BASICSTEPS

Introduction

The Mental Health BASIC STEPS assessment tool allows all ambulance staff to provide a thorough and effective assessment with a person experiencing mental ill health, based on several risk factors aligned around the acronym BASIC STEPS.

This video below has been developed and created with the aim to provide additional support to staff to strengthen their understanding of the use of the BASIC STEPS tool and to provide a visual demonstration to coincide with the written guidance of its use.

This learning is for all clinical staff utilising the BASICSTEPS tool.

During the video, we please ask for staff to take notes of things you have observed during the assessment being completed. This can be reflections of how the assessment is being completed or notes on how the patient is presents throughout.

Additional Information

A BASICSTEPS learning module is available on ESR, and can be found using the link below.

Course: 242 NWAS Online – Mental Health – Assessment Tool: A Basic Step

Written guidance for each step can be found below.

Behaviour

• Engagement and rapport – Engaging in assessment or not engaging, calm, aggressive, agitated, distressed, withdrawn, hyperactive, hypoactive.
• Has their behaviour suddenly changed and/or what is different today? Any triggers such as an argument, relationship breakdown, bereavement or an impulsive act for example.
• Have they taken an overdose? Utilise TOXBASE app for additional information and support
• Have they consumed alcohol?
• Have they taken any illicit drugs?

Appearance

• How does the patient look? Is there any evidence of self neglect? Are they dressed appropriately?
• Eye contact
• Facial expression
• Body language and posture
• Have they self-harmed with this episode? What is the nature of the self-harm, when did this occur, any treatment required.
• Document a brief description – Clothing and general appearance

Also consider where relevant the persons environment that they are living in, for example tidy and clean, cluttered and untidy.

Speech

• Do they communicate with speech that is normal for them? Monotone, non-communicative, repetition, non-sensical, single word answers, excessive speech, word-finding difficulties, soft or loud volume
• Is there any pressure of speech? Speaking rapidly, sometimes loudly or frantically, with an urgency not apparent to you, sometimes difficult to understand or interrupt

 Insight

• Do they acknowledge the need for help or why you are there?
• Does the patient recognise they are unwell?
• Do they understand others concerns?
• Do they recognise they need help or treatment?
• If they don’t agree with your suggested plan of treatment, can they articulate clearly their rationale.

 Cognition

• Ascertain can the person follow simple instructions?
• Orientation – To date, time, place and person (make this relevant to the person)
• Attention
• Memory
• Alertness

 Set of Observations

• If able to and relevant to the clinical presentation, obtain a set of observations and record NEWS.
• Consider if the presentation could be a medical issue or a mixed presentation (physical and mental health).

 Thoughts

• Content – Consider depressive thoughts, negative, hopelessness, worthlessness, obsessive and compulsive thoughts. Is there any evidence of thought blocking (sudden cessation of thoughts, possibly mid-sentence) or flight of ideas (abrupt changes from topic to topic)?
• Any thoughts of suicide, self-harm or thoughts of harming others? How long have they had these thoughts? Do they have a plan? Do they have any intention to carry this out?
• Delusions – False beliefs not part of a cultural belief system and persist despite contradicting evidence.

Emotional State

• Do they feel: Low, hopeless, depressed, ambivalent, that they cannot go on, shame or guilt over an event/ issue, they are not coping. How long have they felt like this?
• Are they happy, labile, anxious, angry, empty (flat), upset, crying, feeling better now?
• Is their emotional state in context with the situation and their presentation?
• Objectively – How we observe and described their mood
• Subjectively – How the patient reports and described their mood

Perceptual Disturbance

• Hallucinations – Auditory (hearing), Gustatory (taste), Olfactory (smell), Tactile (touch), Visual (seeing)
• Do they consider that these are hallucinations or do they believe that they are real?
• Are these part of a persons normal presentation? Is it new, are they distressing and are they willing to share the content of these?
• Are there any increased risks to self or others as a result? For example, command hallucinations.
• Consider causes of this – Including mental illness, intoxication, withdrawal from drugs or alcohol, epilepsy, Parkinson’s disease, delirium, dementia, side effects of medication etc.

Shared Decision Making

• Access local agreed pathways or personal care (safety) plan if available
• Have you documented & considered past medical history, medications, social history & family history?
• Discuss with & involve person & family if able to regarding what happens next.
• Provide appropriate escalation advice & signposting if not transporting; think who else do I need to speak with to keep this person and others safe, for example contacting local mental health team.
• Consider safeguarding of patient or others is required & in line with local service policy. Any child under 18 who expresses suicidal ideation or self harm behaviours must have a safeguarding referral made.

Contact Information

For any additional information or enquires, please contact mentalhealthteam@nwas.nhs.uk.