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Key messages The threshold assessment grid is a method of assessing the urgency of written mental health referrals. This study suggests that it can be successfully adapted to structure a brief face-to-face mental health triage assessment.
The TAG-triage assessment appeared to have equivalent utility to a full mental health assessment when identifying clinical risk.
Compared to a full mental health assessment, long term occupational outcomes were similar when using TAG-triage to structure the initial patient contact.
Introduction
The initial clinical assessment of mental health disorder is potentially the most time-consuming component of the overall episode of care within an occupational mental health service. The UK Armed Forces (UK AF) operate an occupationally focused mental health service provided by clinical staff based in Departments of Community Mental Health (DCMH) throughout the UK and overseas. 1 Open source information about DCMH activity suggests that 20.0%-24.0% of referred military personnel are found to have no formal psychiatric disorder following face-to-face assessment. 2 Mental health assessments that conclude that no further specialist mental health input is required represent a substantial time investment which constrains the availability of DCMH staff to carry out genuinely urgent assessment and deliver specialist care. A departmental audit was conducted in a DCMH prior to introducing a new assessment format, which demonstrated that referral letters were sometimes brief and lacked clinical detail, thus limiting the ability to accurately assess the urgency and associated timeframe for assessment. The disparity between the information provided by some referrers and the requirement for information on the part of the mental health team has been noted in the civilian literature. 3 A number of referrals were annotated 'urgent' and therefore required formal assessment within one working day to conform with prevailing DCMH performance indicators. Despite referrers receiving guidance, there was sometimes a marked difference in the conceptualisation of urgency between referrers and the DCMH team. Implementation of a brief assessment initiative was motivated by concern that clinician time was not being used to full advantage in relation to the clinical assessment component. The use of Threshold Assessment Grid (TAG) theoretically provides a vehicle for educating referring agencies about the need to accurately identify and document clinical risk when making a referral to the DCMH, an attribute noted in previous...