Level 4 - High Intensity Services¶
Definition¶
High intensity services including periods of intensive intervention that may involve multidisciplinary support. Usually supporting people experiencing severe mental illness, significant functional impairment and/or risk factors.
Care environment¶
Typically, face-to-face interventions in community locations (e.g., consulting rooms) or outreach to the person within their home or other environment.
Core clinical services¶
A comprehensive psychological assessment (if not already undertaken) is required for all individuals suited to this level of care.
- Evidence-based psychological interventions provided by a mental health clinician.
- Clinical care coordination services within primary care (if more than 2 services are involved in providing care).
- Involvement of a mental health nurse.
- Community-based psychiatric care.
- Active GP management, mental health assessment, integrated physical health care (and development of a MHTP).
Support services¶
Additional services are likely to be needed and may include:
- psycho-social disability support services (including peer support, daily living support, social skills training, and social participation support).
- community supports (including peer support and social participation support).
- assistance to access support and advice relating to known environmental stressors.
- lifestyle interventions (e.g., nutrition, sleep, exercise, meaningful social connections).
Referral criteria¶
A person requiring this level of care usually has a diagnosed mental health condition with significant symptoms and/or significant problems with functioning. A person with a severe presentation is likely to be experiencing moderate or higher problems associated with Risk of Harm, Functioning, and Impact of Coexisting Conditions. Where problems are assessed as very severe in symptom, risk or functioning domains, a referral to Level 5 care should be considered.
Using the Initial Assessment Rating Glossary to support decision making¶
Individuals suited to this level of care may have been rated:
- Severe Symptom Severity and Distress (score = 3) with significant associated problems on one or more other Primary Domains (Risk of Harm, Functioning, scores 2 or 3, or Co-existing Conditions score of 2-4)
- Severe Symptom Severity and Distress in the context of very severe problems (score = 4) on either Risk of Harm or Functioning are not suited to this level but should be referred for Level 5 care.