Find your Care Cluster

Some definite but minor problems of depressed mood, anxiety or other disorder without any distressing psychotic symptoms present. Likely to be linked to life events

Or

You may be experiencing some mild but significant and troubling changes in your mood and behaviour which may make some aspects of your daily life difficult.

• Care is usually provided by Primary Care or IAPT Services
• The problem is likely to be short term when treated
• The care package will contain low intensity psychological interventions the essence of which is self-directed care.
• Clinical review will be carried out at 12 weeks from commencement of treatment
• Treatment may be provided for up to 3 months
• Risk to patient or others is usually low

Some definite problems of depressed mood, anxiety or other disorder but not with any distressing psychotic symptoms.

Or

You may be experiencing some mild but significant and troubling changes in your mood and behaviour which are likely to be causing difficulties in several areas of your life. You may have had some treatment, and now require more

• Care is usually provided by Primary Care or IAPT Services
• The problem is likely to be short term when treated
• May have previously received services on Care Cluster 1
• The care package will contain low intensity psychological interventions including group therapy and self-guided materials, lifestyle and physical health advice and individual therapy, the essence of which is self-directed.
• Clinical review will be carried out at 15 weeks from commencement of treatment
• Treatment may be provided for up to 4 months
• Risk to patient or others is usually low

Moderate problems involving depressed mood, anxiety or other disorder (not including psychosis).

Or

You may be experiencing moderate but troubling changes in your mood and behaviour that are likely to be causing some significant difficulties in a number of areas of your life.

• Care is usually provided by Primary Care or IAPT Services
• The problem is likely to be short term when treated
• The care package will contain high intensity psychological interventions, including individual therapy, possible medication and lifestyle and physical health advice.
• Clinical review will be carried out at a maximum of 6 months from commencement of treatment
• Treatment may be provided for up to 6 months
• Risk to patient safety is usually low

Severe depression and/or anxiety and/or other increasing complexity of needs with disruption to function in everyday life

or

You may be experiencing more severe problems with your moods and behaviours which are making it very difficult to cope with daily life. You may feel unsafe and unable to maintain a sense of control in particular situations,

• The care/treatment of people in this cluster will be tailored to individual needs and risks thus it may be delivered by either Primary Care or the Trust or a combination of both.
• The Care Package will contain high intensity psychological interventions and medication. Active support may be given in other aspects of lifestyle and physical health to help with mental needs.
• Clinical review will be carried out at a maximum 6 months from commencement of treatment
• Care/treatment may be provided for up to 12 months
• Management of risk and care coordination may be significant in some cases.
• Risk to patient or others is usually moderate. There may be thoughts of self harm

You may be experiencing some severe problems affecting your mood and behaviour which are creating major difficulties in coping with your normal life. There may be situations in which you fear losing control and/or feel unsafe

• The care/treatment of people in this cluster will be met by the Trust within the Care Programme Approach (CPA) often in partnership with other agencies
• The care package will contain high intensity psychological interventions and probable medication. Aspects of lifestyle and physical health to help with mental health needs will be actively supported.
• Specialist interventions and/or medication are required
• Formal Clinical Reviews will be carried out at least 6 monthly
• Care and support may be provided for up to 3 years
• Management of risk to self and others is likely to be significant.
• Concern for patient safety is high. There may be thoughts of self harm and safeguarding issues

Moderate to very severe disorders that are difficult to treat. These may include treatment-resistant eating disorders, OCD etc, where beliefs are strongly held, some personality disorders and enduring depression.

Or

You will be experiencing more complex moderate to severe difficulties with your mood and behaviours which are affecting everyday life in many ways. You may have been receiving treatment for some time which has not yet led to your recovery. It is likely that a number of situations lead to you feeling you might lose control and/or be unsafe, and a particular feature is that you hold strong beliefs that other people might consider unreasonable.

• The care/treatment of people in this cluster will be met by the Trust within the Care Programme Approach (CPA) often in partnership with other agencies
• The person in this cluster will have very complex and severe needs, with higher risks which may be difficult to treat often due to their unreasonable beliefs
• The care package will contain more complex combinations of treatments including: high intensity psychological interventions and probable medication. Aspects of lifestyle and physical health to help with mental health needs will be actively supported.
• Specialist interventions and/or medication are required
• Formal Clinical Reviews will be carried out at least 6 monthly
• Care and support may be provided for several years.
• Patient safety/safeguarding support may be required

You may be experiencing more complex and severe difficulties with your mood and problems with your behaviour that can make everyday life very difficult. There may be a number of situations in which you fear losing control and/or feel unsafe.

• The care/treatment of people in this cluster will be met by the Trust within the Care Programme Approach (CPA) often in partnership with other agencies
• The person will have complex and severe needs, with particularly disabling problems and ongoing risks.
• The care package will contain more complex combinations of treatment including: high intensity psychological interventions, probable medication, and consideration of ECT. Aspects of lifestyle and physical health to help with mental health needs will be actively addressed.
• Specialist interventions and/or medication are required
• Formal Clinical Reviews will be carried out at least 6 monthly
• Care and support may be provided for several years
• Patient vulnerability/safeguarding support may be required

Wide range of symptoms, impulsive behaviour and a chaotic and challenging lifestyle

Or

You may be having a number of moderate to severe problems including mood swings and mood changes. This is likely to lead to many situations where you feel out of control and you may have acted in risky or possibly dangerous ways. These issues may be affecting many areas of your life.

• The care/treatment of people in this cluster will be met by the Trust within the Care Programme Approach (CPA) often in partnership with other agencies
• Patients may feel unable or unwilling to engage with services
• The care package will contain more complex combinations of treatments including: high intensity psychological interventions, probable medication. Aspects of lifestyle and physical health to help with mental health needs will be actively addressed.
• Formal Clinical Reviews will be carried out at least 6 monthly
• Care and support may be provided for several years
• The person will be particularly difficult to effectively engage with services, with ongoing risks and possible self harm.
• Patient vulnerability/safeguarding support may be required

This Care Cluster is currently unused

Presenting to the service for the first time with mild to severe psychotic phenomena. They may also have depressed mood and /or anxiety or other behaviours. Drinking or drug taking may be present but will not be the only problem.

Or

You have for the first time, been assessed as having mild to severe psychotic symptoms.

• The care/treatment of people in this cluster will be met by the Trust within the Care Programme Approach (CPA) often in partnership with other agencies
• The problem is likely to be a first episode but patients may also experience other feelings such as depression, anxiety etc.
• The care package will be specific to needs and may include psychological therapies and medication. Care will require ongoing co-ordination and significant risk management. Aspects of lifestyle and physical health to help with mental health needs will be actively addressed.
• Formal Clinical Reviews will be carried out at least 6 monthly
• Care and support should be provided for up to 3 years.
• The person will be vulnerable to harm from self or others. They may be at risk of suicide or present a risk to others.
• Patient safety issues are normally moderate and they may have thoughts of self-harm. vulnerability/safeguarding support may be required

History of psychotic symptoms that are currently controlled and causing minor problems if any at all. Currently experiencing a period of recovery and capable of full or near full functioning. However, there may be impairment in self-esteem and efficacy and vulnerability to life.

Or

You will have a history of troubling thoughts/ideas that are currently well controlled and only causing minor problems. You are well and getting on with your everyday life.

• The care/treatment of people in this cluster will be met by the Trust within either the Care Programme Approach (CPA) or Non CPA Approach, often in partnership with other agencies
• The care package will be specific to needs and may include psychological therapies and medication. Aspects of lifestyle and physical health linked with mental health needs will be actively addressed
• Formal Clinical Reviews will be carried out at least 6 monthly.
• If required, care and support may be provided for several years
• The person will be near full functioning with no obvious risks.
• Patient safety issues will be managed via a relapse prevention and crisis plan

History of psychotic symptoms with a significant disability with major impact on role functioning, social relationships and family. They are likely to be vulnerable to abuse or exploitation.

Or

You will have a history of troubling thoughts/ideas which may be significantly affecting your life and ability to cope.

• The care/treatment of people in this cluster will be met by the Trust within the Care Programme Approach (CPA) often in partnership with other agencies
• The care package will be specific to needs and may include psychological therapies and medication. Aspects of lifestyle and physical health linked with mental health needs will be actively addressed
• Formal Clinical Reviews will be carried out at least 6 monthly.
• Care and support may be provided for several years
• Appropriate risk management will be needed
• Patient safety concerns (including vulnerability to abuse or exploitation) may be present when unwell. Safety concerns should be managed via a relapse prevention and crisis plan.

History of psychotic symptoms which are not controlled. You will present with severe to very severe psychotic symptoms and some anxiety or depression. They have a significant disability with major impact on role functioning.

Or

Psychotic symptoms which are active, on-going and not currently well controlled. You may also be experiencing problems with anxiety and/or depression. This may be having a major impact on your everyday life and ability to cope

Or

You have troubling thoughts/ideas which are active, on-going and not currently well controlled. You may also be experiencing problems with anxiety and/or very low mood. This may be having a major impact on your everyday life and ability to cope.

• The care/treatment of people in this cluster will be met by the Trust within the Care Programme Approach (CPA) often in partnership with other agencies
• The care package will be specific to needs and may include psychological therapies and medication. Aspects of lifestyle and physical health linked with mental health needs will be actively addressed
• Formal Clinical Reviews will be carried out at least 6 monthly
• Care and support may be provided for several years
• Appropriate risk management will be needed
• Patient safety concerns (including vulnerability to abuse or exploitation) may be present when unwell. Safety concerns should be managed via a relapse prevention and crisis plan.

Acute psychotic episode with severe symptoms that cause severe disruption to role functioning and severe disruption to activities of daily living. They may present as vulnerable and a risk to others and themselves. Cognitive problems may be present.

Or

Acute psychotic episode with severe symptoms that cause severe disruption to the role functioning. You may present as vulnerable and a risk to others or themselves.

Or

You will be experiencing, or have just experienced, an acute onset of severe symptoms of extremely troubling thoughts/ideas which may be significantly disrupting your life. You may feel very vulnerable and may be a risk to yourself and/or other people.

• The care/treatment of people in this cluster will be met by the Trust within the Care Programme Approach (CPA) possibly as an inpatient or receiving Home Treatment often in partnership with other agencies
• Life will be severely disrupted and there may be memory problems
• The care package will be specific to immediate needs, with concern for longer-term engagement, and may need to be intense during the acute period of up to 12 weeks and likely to include psychological therapies and medication.
• Formal Clinical Reviews will be carried out at least 4 weekly
• Patient safety concerns (including a serious risk to themselves and/ot others, vulnerability to abuse or exploitation) may be present when unwell.
• Safety concerns should be managed via a safety management, relapse prevention and crisis plan.

Acute episode of moderate to severe depressive symptoms. Hallucinations and delusions will be present. It is likely that this group will present a risk of suicide and have disruption in many areas of their lives.

Or

Acute episode of moderate to severe depressive symptoms. Hallucinations and delusions will be present and it is likely that you may present a risk to yourself and have disruption in many areas of life.

Or

Currently, you may be experiencing severely troubling and disrupting thoughts/ideas with moderate to severe depression. This may be significantly disrupting your life and placing you at risk.

• The care/treatment of people in this cluster will be met by the Trust within the Care Programme Approach (CPA) possibly as an inpatient or receiving Home Treatment often in partnership with other agencies
• Life will be severely disrupted and there may be memory problems
• The care package will be specific to immediate needs, with concern for longer-term engagement, and may need to be intense during the acute period of up to 12 weeks and likely to include psychological therapies and medication.
• Formal Clinical Reviews will be carried out at least 4 weekly
• Patient safety concerns (including a serious risk to themselves, vulnerability to abuse or exploitation) may be present when unwell. Safety concerns should be managed via a safety management, relapse prevention and crisis plan.

Enduring, moderate to severe psychotic or affective symptoms with unstable, chaotic lifestyles and coexisting drinking or substance use. May present a risk to self and others and engage poorly with services. Role functioning is often globally impaired. The person may find it difficult to engage well with services.

Or

Enduring, moderate to severe psychotic or affective (Bi-Polar) symptoms with unstable, chaotic lifestyles and co-existing substance misuse

Or

You have troubling and disrupting thoughts/ideas and/or severe anxiety/depressive symptoms which are currently not well controlled. You are using alcohol and/or street drugs. This combination of difficulties will be causing very significant disruption in your life

• The care/treatment of people in this cluster will be met by the Trust within the Care Programme Approach (CPA) often in partnership with other agencies
• The care package will be specific to immediate needs, with concern for longer-term engagement, and likely to include psychological therapies and medication. Aspects of lifestyle and physical health linked with mental health needs will be actively addressed.
• Mental and physical health problems significantly affected by substance misuse
• Formal Clinical Reviews will be carried out at least 6 monthly
• Care and support may be needed for several years
• Patient safety concerns are moderate to severe to both self and others
• Patient safety concerns are high and personal safety is a real risk
• The patient may be unable or unwilling to engage

Enduring, moderate to severe psychotic symptoms with unstable, chaotic lifestyles. There may be some problems with drug and alcohol not severe enough to warrant dual diagnosis care. Have a history of non concordance, are vulnerable & engage poorly with services and may lack insight into their mental illness. Symptoms may not be controlled and may eventually be treatment resistant.

or

Moderate to severe psychotic symptoms and an unstable, chaotic lifestyle. There may be some problems with drugs and alcohol

or

You have moderate to extremely troubling and disrupting thoughts/ideas with anxiety and mood difficulties which are severely disrupting your life. You may also have a mild to moderate problem with alcohol and/or street drugs

• The care/treatment of people in this cluster will be met by the Trust within the Care Programme Approach (CPA) often in partnership with other agencies
• The care package will entail assertive outreach and be specific to needs and immediate risks, with concern for longer term engagement, likely to include psychological therapies and medication. They may have associated co-morbidity, which could be physical as well as mental compounding their psychotic experience.
• May have memory and relationship problems due to mental health problems
• Formal Clinical Reviews will be carried out at least 6 monthly
• The patient may be unable or unwilling to engage so care and support may need to be introduced gradually
• Care and support may be needed for several years
• May present a moderate to severe risk to both self and others through their symptoms, behaviour and lack of insight.
• May present a moderate to severe risk to both self and others through their symptoms, behaviour and lack of insight.
• Patient safety concerns (including vulnerability to abuse or exploitation) may be present when unwell. Safety concerns should be managed via a safety management, relapse prevention and crisis plan.

Early stages of dementia (or may have an organic brain disorder affecting their cognitive function), who have some memory problems or other low level cognitive impairment but who are still managing to cope reasonably well. Underlying reversible physical causes have been ruled out.

Or

Early stages of dementia (or who may have an organic brain disorder affecting their cognitive function) who have some memory problems, or other low level cognitive impairment but who are still managing to cope reasonably well.

Or

You may have experienced some memory problems or cognitive impairment but still cope reasonably well in most areas of your life

• The care/treatment of people in this cluster will be met by the Trust often in partnership with other agencies
• The care package will involve the assessment of cognitive functioning and establishing diagnosis, diagnostic disclosure, and will support the maintenance of coping, for both the person and the care infrastructure around them. Aspects of lifestyle (including activities of daily living) and physical health will be actively promoted, to help support those with mental health needs
• Formal Clinical Reviews will be carried out annually
• Care and support (to include Carers) may be needed for several years
• Patient safety concerns are minimal

Early stages of dementia (or may have an organic brain disorder affecting their cognitive function), who have some memory problems or other low level cognitive impairment but who are still managing to cope reasonably well. Underlying reversible physical causes have been ruled out.

Or

Early stages of dementia (or who may have an organic brain disorder affecting their cognitive function) who have some memory problems, or other low level cognitive impairment but who are still managing to cope reasonably well.

Or

You may have experienced some memory problems or cognitive impairment but still cope reasonably well in most areas of your life

Problems with memory, and/or other aspects of cognitive functioning resulting in moderate problems looking after themselves and maintaining social relationships. Probable risk of self neglect or harm to others and may be experiencing some anxiety or depression.

Or

Problems with memory, and/or other aspects of cognitive functioning resulting in moderate problems looking after themselves and maintaining social relationships.

Or

You are likely to have problems with memory and there may be other thinking problems. These problems are likely to generate challenges in several areas of your life and your relationships.

• The care/treatment of people in this cluster will be met by the Trust often in partnership with other agencies
• The care package will include establishing diagnosis, diagnostic disclosure and support, providing psychosocial intervention, aspects of lifestyle, and physical health to help with mental health needs
• Formal Clinical Reviews will be carried out at least 6 monthly
• Care and support (to include Carers) may need to be provided on an ongoing basis for several years
• Patient Safety: May be a moderate risk of harm to themselves or others and self neglect.
• Patient safety concerns are heightened by memory and awareness problems

People with dementia. They will have significant problems in looking after themselves and their behaviour may challenge their carers or services. They may have high levels of anxiety or depression, psychotic symptoms or significant problems such as aggression or agitation, and may not be aware of their problems.

People with dementia who are having significant problems in looking after themselves and whose behaviour may challenge their carer or services. They may have high levels of anxiety or depression, psychotic symptoms or significant problems such as aggression or agitation.

Or

You are likely to have significant difficulties in many areas of your life. There will be areas of your life where you may feel very unsure and even unsafe. Some of your behaviours may be very difficult for others to cope with.

• The care/treatment of people in this cluster will be met by the Trust often in partnership with other agencies
• The care package will support the maintenance of coping for both the person and the system around them including aspects of lifestyle and physical health to help with mental health needs.
• Formal Clinical Reviews will be carried out at least 6 monthly
• Care and support (to include Carers) may need to be provided on an ongoing basis for several years
• Patient safety: likely to be at high risk of self-neglect or harm to others, and there may be a significant risk of their care arrangements breaking down.
• Patient safety concerns include self-neglect, wider safety issues and risk of breakdown of care

People with cognitive impairment or dementia, with significant problems in looking after themselves, and whose physical condition is becoming increasingly frail. They may not be aware of their problems and there may be a significant risk of their care arrangements breaking down.

Or

People with cognitive impairment or dementia who are having significant problems in looking after themselves, and whose physical condition is becoming increasingly frail.

Or

You are likely to have significant difficulties in many areas of your life, including your physical health. There will be many areas where you may feel unsure and unsafe and some of your behaviours are likely to be difficult for others to cope with.

• The care/treatment of people in this cluster will be met by the Trust often in partnership with other agencies
• The care package will involve the assessment of cognitive functioning and establishing diagnosis, diagnostic disclosure to support both the person and the maintenance of coping for those around them including aspects of lifestyle and physical health to help with mental health needs
• Formal Clinical Reviews will be carried out at least 6 monthly
• Care and support (to include Carers) may need to be provided on an ongoing basis for several years
• Patient safety: May significantly challenge others and there is a risk of self-neglect/harm to others.
• Patient safety concerns include self-neglect, wider safety issues and risk of breakdown of care