Referrals from primary care to community mental health teams: what’s missing?

Abstract

INTRODUCTION:Transfer of care from primary to specialist mental health services almost always requires a referral by hardcopy letter or sent via a structured electronic form. The quality and content of referrals can vary, leading to delays in treatment. AIM:The aim of the research was to explore the quality and content of referral letters received by two urban New Zealand community mental health teams. METHODS:A retrospective audit of 4 months' worth of referrals (n ¼ 92) from primary care to specialist mental health services was undertaken using an audit tool created from a review of literature. RESULTS:The audit identified gaps in the information provided by referrers, including a lack of evidence of treatment in primary care before referral, risk information, information relating to physical health concerns or co-existing problems, evidence of client consent to referral, and recording of ethnicity. Thirty-seven percent of referrals were considered to be of poor quality. Compared to hardcopy letters, referrals generated by an electronic referral system were of a better quality and contained more information. More than 40% of referrals were not accepted, although the reasons for this were not assessed as part of this audit. DISCUSSION:Better integration of primary and secondary mental health care by using electronic referral templates may reduce the number of inappropriate or incomplete referrals. Referrals from primary care to specialist mental health services vary in content and quality, with many falling below a level that specialist services can accept. This impacts on the efficacy of services and ultimately on patients' journeys between primary and secondary care. Development of a standard referral template for use by primary care services may improve the quality of referrals.

Conceptual and practical challenges associated with understanding patient safety within community‐based mental health services

“…A further body of evidence discusses issues likely to affect safety across the care journey (e.g., care team communication problems), though neither embeds relevant patient safety science literature, nor is it conceived of as safety‐relevant research. Such articles instead identify themselves within the spectrum of care quality, 28 or focus on specific issues, such as inadequate care planning, 29 without linking these findings to safety implications. A bibliometric study of research activity on patient safety in community mental health services exemplifies this problem 30 .…”

“…care team communication problems), though neither embeds relevant patient safety science literature, nor is it conceived of as safety-relevant research. Such articles instead identify themselves within the spectrum of care quality (Allwood, O'Brien, & Glue, 2019), or focus on specific issues, such as inadequate care planning (Newman, O'Reilly, Lee, & Kennedy, 2015), without linking these findings to safety implications. A bibliometric study of research activity on patient safety in community mental health services exemplifies this problem (Silva Souza, Queiroz Bezerra, Santos Pinho, Costa Nunes, & Cardoso Caixeta, 2017).…”

Adolopment of clinical practice guidelines and creation of referral pathways for psychiatric conditions in Pakistan

“…66 A study in New Zealand suggested that better integrated primary-to-secondary care pathways were needed to improve the quality of referrals and care provision. 67 Another study by Wadoo and colleagues found that improvements in primary health care referrals at a mental health clinic in Qatar resulted in a 93% reduction in referrals with incomplete information, an 80% decrease in referrals that should have been directed elsewhere, and received positive feedback from the primary care physicians. 68 Thus, the referral pathways we have created have the potential to bring about similarly positive changes.…”

A service evaluation of the assessment process in a Step4 Psychological Therapies Service

“…Although there is suggestion that referral guidelines are helpful, they may not be consistently adhered to, though the reasons for this are ambiguous (Hartveit, et al , 2013; Rogers et al , 2013). The content and quality of referrals can also vary which can lead to delayed treatment and impact the efficacy of services (Allwood et al , 2019). A lack of necessary information in the referral may affect whether people reach the most appropriate destination first time and the service’s ability to pre-empt appropriateness for therapy prior to assessment (Dehghan et al , 2017).…”