Referral to secondary mental health services should be considered in the following circumstances:
General demographic criteria
- Aged 18 or over
- Resident in the London boroughs of Ealing, Hammersmith and Fulham or Hounslow
Routine referrals should be used for:
- Anxiety/depression where two antidepressants and psychological input (NICE guidelines) have been prescribed with little or no improvement or intolerance
- Moderate to severe mental health condition, for example, severe anxiety/depression (where it’s identified as above), bipolar disorder, or schizophrenia
- Enduring personality disorder, that is which gives rise to a history of severe social disability, long term risk of self-harm, self-neglect or a serious long term risk of danger to others
- Where the GP requires the expertise of secondary care to confirm a diagnosis or to implement or refer for specialist treatment.
Risk and quality of life factors:
- Immediate action is not required - if it is, then urgent, or emergency referral is required
- There may be safeguarding concerns - for children or vulnerable adults - related to mental health, but urgent or immediate action is not required
- Where mental health problems will lead to progressive deterioration of the level of functioning without intervention from mental health services.
- Where this is a recurrent episode, within the last year, that is a re-referral
- Where discussion on the consultant phone line has confirmed that referral is appropriate
- Where primary care interventions and voluntary/non-statutory options have been exhausted
- Mental health problems where an assessment’s requested under the Community Care Act 1990.
Urgent referrals should satisfy the general demographic criteria and the criteria for routine referrals, plus any of the following:
- Suicidal ideas or plans, with clear means, or history of such attempts
- Psychotic symptoms including delusions, hallucination or thought disorder
- Severe agitation accompanying anxiety or depression
- Associated with sufficient functional impairment that there’s a risk to their own or others’ safety through direct harm or neglect
- Direct harm: where the patient feels so threatened by others that they have thoughts of and intent of harming others or themselves Alcohol use, lack of safety factors and a clear plan with preparation increase the level of risk
- Self-neglect: where the patient’s physical situation or level of psychological distress is found to be intolerable or they’re at risk due to being vulnerable to others, for example through disinhibited behaviour in mania
- Where serious safeguarding concerns (for children or vulnerable adults) appear related to mental health.
Emergency referrals should satisfy the general demographic criteria and the criteria for urgent referrals, plus any of the following:
- Presence of command hallucinations
- Immediate intent and means to harm self or others
- No other means to temporarily mitigate risk, for example, no carer to accompany the patient
- Where there are serious and immediate safeguarding concerns which appear related to mental health - for children or vulnerable adults
- Any other mental health crisis where an assessment’s required under the Mental Health Act.