NHS Mental Health Care Cluster Descriptions

Cluster Clarification

1. Common Mental Health Problems (Low Severity)

This group has definite but minor problems of depressed mood, anxiety or other disorder but they do not present with any distressing psychotic symptoms

Mild mental health problems

Currently, you may be experiencing some mild but significant and troubling changes in your mood and behaviour. This may make some aspects of your daily life difficult but, typically, people with these difficulties usually recover very well and quickly with support.

2. Common Mental Health Problems (Low Severity with Greater Need)

This group has definite but minor problems of depressed mood, anxiety or other disorder but not with any distressing psychotic symptoms. They may already have received care associated with cluster 1 and require more specific intervention or previously been successfully treated at a higher level but are representing with low level symptoms.

Mild mental health problems with greater need

Currently, you may be experiencing some mild but significant and troubling changes in your mood and behaviour. These are likely to be causing difficulties in several areas of your life. You may have had some treatment, and now require more. Most people in your position recover well with support. Alternatively, you may have had considerable treatment and be well on your way to recovery.

3. Non-Psychotic (Moderate Severity)

This group has moderate problems involving depressed mood, anxiety or other disorder (not including psychosis).

Moderate mental health problems

Currently, you may be experiencing moderate but troubling changes in your mood and behaviour that are likely to be causing some significant difficulties in a number of areas of your life. With treatment, you are likely to make a good recovery.

4. Non-Psychotic (Severe)

This group is characterised by severe depression and/or anxiety and/or other increasing complexity of needs. They may experience disruption to function in everyday life and there is an increasing likelihood of significant risks.

Severe mental health problems

Currently, you may be likely to be experiencing more severe problems with your moods and behaviours which are making it very difficult to cope with daily life. You may feel unsafe and unable to maintain a sense of control in particular situations, but with treatment, drawing on your personal strengths with support you are likely to recover and resume your everyday life.

5. Non-Psychotic Disorders (Very Severe)

This group will be severely depressed and/or anxious and/or other. They will not present with distressing hallucinations or delusions but may have some unreasonable beliefs. They may often be at high risk for suicide and they may present safeguarding issues and have severe disruption to everyday living.

More severe mental health problems

Currently, you may be experiencing some severe problems affecting your mood and behaviour which are creating major difficulties in coping with your normal life.

There may be many situations in which you fear losing control and/or feel unsafe, but with treatment and drawing on your personal strengths with support, you are likely to recover and resume your everyday life.

6. Non-Psychotic Disorders of over-valued ideas

This group will have moderate to very severe disorders that are difficult to treat. This may include treatment resistant eating disorder, OCD etc, where extreme beliefs are strongly held, some personality disorders and enduring depression.

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Moderate complex difficulties

Currently, you will be experiencing more complex   moderate to severe difficulties with your mood and behaviours which are affecting everyday life in many ways. You may have been receiving treatment for some time which has not yet led to your recovery. It is likely that a number of situations lead to you feeling you might lose control and/or be unsafe, and a particular feature is that you hold strong beliefs that other people might consider unreasonable. These beliefs are likely to be a focus of treatment. There is hope for a good recovery, building on your personal strengths, with support

7. Enduring Non-Psychotic Disorders (High Disability)

This group suffers from moderate to severe disorders that are very disabling. They will have received treatment for a number of years and although they may have improvement in positive symptoms considerable disability remains that is likely to affect role functioning in many ways.

More complex and severe difficulties

Currently, you may be experiencing more complex and severe difficulties with your mood and problems with your behaviour that can make everyday life very difficult.

There may be a number of situations in which you fear losing control and/or feel unsafe. You may have had considerable previous treatment in the past which has

assisted you, but there are a number of areas where you need further help in order to make a good recovery, building on your personal strengths, with support.

8. Non-Psychotic Chaotic and Challenging Disorders

This group will have a wide range of symptoms and chaotic and challenging lifestyles. They are characterised by moderate to very severe repeat deliberate self-harm and/or other impulsive behaviour and chaotic, over dependent engagement and often hostile with services.

Very complex difficulties

Currently, you may be having a number of moderate to severe problems including mood swings and mood changes. This is likely to lead to many situations where you feel out of control and you may have acted in risky or possibly dangerous ways. These issues may be affecting many areas of your life. There will be a number of areas where you feel you require further treatment in order to make a recovery, building on your personal strengths, with support.

9. This Cluster is currently blank

 

10. First Episode Psychosis’

This group will be presenting to the service for the first time with mild to severe psychotic phenomena. They may also have depressed mood and/or anxiety or other behaviours. Drinking or drug-taking may be present but will not be the only problem.

First episode significantly troubling thoughts/ideas

You may have previously sought help for other mental health problems, such as anxiety or depression, but have, for the first time, been assessed as having mild to severe psychotic symptoms. You may have experienced elevated mood (mania) and may have additional problems with alcohol or street drugs. With support, drawing on your personal strengths, you are likely to make a very good recovery and resume your everyday life.

11.Ongoing or Recurrent Psychosis (Low Symptoms)

This group has a history of psychotic symptoms that are currently controlled and causing minor problems if any at all. They are currently experiencing a period of recovery where they are capable of full or near functioning. However, there may be impairment in self-esteem and efficacy and vulnerability to life.

Ongoing/recurrent troubling thoughts/ ideas currently well controlled

You will have a history of troubling thoughts/ideas that are currently well controlled and only causing minor problems. You are well and getting on with your everyday life. However, you may have some current difficulties with confidence and coping.

12.Ongoing or Recurrent Psychosis (High Disability)

This group have a history of psychotic symptoms with a significant disability with major impact on role functioning. They are likely to be vulnerable to abuse or exploitation.

Ongoing or recurrent troubling thoughts/ideas with higher impact /disability

You will have a history of troubling thoughts/ideas which may be significantly affecting your life and ability to cope. You may need on-going support to help you to manage your symptoms. You may be feeling vulnerable but can be helped to achieve a good quality of life, drawing on your personal strengths, with support.

13.Ongoing or Recurrent Psychosis(High Symptom & Disability)

This group will have a history of psychotic symptoms which are not controlled. They will present with severe to very severe psychotic symptoms and some anxiety or depression. They will have a significant disability with major impact on role functioning.

Ongoing/recurrent psychosis-high symptoms and impact

You have troubling thoughts/ideas which are active, on-going and not currently well controlled. You may also be experiencing problems with anxiety and/or very low mood. This may be having a major impact on your everyday life and ability to cope. You can be helped to achieve a good recovery, drawing on your personal strengths, with support.

14. Psychotic Crisis

This group will be experiencing an acute psychotic episode with severe symptoms that cause severe disruption to the role functioning. They may present as vulnerable and a risk to others or themselves.

Severely troubling and disrupting thoughts/ideas

You are experiencing, or have just experienced, an acute onset of severe symptoms of extremely troubling thoughts/ideas which may be significantly disrupting your life. You may feel very vulnerable and may be a risk to yourself and/or other people. You may require crisis support to help you to recover and resume your everyday life, building on your personal strengths, with support.

15. Severe Psychotic Depression

This group will be suffering from an acute episode of moderate to severe depressive symptoms. Hallucinations and delusions will be present. It is likely that this group will present a risk of suicide and have disruption in many areas of their lives.

Severely troubling and disrupting thoughts/ideas and depression

Currently, you may be experiencing severely troubling and disrupting thoughts/ideas with moderate to severe depression. This may be significantly disrupting your life and placing you at risk. You may require crisis support to help you to recover and resume your everyday life, building on your personal strengths, with support.

16. Dual Diagnosis

This group has enduring, moderate to severe psychotic or affective symptoms with unstable, chaotic lifestyles and co-existing problem drinking or drug taking. They may present a risk to self, and others and engage poorly with services. Role functioning is often globally impaired

Mixed diagnosis

You have troubling and disrupting thoughts/ideas and/or severe anxiety/depressive symptoms which are currently not well controlled. You are using alcohol and/or street drugs. These difficulties will be causing very significant disruption in your life with many risks to yourself and others around you. You may not always be good at keeping appointments and need extra support to do this. There are a number of areas of your life where you need may need help in order to make a good recovery, building on your personal strengths, with support.

17. Psychosis and Affective Disorder – Difficult to Engage

This group has moderate to severe psychotic symptoms with unstable, chaotic lifestyles. There may be some problems with drugs and alcohol not severe enough to warrant dual diagnosis care. This group have a history of non-concordance, are vulnerable and engage poorly with services.

Disrupting thoughts/ideas and mood difficulties

You have moderate to severe troubling and disrupting thoughts/ideas which may include anxiety and mood difficulties which are severely disrupting your life. You may also have a mild to moderate problem with alcohol and/or street drugs but this is not severe enough to warrant dual diagnosis care. You may struggle to remember to take your medication and to keep appointments and may need extra support to do this. There are a number of areas where you need help in order to make a good recovery, building on your personal strengths with appropriate support.

18. Cognitive Impairment (Low Need)

People who may be in the early stages of dementia (or who may have an organic brain disorder affecting their cognitive function) who have some memory problems, or other low level cognitive impairment but who are still managing to cope reasonably well. Underlying reversible physical causes have been ruled out.

Mild cognitive (memory) impairment

You may have experienced some memory or thinking problems but still cope reasonably well in most areas of your life. You are functioning well in most everyday situations. Services will work with you to help you to address or adapt to the difficulties you are experiencing.

19. Cognitive Impairment or Dementia Complicated (Moderate Need)

People who have problems with their memory, and/or other aspects of cognitive functioning resulting in moderate problems looking after themselves and maintaining social relationships. Probable risk of self-neglect or harm to others and may be experiencing some anxiety or depression.

Moderate cognitive/memory impairment or dementia

You are likely to have problems with memory and there may be other thinking problems. These problems are likely to cause difficulties in several areas of your life and your relationships. There may be a number of situations in which you fear losing control and/or feel unsafe. Services will work with you to help you to address or adapt to the difficulties you are experiencing.

20. Cognitive Impairment or Dementia Complicated (High Need)

People with dementia who are having significant problems in looking after themselves and whose behaviour may challenge their carer or services. They may have high levels of anxiety or depression, psychotic symptoms or significant problems such as aggression or agitation. They may not be aware of their problems. They are likely to be at high risk of self-neglect or harm to others, and there may be a significant risk of their care arrangements breaking down.

Complex memory impairment or dementia

You are likely to have significant difficulties in many areas of your life. There will be areas of your life where you may feel very unsure and even unsafe. Some of your behaviours may be very difficult for others to cope with. Your care arrangements may be at high risk of breaking down. Services will work with you and your carers to ensure you are kept and supported.

21. Cognitive Impairment or Dementia

Complicated (High Physical or Engagement)

People with cognitive impairment or dementia who are having significant problems in looking after themselves, and whose physical condition is becoming increasingly frail. They may not be aware of their problems and there may be a significant risk of their care arrangements breaking down.

Very severe and/or complex memory impairment or dementia

You are likely to have significant difficulties in many areas of your life, including your physical health. There will be many areas where you may feel unsure and unsafe and some of your behaviours are likely to be difficult for others to cope with. Because of this your care arrangements are at a high risk of breaking down.

Services will work with you and your carers to ensure you are kept and supported.

0. Variance

Despite careful consideration of all other clusters, this group of service users are not adequately described by any of their descriptions. They do, however, require mental health care and will be offered a service.

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Uncertain - requiring longer assessment

Despite careful consideration of all other Care Clusters, your current mental health needs are not fully reflected in any of their descriptions.  However it is clear that you do require mental health care at this current time and will be offered appropriate support to address your mental health needs and help you to make a good recovery

*Adapted from 'User and Carer Cluster Descriptions' Worcester Health and Care NHS Trust and Derbyshire Healthcare NHS Foundation Trust

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