When should I consider referring a patient with dissociative symptoms to a specialist mental health service?

Consider referring a patient with dissociative symptoms to a specialist mental health service when:

• They present with clinically important symptoms that suggest complex or severe presentations, such as those seen in complex PTSD, which includes dissociative symptoms alongside severe affect regulation problems and difficulties in relationships.
• There is diagnostic uncertainty or concern about underlying neurological or psychiatric conditions that require specialist assessment.
• The patient is in crisis or at risk of harm, requiring urgent specialist mental health assessment and intervention.
• The symptoms significantly impair functioning or cause distress that cannot be managed adequately in primary care.
• There is a need for multidisciplinary assessment or specialist interventions beyond the scope of primary care.

In these cases, referral to specialist mental health services such as secondary care PTSD services, community mental health teams, or child and adolescent mental health services (CAMHS) is appropriate to ensure comprehensive assessment and management.