What criteria should I use to determine if a patient with GAD requires referral to a mental health specialist?

Referral to a mental health specialist for a patient with generalized anxiety disorder (GAD) should be considered if the patient has severe anxiety with marked functional impairment combined with any of the following criteria: a risk of self-harm or suicide; significant comorbidity such as substance misuse, personality disorder, or complex physical health problems; self-neglect; or an inadequate response to step 3 interventions (high-intensity psychological or drug treatments) ¹.

Specialist assessment should include evaluation of symptom duration and severity, functional impairment, comorbidities, risk to self and self-neglect, review of current and past treatments including adherence and impact, home environment, community support, and relationships with families and carers ¹.

Referral is particularly indicated for complex, treatment-refractory GAD with very marked functional impairment or high risk of self-harm, where highly specialist treatment such as complex drug and/or psychological regimens and multi-agency input may be required ¹.

Additionally, if the patient has not been offered or has refused interventions in steps 1 to 3, they should be informed about the potential benefits and offered any treatments they have not tried before referral ¹,².