Referrals: clinical responsibilities and considerations
The National Health Service (NHS) is used here as the main setting for discussing the important and sometimes complex nature of referrals and referral routes. Some brief consideration is also given to alternative contexts (e.g., private therapy). The NHS is continually changing, and influences include market forces and funding structures. Further details of the most recent clinical commissioning arrangements in relation to mental health can be found at www.mind.org.uk/media/343129/ No_Health_Without_Mental_Health_CCG.pdf. The current mental health strategy for England (DH, 2011) has a number of aims, in summary, these include improved mental health nationally, better recovery rates and physical health for people suffering from mental health difficulties, in addition to better care and support mechanisms and service user choice as well as the minimisation of harm. It is also hoped that local mental health services will become available, in a comparable manner to those for physical health. Another part of the strategy is to improve life for people with mental health issues and their families and to work towards a better public understanding of mental health which it is hoped will minimise the stigmatisation of people because they have mental health problems. The policy document, Mental Health: Priorities for Change (DH, 2014) sets out 25 priorities for change in how children and adults with mental health problems are supported and cared for, which should support the government’s strategy on mental health
This chapter highlights some issues relating to making and receiving referrals and referral routes. The medical model’s influence is discussed, as the categorisation of patient’s problems becomes viewed as more central for competing health services to measure and evaluate the effectiveness of psychotherapy. Different service influences are considered, illustrating some of the referral dilemmas faced by clinicians and services. Referral processes are described along with other clinical responsibilities, and case illustrations are used to suggest ways to manage referrals. To begin, we sketch out some changes taking place in the NHS and the main referral routes.