Psychiatric Referrals

Primary Care Mental Health Services

Largely nurse based services. They usually offer SHORT courses of therapy/ counselling/CBT (around 6 sessions).

Suitable patients are quite stable, only expected to require short term input. Their risk history should be minimal, and should not require urgent input as may be put on a waiting list. They can sometimes tackle issues such as bereavement, postnatal mental health etc.

If in doubt ring and ask.

Secondary care: Community Mental Health Services (CMHT)

More appropriate for patients with complicated histories, inpatient admissions, those known to services, those with a risk history (i.e. to self or others).

Usually a referral is seen by a ‘gateway’ CPN who reads the referral, gets old notes and looks on Total Care (the prehistoric psychiatry computer system). They triage the patient, and either do an assessment, discuss at the team meeting for suitability for therapy, doctor review, or chose the most appropriate service. Patients are usually seen in a few weeks.

Services available in the CMHT are:

  • A Consultant (and SHO)
  • CPNs and Social Workers (who take the role of ‘Care Coordinator’)
  • A Therapy team- who will assess, and offer a psychodynamic/ CBT approach. They usually have waiting list. Therapy can run for up to a year if necessary.

If you are not sure whether someone is suitable for CMHT, or whether they need review sooner, i.e. within the next week, ring the Duty nursing team for the area.

Other Teams

Assertive Outreach Team: Deal with difficult cases who have a tendency to disengage from services. They are often managed without medications.

Early Intervention Team: Work with patients under 35 years old, who have suffered a new psychotic episode. The patients stay with the team for 3 years and are again often managed without medication.

Rehab: Work with patients suffering from chronic mental health issues who have difficulties with activities of daily living.

Crisis Resolution Home Treatment Team: This team works with patients who are at the point of hospital admission, as an alternative to inpatient treatment. They offer intensive but short lived (a couple of weeks) interventions. They are increasingly involved in early discharge from hospital as well.

Tips for Psychiatric referral

(Collected ‘from the horses mouth’, i.e. from Community nurses!)

  • If you are discussing sensitive issues about a patient on the phone, ask the patient to sit in the waiting area (apparently a common problem).
  • Collect as much relevant information as you can about the patient AND INCLUDE IT. (As for any referral). Include info such as- risk to self or others, home circumstances, the view of relatives/carers, the patient’s views, any children involved?
  • Give your impression and what you think they need.