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

You should consider referring a patient with catatonia to secondary mental health services, particularly if they are presenting in a crisis, or if their condition suggests severe mental illness or psychosis.

• Crisis Presentation: If a patient is referred in crisis, they should be seen by specialist mental health secondary care services within 4 hours of referral NICE CG136,NICE CG155. Crisis assessments should be undertaken by experienced health and social care professionals competent in crisis working NICE CG136.
• Severe Mental Illness: Patients with severe mental illness should be referred to and followed up within secondary care, with mental health services taking the lead for assessment and care planning NICE NG58. Secondary care mental health services should undertake a comprehensive assessment of the person's mental health needs NICE NG58.
• Possible Psychosis (Children and Young People): For children and young people experiencing symptoms suggestive of possible psychosis, referral for assessment to a specialist mental health service should be made without delay NICE CG155. While this guideline specifically addresses children and young people, the principle of prompt referral for suspected psychosis is relevant given that catatonia can be a feature of psychotic disorders.