Referrals from primary care to community mental health teams: what's missing?

INTRODUCTION: Transfer of care from primary to specialist mental health services almost always requires a referral by hardcopy letter or sent via a structured electronic form. The quality and content of referrals can vary, leading to delays in treatment. AIM: The aim of the research was to explore the quality and content of referral letters received by two urban New Zealand community mental health teams. METHODS: A retrospective audit of 4 months' worth of referrals (n = 92) from primary care to specialist mental health services was undertaken using an audit tool created from a review of literature. RESULTS: The audit identified gaps in the information provided by referrers, including a lack of evidence of treatment in primary care before referral, risk information, information relating to physical health concerns or co-existing problems, evidence of client consent to referral, and recording of ethnicity. Thirty-seven percent of referrals were considered to be of poor quality. Compared to hardcopy letters, referrals generated by an electronic referral system were of a better quality and contained more information. More than 40% of referrals were not accepted, although the reasons for this were not assessed as part of this audit. DISCUSSION: Better integration of primary and secondary mental health care by using electronic referral templates may reduce the number of inappropriate or incomplete referrals. Referrals from primary care to specialist mental health services vary in content and quality, with many falling below a level that specialist services can accept. This impacts on the efficacy of services and ultimately on patients' journeys between primary and secondary care. Development of a standard referral template for use by primary care services may improve the quality of referrals.