Psychological ill health is a key driver of absence from work, treatment costs and poor performance.  Those suffering from serious conditions like depression, psychosis, alcohol or drug use disorders and significant emotional (or medically unexplained) complaints represent some of the most challenging presenting conditions, for clinicians and businesses.

The appropriate triage, assessment and management of psychological conditions therefore has huge implications for managing health performance in work, claims risks profiles (for PMI, PHI/IP) for your business, as well as for the care the patients receive.

There's been a trend within some health businesses in recent months towards promoting remote (telephone or online) triage and assessment of clinical psychological presenting conditions, with follow-up support through face-face intervention, usually provided through onward referral to clinical psychologists or CBT specialists.

Remote triage services may be presented as improving access to care for patients, potentially helping to improve treatment outcomes, or even helping to manage PMI claims costs, all of which are bold claims and certainly warrant a closer investigation.

There's an important distinction between conditions which are termed 'clinical' and those which may be viewed as short-term or less complex, which most Employee Assistance Programmes (EAPs) are perfectly well designed to support.  When EAPs are promoted effectively and aligned closely with other health services, for example occupational health practitioners, they can be a powerful health risk management tool for any business.

However, the 'clinical' conditions may present to such a degree that they can easily become chronic, debilitating and often incredibly complicated cases.  It's the triage, assessment and management of these complex cases that's of greatest concern to those treating patients, funding care, or supporting rehabilitation programmes.

In new guidance*, published this month by the World Health Organisation (WHO), simplified diagnosis and treatment guidelines are provided, which Blossoms Healthcare believes all health practitioners should consider closely.

The guidelines* are designed to facilitate the management of mental health disorders and extend competence frameworks for diagnosis and management to non-mental health specialists (including doctors, nurses and other health providers).

The WHO guidelines are purely evidence based and "transform a world of expertise and clinical experience, contributed by hundreds of experts, into less than 100 pages of clinical wisdom and succinct practice advice" says Dr Margaret Chan, Director-General of the World Health Organisation.

In the Foreword (page 5), Dr Chan also says "there is a mistaken idea that improvements in mental health require sophisticated technologies and highly specialised staff.  The reality is that most mental, neurological and substance use conditions with high morbidity and mortality can be managed by non-specialist health-care providers.  What is required is increasing the capacity of the primary health care system for delivery of an integrated package of care by training, support and supervision".

Blossoms are happy to declare an interest in supporting appropriate access to primary care, as it's one of our key specialities.  However, when leading health authorities like the WHO lay down principles of care for the treatment of mental health conditions, such as 'ensure clare communication' (page 16) and 'perform a physical assessment' (page 16), we believe there is a strong basis in suggesting that remote triage, assessment or management of complex psychological conditions is far from best clinical practice.

With regard to 'ensuring clear communication', we'd all recognise that much of the way we communicate is non-verbal.  For example, body language, demeanour and facial expressions are all key parts of any day-to-day conversation, let alone an effective patient assessment.

Given the difficulties in remotely gauging non-verbal communication effectively, as well as the difficulties in being able to conduct any type of physical assessment, "remote triage" is probably more accurately described as "signposting to treatment", rather than clinical triage.

That kind of approach to assessing a patients' condition could easily result in unnecessary or inappropriate treatment, may be counter-productive in resolving the presenting issues and event potentially detrimental to the individuals' health.

Blossoms believes any business considering remote psychological support, beyond the care available through most EAPs, should seek specialist independent advice (for example, from specialist healthcare intermediaries, brokers or even a friendly doctor) before implementing any new services.

* http://www.who.int/mediacentre/news/releases/2010/mental_health_20101007/en/index.html

* http://whqlibdoc.who.int/publications/2010/9789241548069_eng.pdf