A Mental Health Care Cluster is a MENTAL HEALTH CARE CLUSTER which is a type of CATEGORY VALUED PERSON OBSERVATION.

A Mental Health Care Cluster is part of a currency developed to support the National Tariff Payment System for Mental Health Services.  Mental Health Care Clusters are 21 groupings of Mental Health PATIENTS based on their characteristics, and are a way of classifying individuals utilising Mental Health Services that forms the basis for payment.

A Mental Health Care Cluster is assigned using a decision tree or algorithm based on the PERSON SCORE from the Mental Health Clustering Tool undertaken by a CARE PROFESSIONAL for the PATIENT.

This is done by first assigning the PATIENT to one of three Mental Health Care Cluster Super Classes, to narrow down the number of possible Mental Health Care Clusters which are applicable to the PATIENTS condition. The PATIENT is then assigned to the most appropriate of this sub-set of Mental Health Care Clusters.

The Mental Health Care Clusters into which the presenting needs of the PATIENT may fall are:

Care Cluster 0:  Variance - Despite careful consideration of all the other Mental Health Care Clusters, this group of PATIENTS are not adequately described by any of their descriptions. PATIENTS who cannot be initially assigned to a Mental Health Care Cluster Super Class during the clustering process will be automatically assigned to this Mental Health Care Cluster.

Care Cluster 1:  Common Mental Health Problems (Low Severity) - This group of PATIENTS has definite but minor problems of depressed mood, anxiety or other disorder, but they do not present with any psychotic symptoms

Care Cluster 2:  Common Mental Health Problems (Low Severity with Greater Need) - This group of PATIENTS has definite but minor problems of depressed mood, anxiety or other disorder, but not with any psychotic symptoms. They may have already received care associated with Care Cluster 1 and require more specific intervention, or previously been successfully treated at a higher level but are re-presenting with low level symptoms

Care Cluster 3:  Non-Psychotic (Moderate Severity) - This group of PATIENTS have moderate problems involving depressed mood, anxiety or other disorder (not including psychosis)

Care Cluster 4:  Non-Psychotic (Severe) - This group of PATIENTS is characterised by severe depression and/or anxiety and/or other disorders, and increasing complexity of needs. They may experience disruption to function in everyday life and there is an increasing likelihood of significant risks.

Care Cluster 5:  Non-Psychotic Disorders (Very Severe) - This group of PATIENTS will be severely depressed and/or anxious and/or other. They will not present with 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.

Care Cluster 6:  Non-Psychotic Disorder of Over-Valued Ideas - This group of PATIENTS suffer from moderate to very severe disorders that are difficult to treat. This may include treatment resistant eating disorders, Obsessive Compulsive Disorder etc, where extreme beliefs are strongly held, some personality disorders, and enduring depression.

Care Cluster 7:  Enduring Non-Psychotic Disorders (High Disability) - This group of PATIENTS suffer from moderate to severe disorders that are very disabling.  They will have received treatment for a number of years and although they may have an improvement in positive symptoms, considerable disability remains that is likely to affect role functioning in many ways.

Care Cluster 8:  Non-Psychotic Chaotic and Challenging Disorders - This group of PATIENTS 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-dependant engagement, and are often hostile with services.

Care Cluster 9:  Cluster Under Review - Note: This Mental Health Care Cluster is under review and should not be used.

Care Cluster 10:  First Episode Psychosis - This group of PATIENTS will be presenting to the Mental Health service for the first time with mild to severe psychotic phenomena. They may also have depressed mood and/or anxiety and/or other behaviours. Drinking or drug taking may be present but will not be the only problem.

Care Cluster 11:  Ongoing Recurrent Psychosis (Low Symptoms) - This group of PATIENTS have 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.

Care Cluster 12:  Ongoing or Recurrent Psychosis (High Disability) - This group of PATIENTS 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.

Care Cluster 13:  Ongoing or Recurrent Psychosis (High Symptoms and Disability) - This group of PATIENTS will have a history of psychotic symptoms which are not controlled. They will present with moderate to severe psychotic symptoms and some anxiety or depression. They have a significant disability with major impact on role functioning.

Care Cluster 14:  Psychotic Crisis - This group of PATIENTS will be experiencing an acute psychotic episode with severe symptoms that cause severe disruption to role functioning. They may present as vulnerable and a risk to others or themselves.

Care Cluster 15:  Severe Psychotic Depression - This group of PATIENTS 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.

Care Cluster 16:  Dual Diagnosis - This group of PATIENTS have enduring, moderate to severe psychotic of affective symptoms with unstable, chaotic lifestyles and co-existing substance misuse. They may present a risk to self and others and engage poorly with services. Role functioning is often globally impaired.

Care Cluster 17:  Psychosis and Affective Disorder (Difficult to Engage) - This group of PATIENTS have moderate to severe psychotic symptoms with unstable, chaotic lifestyles. There may be some problems with drugs or alcohol not severe enough to warrant dual diagnosis care. This group have a history of non-concordance, are vulnerable, and engage poorly with services.

Care Cluster 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.

Care Cluster 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.

Care Cluster 20:  Cognitive Impairment or Dementia (High Need) - People with dementia who are having significant problems in looking after themselves and whose behaviour may challenge their carers 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.

Care Cluster 21:  Cognitive Impairment or Dementia (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.

Further information relating to the Mental Health Clustering Tool and Mental Health Care Clusters is available from the  Monitor part of the gov.uk website at: Guidance on mental health currencies and payment.

This supporting information is also known by these names:

Context	Alias
plural	Mental Health Care Clusters