What referral pathways exist for patients requiring forensic psychiatric assessment in primary care?

In primary care, patients requiring forensic psychiatric assessment should be referred to secondary care mental health services or specialist forensic services depending on the risk and complexity of the case. Referral pathways include:

• Referral to secondary care mental health services or CAMHS for assessment and further management of psychosis or suspected psychosis, including cases with coexisting substance misuse. This is the initial step for patients with severe mental illness requiring specialist assessment. NICE CG120
• Consideration of referral to forensic services when there is current violence or threats suggesting significant risk, a history of serious violence, predatory offending, or targeting of vulnerable people. Primary care professionals should consider this especially when risk of violence is identified. NICE CG77
• Collaboration with secondary care mental health services is essential, as they conduct detailed risk assessments and can initiate referrals to forensic services if indicated. NICE CG77
• In crisis situations, patients should be referred urgently to specialist mental health secondary care services, which may include forensic psychiatric teams if forensic risk is present. Crisis resolution and home treatment teams are accessible 24/7 for urgent assessments. NICE CG136

Thus, the primary care referral pathway for forensic psychiatric assessment involves initial referral to secondary mental health services, with escalation to forensic services based on risk assessment and history of violence or offending. Close collaboration between primary care, secondary mental health, and forensic services is key to appropriate management. NICE CG120,NICE CG136,NICE CG77