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

Consider referring a patient with health anxiety to a mental health specialist if:

• They have received at least two interventions (such as psychological therapy, medication, or bibliotherapy) in primary care but continue to experience significant symptoms.
• There is a need for a thorough, holistic reassessment of the individual, including evaluation of previous treatments, comorbidities, social circumstances, and risk assessment.
• The patient has complex or comorbid conditions that require specialist input, such as severe anxiety symptoms, panic disorder, or associated depression.
• They require access to specialist psychological therapies (e.g., CBT with an experienced therapist) not available in primary care or need more intensive management.
• There is a need for shared decision-making about treatment options beyond primary care capabilities, including pharmacotherapy adjustments or tertiary centre referral.

Referral should be considered after initial management attempts in primary care have not sufficiently improved symptoms or when complexity of the case exceeds primary care resources and expertise ².