Emotional Wellbeing & Mood EMOTIONAL WELLBEING & MOOD (QMS-F072) Contact Document Ref: QMS-F072 (Depression Screening & Wellbeing) Version: 1.0 Confidentiality Level: HIGH (Medical Records) CQC Alignment: Caring (Emotional Support) Service User Full NameService User ID NumberOperating Local Authority- Select -HaringeyIslingtonWaltham ForestBarnetOtherCare Funding & Financial Arrangements- Select -Local Authority Managed (Direct Commissioning)NHS Funded (Continuing Healthcare - CHC)Direct Payments (Personal Budgets)Self-Funded (Full Cost)OtherSECTION 1 - Social Isolation BaselineCurrent Living Arrangement- Select -Lives aloneLives with spouse / partnerLives with family membersSupported living complexSocial Isolation Risk Level- Select -HIGH Risk (Rarely sees anyone other than care workers)MEDIUM Risk (Sees family/friends 1-2 times a week)LOW Risk (Strong, active daily support network)SECTION 2 - Emotional & Psychological ObservationsIdentify any emotional indicators recently observed or reported: Frequent tearfulness or crying Expressing feelings of worthlessness, hopelessness, or guilt Loss of interest in previously enjoyed hobbies Noticeable changes in sleep patterns (insomnia or oversleeping) Increased irritability or frustration Expressing a desire to "give up" / Suicidal ideation None of the aboveMandatory Crisis Escalation- Select -I confirm that this severe risk has been escalated immediately to the GP, CMHT, 111, or 999 as appropriate.Has a formal diagnosis of depression, anxiety, or another mood disorder been made?- Select -YesNoDetails of Diagnosis & Professional InvolvementSECTION 3 - Meaningful Engagement & SupportMeaningful Engagement ProfilePreventative Action Plan GP referral requested for mood review Referral to local befriending service / Age UK Care workers instructed to allocate extra 5 mins for conversation Ensure curtains are opened to maximise natural light Prompt to listen to preferred music or radio stationSECTION 4 - Risk Control & Sign-offSpecific Instructions for Care WorkersAssessor NameDate of AssessmentSave Wellbeing Assessment
