conditional field="comms" condition="(comms).is('Understanding and Communicating')"], in particular: [checkbox value="concentrating|remembering|solving every day problems|learning a new task|understanding verbal communication|initiating and maintaining a conversation"][/conditional].

[checkbox name="gar" value="Getting around"][conditional field="gar" condition="(gar).is('Getting around')"], in particular: [checkbox value="standing for longer than 30 minutes|standing up|moving around the home|getting out of the home|walking distances greater than 1km"][/conditional].

[checkbox name="selc" value="Self-care"][conditional field="selc" condition="(selc).is('Self-care')"], in particular: [checkbox value="washing the whole body|getting dressed|eating|being alone for a few days"][/conditional].

[checkbox name="lifea" value="Life activities"][conditional field="lifea" condition="(lifea).is('Life activities')"], in particular: [checkbox value="managing a household|doing house hold tasks well|completing housework|completing housework in a timely manner|attending work|attending school|completing work tasks adequately|completing school tasks adequately|getting all work done|getting all work done in a timely manner"][/conditional].

[checkbox name="partin" value="Participation in society"][conditional field="partin" condition="(partin).is('Participation in society')"], in particular: [checkbox value="problems joining in community activities|problems because of barriers in the world|problems living with dignity due to the attitudes of others|time spend managing a health condition|Emotional impact of a health condition|impact of a health condition on finances|impact of health condition on family|problems doing things autonomously for relaxation or pleasure"][/conditional].

Communication Issues: [textarea cols=30 rows=1 default="Nil identified"]

MEDICATIONS

Discharge Medication: [textarea cols=40 rows=30 default="nil"]

MH Medications Recently Ceased: [textarea cols=40 rows=30 default="not reported"]

Allergies and Adverse Reactions: [textarea cols=80 rows=5 default="nil known"]

RESULTS REVIEW

HoNOS:

[checkbox value="No issues of note|Behavioural disturbance|Non-accidental self injury|Problem drinking or drug use|Cognitive problems|Problems related to physical illness or disability|Problems associated with hallucinations and delusions
|Problems associated with depressive symptoms|Other mental and behavioural problems|Problems with social or supportive relationships|Problems with activities of daily living|Overall problems with living conditions|Problems with work and leisure activities and the quality of the daytime environment"]. [textarea cols=40 rows=5 default=""]

Physical Investigations: [textarea cols=80 rows=5 default="N/A"]

Other Results: [textarea cols=80 rows=5 default="N/A"]

DISCHARGE INFORMATION
 
Discharge plan: [checkbox value="provided patient name the details of the expected time and date of discharge|established carer’s capability and willingness to assist|arranged for sufficient quantities of medication to last until the next consultation|checked that the patient understands the purpose, dosage, frequency and side-effects of their medication|discussed the expected recovery path and confirmed understanding|confirmed necessary follow-up appointments with the patient's healthcare provider|arranged travel assistance|provided details of the patient's medical follow-up appointments|provided contact details for community mental health services and follow up arrangements|provided contact details for private mental health services and follow up arrangements|educated the patient about signs of possible relapse and what to do|provided the patient with emergency contact numbers|provided the patient with a self-management plan (including coping strategies)|provided the patient with a crisis management plan|confirmed community support arrangements including referrals to other services / programs"] [textarea cols=40 rows=2 default=""]

Legal Status: [comment memo="choose one Legal Status"][checkbox value="Ambulatory - Voluntary Mental Health Client|Ambulatory - CTO|Ambulatory - Other|Forensic Patient|Forensic - CTO|No Act Applies|Other|Not known|Voluntary|Involuntary"].

Trustee and Guardian details: [textarea cols=40 rows=2 default="N/A"]

Guardianship details: [textarea cols=40 rows=2 default="N/A"]

CTO details: [textarea cols=40 rows=2 default="N/A"]

Involuntary Patient Order details: [textarea cols=40 rows=2 default="N/A"]

Forensic Patient status details: [textarea cols=40 rows=2 default="N/A"]

Other Legal Status details: [textarea cols=40 rows=2 default="N/A"]

Appointments on Discharge: [checkbox value="Nil|Private Psychiatrist|New Service Case Manager|GP|Out of State Mental Health Service"] [textarea cols=40 rows=2 default=""]

Other Services Involved: [textarea cols=80 rows=2 default="None"]

Recommended follow up: [textarea cols=80 rows=2 default="Recommended patient name follow up with their GP"]

Performed by: [textarea cols=80 rows=2 default="N/A"]

Copies to: [textarea cols=80 rows=2 default="Patient's GP"]