Abstract
Aims and methodWe assessed 92% (117/127) of the patients in our community mental health learning disability team using the Mental Health Clustering Tool (MHCT) to establish whether their needs could be captured sufficiently well to enable assignment to a care cluster for payment by results in mental health. We explored the characteristics of those assigned to Cluster 0 to identify how they differed from those who could be assigned to Clusters 1-21.ResultsAs expected, nearly half of the case-load (48%) could not be assigned to any cluster except Cluster 0, the variance cluster, which is used when the needs of patients cannot be captured by the current 21 care clusters but a service is, or will be, provided.Clinical implicationsThe MHCT in its current form does not adequately capture the needs of people with more severe intellectual disability. An integrated mental health and learning disability clustering tool is in development. This is expected to include new rating scales and new clusters, however until the development is completed and validated it will not be possible to implement payment by results in mental health in learning disability services.
Highlights
An integrated mental health and learning disability clustering tool is in development, based on the Health of the Nation Outcome Scales (HoNOS)-LD scales, which may become available to clinicians during 2012
This paper reports a local evaluation of the Mental Health Clustering Tool (MHCT) when used for people with intellectual disability accessing specialist mental health services
59.8% (70/117) individuals had mild intellectual disability, and 65.7% of people with mild intellectual disability were assigned to Clusters 1-21 compared with 31.9% of people with moderate or severe intellectual disability assigned to Clusters 1-21
Summary
The average age of women in the sample was slightly greater than that for men (mean 44.8 years v. 42.2 years) and 62% of the sample was male. The MHCT scale 13 (‘Strong unreasonable beliefs occurring in non-psychotic disorders only’) was excluded from the analysis because data were missing in 49% of cases These results indicated significant differences between cluster groups in MHCT scale severity on the three scales measuring problems with activities of daily living, historic problems with agitated, aggressive behaviour/expansive mood, and vulnerability. This multivariate analysis indicated that only the presence of pervasive developmental disorder and Scale A score severity were independently associated with assignment to Cluster 0
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