To ask the Minister of Health to detail (i) any systems that are in place to identify patients whose mental health deteriorates while waiting for assessment; and (ii) the number of patients who have been escalated for urgent review, in each of the last three years.

(i)The Health and Social Care Trusts provided the following responses:

Belfast Health and Social Care Trust

When a referral is received from a GP requesting an initial assessment every referral is triaged and priority given as indicated by the clinical information. If a person’s presentation deteriorates the current mechanism is that the GP as the referral agent can submit additional information that will inform a more urgent appointment.

Northern Health and Social Care Trust

Where an individual’s mental health deteriorates while waiting for an assessment via the Community Mental Health Team (CMHT) they can be referred or self-present to the Urgent Mental Health Service (comprising of the Crisis Resolution & Home Treatment Team or the Mental Health Liaison Service). The Urgent Mental Health Service is operational 24/7 and provides urgent community mental health assessment within 4 hours of referral or within 2 hours of referral via Antrim or Causeway Emergency Departments.

South Eastern Health and Social Care Trust

The South Eastern Health and Social Care Trust operates a range of clinical screening, triage, prioritisation and risk management processes to support the identification and management of individuals whose mental health may deteriorate while awaiting assessment. Referrals are clinically reviewed on receipt and prioritised according to presenting need and level of risk. Referrals may be re-prioritised where additional information is received from referrers, service users, carers or other professionals indicating an increase in risk or clinical need.

Community Mental Health Services do not routinely monitor individuals from the point of referral until assessment. Whilst a patient is awaiting assessment, the GP remains the primary coordinator of the individual's care. Patients, family members and carers are advised to contact their GP if there is any deterioration in mental health or increase in risk. GPs can provide further assessment, arrange appropriate intervention and, where required, escalate referrals for urgent clinical review. Individuals may also present to Emergency Departments in the event of an acute mental health crisis.

Any new information received by Trust services relating to a patient's presentation or risk is reviewed by clinical staff and, where appropriate, referrals may be escalated for urgent consideration. Established clinical governance, risk assessment and triage arrangements support this process.

Within Healthcare in Prison, those living in prison have access to a range of supports designed to identify and respond to any deterioration in mental health while awaiting assessment. These include 24-hour access to primary care nursing services, support from Northern Ireland Prison Service staff, and access during core hours to Healthcare in Prison staff, Healthcare Information Mentors (ASK HIM), Healthcare Education Mentors (ASK HER), and voluntary and community sector supports. Patients of concern are discussed through daily Healthcare in Prison safety huddles and clinical handovers, with multidisciplinary meetings convened where there are significant concerns regarding an individual's presentation. Routine referrals can be escalated and prioritised for urgent assessment where there is evidence of deterioration in a patient's mental health or level of risk

Southern Health and Social Care Trust

Referrals are triaged and allocated based on clinical presentation and reported risk. Service users receive a letter detailing their triage outcome, relevant contact numbers, and coping advice for deteriorating mood.

If waiting times exceed ministerial targets, the Trust will issue a "breach letter." This confirms the patient remains on the waiting list and reiterates support contacts and crisis advice. The Trust has clear processes in place for updating waiting list priority should they become aware of change to risk profile for the person waiting assessment.

For individuals on a waiting list for an initial mental health assessment who have experienced a deterioration in their mental health while waiting, the receiving care team are often unaware unless additional information/new referral is received, emergency presentation occurs, or the individual/ carer contact services.

Western Health and Social Care Trust

Within WHSCT, if a patient’s mental health deteriorates whilst awaiting assessment, the GP can refer the patient to the WHSCT Primary Care Liaison Service (PCLS) for an urgent assessment or alternatively the GP may refer the patient to the Emergency Department for a Crisis assessment who then would signpost to possible admission to hospital, Home Treatment Team, Community Mental Health Teams or the Community and Voluntary sector for support as per assessed need.

Please note the WHSCT crisis service operates 24/7 and patients can also self-present to Emergency Departments for assessment if required.

If a patient has been on a previous waiting list and presents or is flagged through any of the above mechanisms, multi-disciplinary meetings are arranged to identify appropriate next steps for the patients assessed need.

(ii)The Health and Social Care Trusts provided the following responses:

Belfast Health and Social Care Trust

This data is not gathered. There are 50 available “urgent” appointments available across two Assessment Centre sites weekly

Northern Health and Social Care Trust

The number of people in the NHSCT who attend for urgent review within urgent mental health services and CMHTs due to a concern regarding their Mental Health is detailed below for the last three years.

*Due to how data is inputted on Encompass from 07/11/2024 by community teams, this figure cannot be provided as data quality remains poor.

South Eastern Health and Social Care Trust

The Trust does not routinely collect or report data on the number of patients whose referrals have been escalated from routine to urgent review whilst awaiting assessment within Community Mental Health Services. Current reporting systems can identify referrals assigned an urgent priority but do not provide reporting on subsequent escalation activity; therefore, the requested figures are not available.

Within Healthcare in Prison, the number of referrals escalated from routine to urgent review following a deterioration in clinical presentation is not routinely reported through central performance systems. However, based on local operational knowledge, it is estimated that approximately three to five patients per year had their referral escalated from routine to urgent review in each of the last three years. This figure should be regarded as an estimate rather than a validated performance measure.

This response reflects information available within Community Mental Health Services and Healthcare in Prison at the time of reporting.

Southern Health and Social Care Trust

The Trust cannot report on the number of escalated referrals from either Encompass or PARIS.

Western Health and Social Care Trust

Primary Care Liaison: Urgent Referrals Received

NB- Since the implementation of the new Encompass regional programme on the 8th May 2025, the Western Trust continues to undertake extensive data validation with service teams and the 2025/26 data supplied in this response may be subject to change.