When should I consider referring a patient with hallucinations to a mental health specialist?

Consider referring a patient experiencing hallucinations to a mental health specialist without delay if they are distressed, have a decline in social functioning, and present with transient or attenuated psychotic symptoms or other experiences suggestive of possible psychosis. This includes patients who have a first-degree relative with psychosis or schizophrenia, as they may be at increased risk of developing psychosis. Such patients should be referred for assessment by a consultant psychiatrist or a trained specialist with experience in at-risk mental states NICE CG178.

Additionally, refer patients urgently if they present in crisis, such as those who are feeling hopeless, thinking about or planning self-harm or suicide, or have a history of suicide attempts or self-harm. Crisis assessments should be conducted by experienced professionals and patients should be seen by specialist mental health secondary care services within 4 hours of referral NICE CG136,NICE NG66.

Patients with suspected or known coexisting substance misuse and hallucinations should also be referred to secondary care mental health services for assessment and management. This includes those suspected of psychosis with substance misuse or vice versa NICE CG120.