What are the key indications for referring a patient to psychological therapies in primary care?

Key indications for referring a patient to psychological therapies in primary care include:

• Persistent subthreshold depressive symptoms or mild to moderate depression, especially if there is inadequate response to initial interventions such as low-intensity psychosocial interventions or medication.
• Severe and complex depression, including cases with risk to life, severe self-neglect, or significant psychiatric comorbidity.
• Generalised anxiety disorder or panic disorder where initial treatments (psychological intervention, medication, or bibliotherapy) have not sufficiently improved symptoms after two interventions.
• Patients with psychosis or schizophrenia who require psychological interventions such as cognitive behavioural therapy (CBT) to assist recovery from persisting positive and negative symptoms or for those in remission.
• Patients at significant risk of relapse or with a history of recurrent common mental health disorders, where psychological therapies may reduce the risk of recurrence.
• Patients with chronic physical health problems who have depression and may have difficulty engaging with face-to-face psychological treatments, where alternative delivery methods (e.g., telephone-based therapy) or antidepressants may be considered.

Referral decisions should be informed by the severity and persistence of symptoms, response to previous treatments, patient preference, and any comorbidities or functional impairments present. Psychological therapies should be offered as part of a stepped-care model, starting with the least intrusive effective intervention and escalating as needed.

NICE CG178,NICE CG113,NICE CG91