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What should prompt an urgent referral to a community mental health team?

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Abstract:

Background: There is often little guidance to advise general practitioners on whether a referral to a community mental health team should be classified as 'urgent' or not.

Aims: (1) To identify the proportion and appropriateness of referrals considered urgent by the referrer; (2) To develop a set of criteria to guide what should constitute an 'urgent' referral. Methods One hundred consecutive referral letters to a community mental health team were analysed to determine the proportion that were considered urgent by the referrer compared to a consensus panel of psychiatrists. A Delphi group was then used to develop a set of criteria to guide referrers as to what should be regarded as an urgent referral.

Results: Thirty-three percent of referrals were deemed urgent by the referrer, compared to 17% by the psychiatric consensus panel, with little agreement between the two (kappa = 0.021, P = 0.013). Referrals that were made using a single assessment process (SAP) form were significantly more likely to be inappropriately marked as being urgent (P < 0.001). A set of 12 criteria was developed using the Delphi technique.

Conclusions: There was significant disagreement between the referrers and the assessing team as to which referrals required urgent attention. The findings justified the creation of guidelines, and this paper outlines a set of 12 criteria to guide what should prompt an urgent referral.

Keywords: COMMUNITY MENTAL HEALTH SERVICES; DELPHI TECHNIQUE; PRIMARY HEALTH CARE

Document Type: Research Article

Affiliations: 1: Academic Clinical Fellow, John Radcliffe Hospital, Oxford, St Charles Hospital, London, Woodland Acres, Hascombe Road, Godalming, Surrey, GU8 4AA, UK;, Email: catrionahilton@doctors.org.uk 2: Specialist Registrar in Older Adults Psychiatry and Honorary Clinical Lecturer, Department of Psychological Medicine, Imperial College, St Charles Hospital, London, UK 3: Specialist Registrar in Psychiatry, St Charles Hospital, London, UK 4: Consultant and Honorary Senior Lecturer in Older Adults Psychiatry, St Charles Hospital, London, UK

Publication date: December 1, 2008

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