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

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 17 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

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 ,,.
    • All people experiencing a first episode or first presentation of psychosis should be referred to Early Intervention in Psychosis (EIP) services .
    • 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 .
  • 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 ,.
    • Consider re-referral if the person's functioning declines significantly ,.
    • Re-refer if they develop intolerable or medically important adverse effects from medication ,.
  • Specific Situations Requiring Secondary Care Involvement:
    • If comorbid alcohol or drug misuse is suspected, re-refer to secondary care ,. Secondary care mental health services should not exclude people with severe mental illness due to their substance misuse . Ensure the person is referred to and followed up within secondary care, with mental health services taking the lead for assessment and care planning .
    • Re-refer if there is a potential risk to the person or others ,.
    • If a woman with a psychotic disorder is pregnant or planning a pregnancy, re-refer to secondary care ,.

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