What referral criteria should I consider for patients exhibiting prolonged grief disorder symptoms?

There are no specific UK NICE guidelines explicitly detailing referral criteria solely for prolonged grief disorder (PGD); however, clinical practice for referral can be informed by the approach to related mental health conditions such as PTSD and depression, alongside emerging evidence from research on PGD interventions. Referral should be considered when a patient exhibits clinically significant distress and functional impairment due to prolonged grief symptoms that persist beyond the expected cultural or normative period of bereavement. This includes symptoms causing moderate to severe impairment in social, occupational, or other important areas of functioning, or when there is a risk of self-harm or suicide.

In primary care, initial assessment should evaluate the severity of symptoms, impact on daily functioning, and any co-morbid mental health conditions such as depression or PTSD, which commonly co-exist with grief disorders. If symptoms are severe, persistent, or complicated by other mental health issues, referral to specialist mental health services for psychological therapy is appropriate. This aligns with NICE’s approach to PTSD and depression, where referral is indicated for moderate to severe symptoms or when risk is identified ¹,²,³.

Emerging research, such as the randomized controlled trial by Litz et al. (2014), supports the effectiveness of therapist-assisted interventions for PGD, suggesting that early referral to psychological therapies can be beneficial in preventing chronic impairment (Litz et al., 2014). Therefore, patients with prolonged grief symptoms that do not improve with initial support or who show signs of complicated grief should be referred for specialist psychological assessment and treatment.

In summary, referral criteria for patients with symptoms of prolonged grief disorder include:

• Persistent grief symptoms causing moderate to severe functional impairment beyond the expected bereavement period.
• Presence of significant distress impacting social, occupational, or personal functioning.
• Risk of suicide, self-harm, or other safety concerns.
• Co-morbid mental health conditions complicating the clinical picture.
• Lack of improvement with initial primary care management or active monitoring.

Referral should be made to specialist mental health services offering evidence-based psychological therapies, with consideration of collaborative care models to support ongoing management ¹,²,³ (Litz et al., 2014).