When should I consider referring a patient with schizoaffective disorder to secondary mental health services?

You should consider referring a patient with schizoaffective disorder to secondary mental health services in several key situations:

• Initial Referral for Suspected or First Episode Psychosis:
  • Refer without delay if a person is distressed, has a decline in social functioning, and presents with transient or attenuated psychotic symptoms, other experiences or behaviour suggestive of possible psychosis, or has a first-degree relative with psychosis or schizophrenia, as they may be at increased risk of developing psychosis ¹,⁴,⁵.
  • All people experiencing a first episode or first presentation of psychosis should be referred to Early Intervention in Psychosis (EIP) services ¹.
  • If the EIP service cannot provide urgent intervention for a person in crisis, refer them to a crisis resolution and home treatment team, with support from EIP services ¹.
• Re-referral for Patients Managed in Primary Care:
  • Re-refer to secondary care if there is a poor or partial response to treatment or if treatment adherence is poor ⁴,⁵.
  • Consider re-referral if the person's functioning declines significantly ⁴,⁵.
  • Re-refer if they develop intolerable or medically important adverse effects from medication ⁴,⁵.
• Specific Situations Requiring Secondary Care Involvement:
  • If comorbid alcohol or drug misuse is suspected, re-refer to secondary care ⁴,⁵. Secondary care mental health services should not exclude people with severe mental illness due to their substance misuse ². Ensure the person is referred to and followed up within secondary care, with mental health services taking the lead for assessment and care planning ².
  • Re-refer if there is a potential risk to the person or others ⁴,⁵.
  • If a woman with a psychotic disorder is pregnant or planning a pregnancy, re-refer to secondary care ⁴,⁵.