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

You should consider referring a patient with anxiety disorders to a mental health specialist in several key situations, particularly when primary care interventions are insufficient or there are significant complexities or risks.

• Immediate Risk: Refer to a crisis resolution and home treatment team if there is thought to be an immediate risk of self-harm or suicide ³. For people with Generalised Anxiety Disorder (GAD), a risk of self-harm or suicide is a specific criterion for referral to Step 4 specialist services ¹,⁴.
• Generalised Anxiety Disorder (GAD): Consider referral to Step 4 (which normally refers to community mental health teams) if the person has severe anxiety with marked functional impairment in conjunction with:
  • A risk of self-harm or suicide ¹,⁴.
  • Significant comorbidity, such as substance misuse, personality disorder, or complex physical health problems ¹.
  • Self-neglect ¹.
  • An inadequate response to Step 3 interventions ¹,⁴.
  This also applies to people with complex, treatment-refractory GAD and very marked functional impairment ⁴.
• Panic Disorder: In most instances, if a person with panic disorder still has significant symptoms after two interventions (any combination of psychological intervention, medication, or bibliotherapy), referral to specialist mental health services should be offered ¹.
• Other Considerations for Referral to Community Mental Health Teams and/or Psychology Services:
  • If there is a mental health disorder of a nature or severity requiring specialist management, or cognitive impairment ³.
  • If the person is experiencing high levels of distress, their risk of self-harm is increasing, they are unresponsive to other strategies, or they request intervention from specialist services ³.
  • If there are high levels of distress in family members, carers, or significant others ³.
  • If there is misuse of recreational drugs or alcohol, refer to appropriate drug and alcohol services ³.
  • For people aged under 18 years, refer them to Child and Adolescent Mental Health Services (CAMHS) ³.
• Recurrent Problems/Relapse Risk: For people with a common mental health disorder who are at significant risk of relapse or have a history of recurrent problems, the choice of treatment or referral for treatment should be informed by their response to previous treatment, residual symptoms, consequences of relapse, discontinuation symptoms, and their preference ¹.