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Who is still afraid of mental health triage?

We regularly allocate and prioritise referrals into NHS mental health services. One triage scale (the UK mental health triage scale) can include service user feedback heard in real time.

Read comments 6
  • Proposal
  • 2022

Meet the team


  • Cardiff medical students HB and WG

What is the challenge your project is going to address and how does it connect to the theme?

In 2002 I led a multidisciplinary group of South Wales mental health professionals that identified all the common (and most of the rare) reasons for referral into our local old age psychiatry service. We then organised the list into a hierarchy based upon a combination of risk and patient (service user) need.

The main output was a referral ‘algorithm’ that was tweaked a little over time and used for all our referrals until 2014. The algorithm was then merged with an Australian triage scale that had been (separately) developed with a focus upon general adult psychiatry over a similar time period.

The degree of convergence was striking; so much so that with minimal effort the contents of both scales naturally became the hybrid UK mental health triage scale. However wider implementation of the triage scale has stalled due (where stated) to an apparent absence of positive patient / service user feedback.

What does your project aim to achieve?

The central objective for this project is to expand and establish patient / service user feedback as an essential component of evaluation, or to introduce this element where it is absent.

The main constraints are time and confidentiality.

This project seeks to agree a process of feedback in real time and in a form that is meaningful both to patients and mental health staff. For ease of description I have named this a ‘digital feedback cycle’.

Q colleagues will almost certainly have personal experience from the retail sector – mobile telephone networks and online banking services routinely deploy digital requests for feedback. The adjectives I hear most often associated with this consumer experience are ‘frustrating’ and ‘pointless’ although some colleagues will of course be ‘diligent’ and ‘thoughtful’.

Maybe we would all be more receptive and compliant if we knew what power our feedback and what productive changes were achieved?

How will the project be delivered?

I am directly involved with NHS colleagues in mental health services that routinely employ the UK mental health triage scale or are currently seeking to implement the scale.

In NHS organisations there are systems and processes to engage with patients / service users in a responsible and accountable manner. External expert advice will be sought from the Patients Association and from the Consumer Association to confirm optimum form and content of feedback enquiry.

In more practical terms the public facing information will include a e-learning resource that describes the triage process with an emphasis upon mental health (already written using Articulate software – bilingual versions in English and Welsh) as well as the feedback questions.

There will be some ethical considerations relating to patients whose mental health may be directly affected by requests for feedback. The project if successfully funded will seek the relevant ethical approval.

How is your project going to share learning?

I have no doubt that the immediate and medium term benefit from patient / service user involvement will refine the attitude of mental health staff and in many cases enable greater collaboration and co production. Data collection will focus initially upon the number of usable feedback cycles achieved.

However I sincerely hope that the longer term learning will permanently address the stated requirement for patient / service user involvement when wider implementation of the mental health triage scale is being considered.

One obvious benefit is the creation of a new regulatory loop as a routine component of mental health triage.

The opportunity to deliver an explanation about mental health triage and to describe this digital feedback cycle would in my view be of general benefit to any service where demand exceeds the available resources and some form of stratification or prioritisation (rationing) is required.

How you can contribute

  • I would particularly any contribution from Q members who have experience incorporating patient / service user feedback digitally or in real time.
  • I have received a suggestion that QR (Quick Response) codes are ideal for this purpose as many of us are now familiar how to access internet sites with the digital black and white squares.
  • I would value feedback from anyone affected adversely by a standard request to provide feedback about a mental health issue or service.

Plan timeline

31 May 2022 Completion of consultation with Patient Association / Consumer Association
1 Sep 2022 Beta testing of initial digital feedback cycle process
30 Nov 2022 Completion of data analysis - feedback and triage allocation


  1. Guest

    Stacey Harris 3 months, 2 weeks ago

    Hi, Sounds like a great sustainable healthcare project.

    Have yu thought about how you might measure the sustainable value of the work.

    Sustainable value = patient and population outcomes over the social, financial and environmental value.

    Sound like you are thinking of measuring the social value but what about the other parts of the equation.

    I would be happy to be contacted to help with this.

    This would also be a great case study for value based healthcare and form part of decarbonising NHS Wales.

    1. Stacey - regarding sustainability. Moving away from paper based records to digitally held records and audio of conversations is a definite trend.

      In Perth, Western Australia I was privileged to observe the local mental health service triaging a geographical area the size of Western Europe with access to a digital database of health records - older paper records occupied x filing cabinets at the rear of a large office space! thanks Bob

  2. Love the focus on service user feedback Bob.  Could be an opportunity to link to Value Based Healthcare PREMs that can be used throughout person pathway, as well as at the point of triage?  Colleagues in ABUHB looked at PREMs in ICHOMs as part of a VBHC piece of work around memory assessment - might be worth linking with them or national VBHC team?

    Health Boards in Wales also about to launch All Wales CIVICA system to capture real time service feedback and provide a means of analysis.  Might be helpful system for your data collection?  Not closely involved in the launch myself but worth exploring?

    Best of luck

  3. A means of accessing service user feedback is a stumbling block for many quality improvements.  This could provide a model for many other projects. Good luck with it, Bob.

  4. An interesting proposal, Bob. I'm not sure what methodology has been applied to other feedback projects, such as 'You said, we did' but a difficulty might be separating out the customer experience and expectations from those of the service. Certainly, testing engagement through the 'digital feedback cycle' will be useful. Pob lwc, Tom.

  5. This looks like a great project, building on and modernising work that has already been successfully implemented.  Good luck!

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