Quality statement 4: Follow-up after any missed appointment

Quality statement

People aged 14 and over with coexisting severe mental illness and substance misuse are followed up if they miss any appointment.

Rationale

Services may find it difficult to engage with people with coexisting severe mental illness and substance misuse and this can lead to people missing appointments. If people are automatically discharged from a service because of non-attendance they can be left without support when they are vulnerable. It is therefore important for them to be promptly and actively followed up, for example, by phoning or visiting them if they miss any appointment, especially after the first missed appointment. This will help to ensure they remain in contact with services or re-engage quickly.

Quality measures

Structure

a) Evidence of local arrangements to identify people aged 14 and over with coexisting severe mental illness and substance misuse who miss any appointment.

Data source: Local data collection, for example, clinic attendance protocols and data-sharing arrangements.

b) Evidence of local arrangements to contact people aged 14 and over with coexisting severe mental illness and substance misuse who miss any appointment.

Data source: Local data collection, for example, service protocols.

c) Evidence of flexibility when arranging appointments for people aged 14 and over with coexisting severe mental illness and substance misuse.

Data source: Local data collection, for example, service protocols for arranging for home visits or meeting at other locations, for example, in a café.

d) Evidence of local arrangements for services to ensure that people aged 14 and over with coexisting severe mental illness and substance misuse are not automatically discharged for missing appointments.

Data source: Local data collection, for example, service protocols and joint strategic working protocols.

Process

a) Proportion of people aged 14 and over with coexisting severe mental illness and substance misuse who are followed up when they miss any appointment.

Numerator – the number in the denominator who are followed up.

Denominator – the number of people aged 14 and over with coexisting severe mental illness and substance misuse who miss any appointment.

Data source: Local data collection, for example, audits of patient records and clinic records.

b) Proportion of people aged 14 and over with coexisting severe mental illness and substance misuse who were not followed up and were discharged from services because of missing any appointment.

Numerator – the number in the denominator who were not followed up.

Denominator – the number of people aged 14 and over with coexisting severe mental illness and substance misuse discharged from services because of missing any appointment.

Data source: Local data collection, for example, audits of patient records and clinic records.

Outcome

a) Proportion of people aged 14 and over receiving treatment for coexisting severe mental illness and substance misuse who re-engage with services after missing an appointment.

Numerator – the number in the denominator who re-engage with services.

Denominator – the number of people aged 14 and over receiving treatment for coexisting severe mental illness and substance misuse who miss any appointment.

Data source: Local data collection, for example, audits of patient records.

b) Proportion of people aged 14 and over with coexisting severe mental illness and substance misuse who complete their planned treatment for substance misuse.

Numerator – the number in the denominator who complete their planned treatment for substance misuse.

Denominator – the number of people aged 14 and over with coexisting severe mental illness and substance misuse who are receiving treatment for substance misuse.

Data source: Local data collection, for example, audits of patient records. Successful completion of drug and alcohol treatment data is available in Public Health England's crisis care profile.

c) Proportion of people aged 14 and over with coexisting severe mental illness and substance misuse who remain in planned treatment for severe mental illness.

Numerator – the number in the denominator who remain in planned treatment for severe mental illness.

Denominator – the number of people aged 14 and over with coexisting severe mental illness and substance misuse.

Data source: Local data collection, for example, audits of patient records.

What the quality statement means for different audiences

Service providers (community, primary and secondary mental health services, including child and adolescent mental health services [CAMHS], and substance misuse services, including voluntary sector organisations) ensure that they are flexible when arranging appointments for people with coexisting severe mental illness and substance misuse. This may include holding drop in clinics and arranging appointments in locations suited to the person's needs (for example, in a café). Ensuring people can access services in these ways will help to avoid missed appointments and keep people engaged. Services should have systems in place to identify people who have missed any appointment and contact them, for example, by phone, text or home visit outside of routine hours, to keep them engaged with the service.

Mental health and substance misuse practitioners (such as community, primary and secondary, including CAMHS, mental health practitioners, care coordinators and drug and alcohol misuse practitioners) work with other practitioners and services to help people with severe mental illness and substance misuse to stay engaged with services. They contact people, for example, by phone, text or home visit outside of routine hours, who have missed any appointment and discuss any non-attendance with other practitioners if needed. They provide appointments at times and locations to meet people's needs where they can. They discuss and agree future care with other practitioners involved before the person is discharged from a service.

Commissioners (clinical commissioning groups, local authorities and NHS England) ensure that the services they commission do not automatically discharge people with coexisting severe mental illness and substance misuse because they miss an appointment. They ensure that the services they commission work together to offer flexibility, for example, with appointment times and locations to meet the specific needs of this group. They ensure that services follow up non-attendance to help people to stay engaged with services.

People aged 14 and over with severe mental illness and substance misuse are contacted if they miss any appointment rather than being automatically discharged from the service. The service works with them to arrange appointments at suitable times and places to help them avoid missing appointments in the future.

Source guidance

Coexisting severe mental illness and substance misuse: community health and social care services (2016) NICE guideline NG58, recommendations 1.3.8 and 1.6.5

Definitions of terms used in this quality statement

Severe mental illness

Severe mental illness includes a clinical diagnosis of schizophrenia, schizotypal and delusional disorders, bipolar affective disorder, or severe depressive episodes with or without psychosis.

[NICE's guideline on coexisting severe mental illness and substance misuse: community health and social care services, terms used in this guideline]

Substance misuse

Substance misuse refers to the use of legal or illicit drugs, including alcohol and medicine, in a way that causes mental or physical damage. This may include low levels of substance use that would not usually be considered harmful or problematic but may have a significant effect on the mental health of people with a mental illness such as psychosis.

[NICE's guideline on coexisting severe mental illness and substance misuse: community health and social care services, terms used in this guideline]

Follow-up

Non-attendance at any appointment or activity is viewed by all practitioners involved in the person's care as a matter of concern. Follow-up actions could include:

  • contacting the person to rearrange an appointment

  • visiting the person at home

  • contacting any other practitioners involved in the person's care, or family or carers identified in the person's care plan

  • contacting the person's care coordinator within mental health services immediately if there is a risk of self-harm or suicide, or at least within 24 hours if there are existing concerns.

[Adapted from NICE's guideline on coexisting severe mental illness and substance misuse: community health and social care services, recommendation 1.6.5]

Equality and diversity considerations

People who are homeless may be difficult to contact if they do not attend an appointment. When people who are homeless first attend services, agreements should be made on how they can be contacted, for example, through friends or relatives or through voluntary services.

People should be provided with information about their appointments that they can easily read and understand. Information should be in a format that suits their needs and preferences. It should be accessible to people who do not speak or read English, and it should be culturally and age appropriate. People should have access to an interpreter if needed.

For people with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard.