Adults

A main objective of the WHO Guide to Mental Health in Primary Care is to extend the expertise of the primary care clinician and improve the cooperation and communication between primary care and secondary mental health services. With this understanding, the following guidelines have been prepared.

Referral to secondary mental health services should be considered in the following circumstances:

• where the patient is displaying signs of suicidal intent or if there seems to be a risk of harm to others
• where the patient is so disabled by their mental disorder that he/she is unable to leave his/her home, look after his/her children or fulfil other activities of daily living
• where the GP requires the expertise of secondary care to confirm a diagnosis or implement specialist treatment
• where the GP feels that the therapeutic relationship with the patient has broken down
• where primary care interventions and voluntary/non-statutory options have been exhausted
• where there is severe physical deterioration of the patient
• where particular psychotropic medication is required (eg clozapine, lithium or donezepil)
• if the patient requests a referral.

When making a referral to secondary mental health services, Social Services or voluntary/non-statutory organizations, the GP should:

• have access to a local resource directory
• consider coordination issues around the referral (eg Care Programme approach, care manager)
• consider implications for the continuing care of the physical health of the patient.

All referral criteria constitute part of the guideline for that particular disorder and assume that, as far as possible, the guideline for diagnosis and management has been followed.

Referral letters

• Patient's name, hospital number (if known), date of birth, address and telephone number
• Presenting complaint
• Reason for referral, including whether for advice only for GP to manage, or for psychiatrist to manage
• Past psychiatric history
• Background
• Current mental state
• Current medication, details of any medication tried in the past few weeks
• Drugs and alcohol history
• Details of carers and significant others.

Last edited: 21/1/2004

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