Mental health care referrals

Professionals working with a suicidal drug client may wish to determine whether the person meets criteria for Borderline Personality Disorder. Borderline clients often have a history of suicidal behavior and high utilization of health and mental health care services. Most people who meet criteria for Borderline Personality Disorder are women, but not all. As mentioned, some professionals find it difficult to work with borderline clients without becoming very upset or cynical. If you cannot work with such a client respectfully, then it is recommended that a referral be made to someone who can (see Chapter 3). Treating the client with dignity is important if trust and a solid therapeutic alliance are to develop. 

The referral for mental health care is often not made until an extensive medical evaluation has been completed. This medical assessment is often warranted, but a delay in recognizing the presence of panic disorder can result in an unending battery of expensive, unnecessary, and sometimes unpleasant medical tests. 

Families are often significantly affected by a family member s SUD. There are few areas in mental health care where patient and family education are as important as they are in the treatment of SUDs. The initial management and intervention described above is focused on educating the patient and family about the nature of SUDs and the need for abstinence. The process of intervention is rarely effective in a single visit, and typically the therapist must conclude the effort with a mutual agreement to keep the door open for future discussion. Referral to AA, Alanon, and Alateen may provide the patient and family with excellent information and edncational materials. 

Patient self-refers for mental health care or comes to treatment via a referral. 

Leave the practice of medicine to the physician. Most physicians do not appreciate a referral such as I m sending you this patient to get him started on Prozac. .. (or any other named medication). However, some physicians, especially those who have had limited training in mental health care, do appreciate the therapist s suggestion. Learn who does and does not. 

Cluster A patients rarely call attention to themselves and often suffer in isolation for much of their lives. They may be brought to treatment by a family member, or if they are employed, there may be a problem in the workplace that precipitates referral. By their nature, those with Cluster A personality disorders are difficult to engage in any modality of therapy, including medications. If the person has deteriorated in mental health to the point of developing a psychosis, medication may be considered for the specific target symptoms. Also, therapists should carefully... 

Evaluation and referral for any mental health-related complaint, even if not appropriate for followup care in medical setting... 

In most individuals, some degree of distress after a disorder is normal and resolves without treatment, and education and counseling may be all that is necessary to reassure them. Therefore, primary care clinicians should avoid indiscriminate pharmacologic treatment and mental health referral for all patients experiencing distress following a disorder (30). However, patients suffering extreme distress, such as those with dissociative symptoms or insomnia, are candidates for symptomatic treatment. 

In another study, conducted in the US Veterans Affairs healthcare system, in adults over 60 years with depression, an examination of whether pain severity and interference with normal work activities moderated the effects of depression treatment response was undertaken [9]. In this study, patients were randomized to integrated care (care debvered in the primary care clinic, by a mental health professional) versus enhanced specialty referral care (care delivered in the 344 subspecialty clinic office) and results were examined... 

Unfortunately, mental health professionals, such as psychologists and psychiatrists, are often not part of the multidisciplinary team responsible for LTMV patients. Therefore, an efficient referral system to access mental health professionals must be in place, so that psychological issues can be addressed before they become major comorbidities. Optimal care should include simple screening for psychological s)unptoms at the same time as the physical assessment, and on an annual basis thereafter (16). The screening can be conducted by any health care professional able to administer the screening tool. Suitable tools are brief, easy to administer, and have known psychometric properties. 

Bruns, E. J., Walrath, C Siegel, G. M., Weist, M. D. (in press). School-based mental health services in Baltimore Association with school climate and special education referrals. Behavior Modification. Cole, R., Poe, S. (1993). Partnerships for care Systems of care for children with serious emotional disturbances and their families. Interim report of the mental health services program for youth. Washington. DC Washington Business Group on Health. 

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