The Mental Health Referral Handover Checklist

The Handover checklists for nursing, casework and occupational therapy have been devised in the wider Support Network series, taking into account the particular knowledge each profession has. The mental health version is the trickiest of the lot, as the information involved is what people have lost jobs, custody and relationships over, and a person receiving the handover is about to enter someone's home and week, and the person receiving the handover really does need some of it to do the role safely.

The failure modes are the same: the thin one that passes on a thin handover to a worker, who, on Tuesday morning, starts an arrangement with a person who has no psychiatric history, and the thick one that passes on a psychiatric history to someone who needed to know about Tuesday mornings, and converts the client from a person to a diagnosis. The discipline which solves it is the one that traverses this whole series, set to its most extreme instance: need to know to act, inside consent, specific and real.

The checklist

First, the person. Two or three sentences the client would know and agree to, preferably be able to help with: what they care about, what a good week looks like, how they want to be treated. In mental health handovers this section has extra weight as it is the balancing element to all the other things the worker may learn during their time at work.

The engagement map. What's worked for this person and helped them to engage, and what has failed to engage (pace preferences), topics that open conversation and topics that close conversation, the interest that carries the early phase, the honest history, one-line statement, and any previous arrangements that have come to an end (because X) so this arrangement is designed to be Y, all taken from the engagement-first and matching articles that came before this one in this series.

The practical brief. The week as designed, as in the translation article: the supporting routine, the anchoring activities, the flex for more difficult weeks, and the direction of the capacity-building activities, or direction of the arrangement as it is meant to go.

The wellbeing frame (practice level). Not the history, not the diagnosis unless the client has agreed, but what the worker needs to do the job well, the things the client observes that lead up to the crisis, the things that help them, and the other things that don't; nothing from the client's safety planning, unless the client has agreed, and they have one; what the client has asked the worker to do or not do when things are tougher.

The three lanes. The escalation plan from the previous part of this series, embedded: routine logging, the prompt line with names and numbers, the crisis paragraph (including what the worker doesn't try).

The scope and date of consent. What the client agreed was to be sent, recorded so the worker knows what it contains and the edges, and the date of the re-read of the document, recovery moves and stale handovers misrepresent people with authority.

Write it with the client

The mental health tuning of the drafting process: wherever possible and appropriate the handover is written with the person and not about them. Partly ethics: this is their information, this is their week, and partly craft: this is a map that the client has supplied, one that is built through the co-writing process, and one that they've read and approved before it goes anywhere. If a client objects to including something that the practitioner believes is necessary for safety, then this tension is negotiated with the client before the referral is made, not alleviated by remaining silent, and the discipline of the broader series is that sensitive facts that must travel, travel at practice level, with handling instructions.

How this plays out in practice

Now imagine the combination this series has created after six articles, at the moment of its first handover: the woman from the matching article, the first Vietnamese speaking worker, the first visit planned. It is two pages, written at one appointment with her daughter as her interpreter, the engagement map, the cooking opens everything; questions about medication close it; the week as designed; the early signs in her own words; the three lanes with the community team's duty number; the consent line, recording what is between her and her clinicians. The worker reads it before visiting and comes ready to know what to offer and what to guard. It was the first real handover, when the practitioner thinks about it, in six services in four years.

Next steps

Create the template from the 6 sections, and then write one with a client, in an appointment as a shared task. Observe what they include that was not in the file. The practice sticks because of that addition.