Purpose of TAG 

TAG is a brief assessment of the severity of an individual’s mental health problems.

Instructions for completing it are contained on the score sheet, and this page provides further guidance. TAG is very easy to complete, requiring seven ticks on the Score Sheet. It is rated by staff for people who have (or are believed to have) mental health problems. Information on diagnosis should be recorded separately, if required.

TAG can be used in different ways, including:

• by GPs and other agencies (e.g. social services) who think someone has mental health problems and want to refer to a specialist mental health team - by appending a TAG to their referral letter, specialist mental health services will be helped to prioritise those most in need of help.
• to give a means of agreeing between agencies at what point in the care system people should receive help - this might be done by locally agreeing thresholds for referral.
• as a routine outcome measure for patients on the caseload of a mental health team
• to give commissioners a means of specifying the way in which community mental health teams are to focus on the severely mentally ill

COMPLETING TAG

TAG has seven domains covering the areas of Safety (two domains), Risk (two domains), and Needs and Disabilities (three domains). In each domain on the Score Sheet, you should tick one box, to indicate the rating of severity for that domain (ranging from ‘None’ to ‘Very Severe’). A checklist is provided for each domain, to indicate some of the important aspects to consider. The checklists are based on evidence and current practice, but must be used in conjunction with clinical judgement. If an aspect which is relevant to the person is not on the checklist, it should still inform the ratings made.

The rating chosen should be the one that best applies to the person being assessed. The time frame is not specified, since problems (e.g. violence) may only occasionally occur, but still be ongoing causes of concern. As a general guide, however, consider problems in the last month, but also include current concerns which originate from before this period.

Example - Domain 1. Intentional Self-Harm

Looking across the row, if ‘High risk to physical safety as a result of deliberate self-harm or suicide attempt’ is the statement that best applies to the person, then tick this box. This rating is classified as ‘Severe’ (shown at the top of the grid).

When all seven domains have been ticked (once in each domain), the assessment is complete. If desired, the number of ticks for each column can be recorded in the first row at the bottom. (The total should then add up to seven).

Example: if there are three ticks in the ‘Severe’ column, write ‘3’ in the box at the bottom of the ‘Severe’ column. Also, if desired, the TAG score can be calculated, by recording the total weighted score for each domain (e.g. 2 points for each Moderate rating) in the second row at the bottom, and then adding those scores together. The maximum TAG score is 24.

HOW TO USE A TAG ASSESSMENT

The two rows at the bottom of the Score Sheet indicate the severity of mental health problems. 445 TAG referrals to mental health services across London were analysed to provide guidance on referral thresholds. If the goal is to ensure that all referrals are suitable, then a threshold of at least 1 severe or very severe domain will ensure that 95% of referrals are suitable, but 74% of referrals not meeting this criterion will in fact be suitable - a high false negative rate. If the concern is to ensure that all suitable referrals are offered assessment, then using a threshold TAG score of 3 or more will ensure that 91% of suitable referrals are identified. However, 80% of unsuitable referrals will also meet this criterion - a high false positive rate.

The best cut-off is found using either a TAG score of 5 or more, or at least 2 moderate domains.

Example: A team may agree with its referrers that a TAG will be completed for all referrals, and that the team will assess anyone referred with a Very Severe rating within 24 hours, with 2 or more Severe ratings within 72 hours, and anyone else with at least 2 Moderate rating within 2 weeks. For patients with less than 2 Moderate ratings, the referral letter will state why the patient's mental health problems are of a severity to warrant specialist mental health service.

Further information on the Threshold Assessment Grid is available from Institute of Psychiatry