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

You should consider referring a patient with catatonia to secondary mental health services, particularly if they are presenting in a crisis, or if their condition suggests severe mental illness or psychosis.

• Crisis Presentation: If a patient is referred in crisis, they should be seen by specialist mental health secondary care services within 4 hours of referral ²,³. Crisis assessments should be undertaken by experienced health and social care professionals competent in crisis working ².
• Severe Mental Illness: Patients with severe mental illness should be referred to and followed up within secondary care, with mental health services taking the lead for assessment and care planning ¹. Secondary care mental health services should undertake a comprehensive assessment of the person's mental health needs ¹.
• Possible Psychosis (Children and Young People): For children and young people experiencing symptoms suggestive of possible psychosis, referral for assessment to a specialist mental health service should be made without delay ³. While this guideline specifically addresses children and young people, the principle of prompt referral for suspected psychosis is relevant given that catatonia can be a feature of psychotic disorders.