When should I consider referring a patient with adjustment disorder to secondary mental health services?

Consider referring a patient with adjustment disorder to secondary mental health services when:

• There is a mental health disorder of a nature or severity requiring specialist management, such as high levels of distress or risk of self-harm or suicide.
• The patient is unresponsive to primary care management strategies and continues to experience significant distress or functional impairment.
• The patient requests intervention from specialist services.
• There are increasing levels of distress or risk to self or others that do not subside despite attempts to manage anxiety and improve coping skills.
• There is evidence of self-harm or suicidal intent, or the risk is immediate, necessitating urgent referral to crisis resolution and home treatment teams or community mental health teams.
• If the patient is under 18 years old, referral should be made to Child and Adolescent Mental Health Services (CAMHS).

In all cases, clinical judgement should guide the urgency of referral based on risk assessment and the patient’s level of distress or impairment.

While adjustment disorder itself may often be managed in primary care with support and monitoring, referral is warranted when the condition is severe, persistent, or complicated by risk factors or comorbidities requiring specialist input.

Ensure communication and coordination with specialist services and maintain follow-up in primary care if the patient declines referral.

NICE CKS,NICE NG225