Suitability criteria

WREN aims to prioritise care for women who are Aged 18 and over, residing in Victoria experiencing mental illness and in addition have one or more of the following:

• Diagnostic complexity or treatment non-responsiveness requiring a period of assessment or observation on an inpatient unit develop a treatment plan to support the participant and their carers, and to support their treatment team to provide ongoing care
• A previous experience of sexual assault and/or harassment and are at risk from a sexual safety perspective and are at risk of re-traumatization, if admitted to a mixed gender adult inpatient unit
• A previous experience of domestic, family or sexual violence or violence in past inpatient admissions and are consequently at risk of harm or re-traumatization on a mixed gendered adult inpatient unit.

• Participants who require inpatient mental health care rather than community care. Wren is not suitable for people presenting solely with psychosocial difficulties. There must also be co-morbid mental health issues present.
• Participants who are willing and consenting to being admitted
• Participants who display readiness to engage in the therapeutic program
• Participants engaging with the service voluntarily
• Participants experiencing mental illness during pregnancy or in the first year postpartum, who are the carer for an infant up to the age of 12 months, and whose infant is at risk of poor parent-infant attachment due to parental mental illness
• Participants who have an eating disorder that is not being sufficiently contained (unable to weight maintain or restore) in spite of engagement with community supports (as per National Eating Disorders Collaboration - Stepped Care system of care for eating disorders)
• Participants requiring mental health treatment for an eating disorder (with a Body Mass Index (BMI) greater than or equal to 14 at the time of admission with the exception of severe and enduring illness) and not requiring acute medical stabilisation or at high risk of refeeding as per the Alfred Health Eating Disorder – Inpatient Access and Treatment Pathways Guideline (see physical health non-suitability criteria below) & Wren Eating Disorder Guidelines

• Participants on an Assessment Order, Inpatient Temporary Treatment Order or on Inpatient Treatment Order under the Victorian Mental Health & Wellbeing Act (2022)   
• Participants who are at potential high risk of rapid deterioration of their mental health or who are experiencing a level of behavioural disturbance that cannot be managed in the Ramsay Clinic Albert Road environment (participants need for compulsory treatment and use of restrictive interventions will be considered in triaging suitability)
• Participants who are at high risk of acute physical health deterioration or who are experiencing an active physical illness requiring treatment in a general medical inpatient setting
• Participants with a severe acquired brain injury or cognitive impairment that precludes meaningful engagement in the therapeutic program
• Participants using alcohol or other substances in a manner that poses a risk to themselves or others, or precludes meaningful engagement in the therapeutic program
• Participants who have access to appropriate alternative treatment settings such as private mental health admissions

• Participants with postnatal mental illness who are not the carer of their infant or with no active plan for reunification - these participants may be considered for the general mental health stream
• Participants with postnatal mental illness of a severity which precludes interaction with their infant or provision of safe care to their infant with clinician support - these participants may be considered for the general mental health stream with the aim of transitioning to the perinatal stream following improvement in their condition
• Participants with perinatal mental illness posing an acute risk of harm to self, their infant or other infants in their vicinity
• Infants with complex medical needs such as: Nasogastric feeding or home oxygen for example

- BMI below 14, with exceptions for individuals with enduring eating disorders - considered on a case-by-case basis

- Haemodynamic instability characterised by:

• Systolic blood pressure <100mmHg (if between 80-100mmHg admission can be considered with assessment/consultation with medical staff)
• Postural blood pressure drop of >20mmHg systolic or >10mmHg diastolic
• Resting heart rate <50bpm or >100bpm
• Postural tachycardia >20bpm
• Temperature <35.5 degrees or >38 degrees
• ECG changes that are not overtly benign
• Random as or fasting BSL <3mmol/L

- High risk of refeeding

• Weight loss of 7.5% in 3 months OR > 10 % in 6 months
• Evidence of severe muscle and/or fat wastage
• None or negligible nutritional intake for > 7 days
• Critically low levels of serum potassium, phosphate or magnesium OR Normal to low levels of serum potassium, phosphate or magnesium following significant or multiple-dose supplementation to maintain these levels

- Requires NGT feeds

- Significant metabolic or electrolyte derangements such as:

• Sodium <130 mmol/L
• Potassium <3.0 mmol/L
• Magnesium <0.6 mmol/L
• Phosphate <0.7 mmol/L
• eGFR <60
• Albumin <26 g/L
• ALT >3 times the upper limit of normal
• Neutrophils <1.0 x10^9/L

- Unavailability of dietician to see participant on day of admission. Dietary requirements will be assessed on a case-by-case basis.

- Unable to commit to the program of the Eating Disorder Unit i.e compliance with prescribed meal plan for the 3 meals and 3 snack times, engage in meal support, attend to the group program and agree to the medical monitoring including weight checks

• Be willing and consent to have care, support, and treatment at home
• Have stable accommodation or suitable alternative accommodation to be seen
• Live within the HiTH catchment (Alfred Mental Health catchment plus 10km radius from RARC – LGA’s Melbourne, Yarra, Stonnington, Glen Eira)
• Have a home environment which is safe for both the participant and visiting staff (subject to a home visit risk assessment including a domestic violence screen)
• Requires daily or twice daily contact
• Preferably have a support network that is willing and able to be actively involved in their care and treatment
• Have capacity to manage their condition and to escalate their care, or have a live-in carer and/or support person who takes this responsibility in the setting of clinical deterioration
• Be able to develop a plan with clinicians and ideally with their support persons which identifies feasible strategies to support their risks to self and others
• Be able to engage in therapeutic interventions including care, support and treatment, completion of a Wellbeing Plan & participation in network meetings
• Careful consideration should also be given to:
  • The nature of acute or chronic deliberate self-harm and the risks this poses to the participant in the home setting
  • Risks of harm to others including any dependents in the participant’s care
• Perinatal – adequate in-home support for care of the infant

• Require 24h observation
• Require more than 2 face-face contacts per days
• High risk of suicide persistent thoughts, a plan, intent, access to means
• Homicidal ideation with plan and intent
• Severe DSH that cannot be managed safely in a hospital in the home model
• Unsafe accommodation
• Perinatal – Imminent/High risk of harm to infant
• Persistent thoughts, a plan, current acts, any history of harm to infant
• Eating Disorders - Haemodynamic instability OR organ dysfunction OR Electrolyte derangement requiring acute hospital admission