When to refer depression/anxiety to specialist mental health services?

Referral to specialist mental health services for co-ordinated multidisciplinary care is indicated for patients with depression if they have more severe depression or chronic depressive symptoms that significantly impair personal and social functioning, have not responded to primary care treatment, and have coexisting psychosocial and/or physical health risk factors ¹,⁵. This includes situations where the depression has not responded to treatment in primary care and the individual has multiple complicating problems such as unemployment, poor housing, or financial difficulties, or significant coexisting mental and physical health conditions ⁵. Specialist referral is also considered when switching to or from a monoamine oxidase inhibitor (MAOI), considering other specialist combination drug treatments, or physical therapies like electroconvulsive therapy (ECT) ¹. For children and young people, referral to specialist services (CAMHS tier 2 or 3) is indicated for moderate or severe depression, signs of recurrence in those who have recovered from moderate or severe depression, unexplained self-neglect of at least 1 month's duration, or active suicidal ideas or plans ³. For anxiety disorders, referral to specialist mental health services is considered at Step 4 of stepped care for panic disorder ⁷. In cases of self-harm, immediate referral to a crisis resolution and home treatment team is required if there is an immediate risk of self-harm or suicide ². If a mental health disorder requires specialist management, or if there is cognitive impairment, high levels of distress, increasing risk of self-harm, unresponsiveness to other strategies, a request for specialist intervention, or high distress in family members/carers, referral to community mental health teams and/or psychology services is appropriate ². For individuals under 18 years old with self-harm, referral to Child and Adolescent Mental Health Services (CAMHS) is necessary ².