Level 5 - Acute and Specialist Community Mental Health Services

Definition

Specialist mental healthcare usually includes intensive team-based specialist assessment and intervention (typically state/territory mental health services) with involvement from a range of different types of mental health professionals, including case managers, psychiatrists, social workers, occupational therapists, psychologists and drug and alcohol workers. This level also often includes more intensive care provided by GPs.

Care environment

Typically, community locations with outreach to the person within their home or other environment. This level may also involve specialist mental health inpatient care within a hospital environment, community based intermediate care, sub-acute unit, or crisis respite centre.

Core clinical services

For this level of care, the person is likely to benefit from psychiatric assessment and care, crisis management, and therapeutic interventions using assertive engagement strategies provided by a multidisciplinary specialist team with outreach capability. Care should be provided in close collaboration with General Practice.

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 significant symptoms (e.g., hallucinations, avoidant behaviour, paranoia, disordered thinking, delusions) and problems in functioning independently across multiple or most everyday roles (work, education, parenting, volunteering) and/or is experiencing:

• Significant risk of suicide, self-harm, self-neglect, or vulnerability.
• Significant risk of harm to others.
• A high level of distress with potential for debilitating consequence.

Using the Initial Assessment Rating Glossary to support decision making

Individuals suited to this level of care may have:

• Very severe problems (score = 4) on one or more of Symptom Severity and Distress, Risk of Harm and Functioning domains

OR

• Severe Symptom Severity and Distress (score = 3) in the context of moderate to severe problems in one or more other Primary Domains (Risk of Harm, Functioning, score 2 or 3, Impact of Co-existing Conditions, score of 2-4) are assigned by the decision logic to ‘Level 4 or above’. Level 5 care should be considered where there are associated severe or higher problems multiple Contextual Domains (Treatment and Recovery History, Social and Environmental Stressors, Family and Other Supports, Engagement and Motivation).