Refer the following people to hospital and/or specialist services:
- People with mental illness and evidence of a physical illness such as head injury or high fever.
- People who are so disturbed that they can no longer be managed at home.
- People who are taking large amounts of alcohol or drugs, as stopping suddenly may lead to a severe withdrawal reaction.
- People whose illness is continuing to have a serious effect on their personal life or work, despite your efforts to provide treatment.
- People who have made a serious suicide attempt e.g. attempted hanging, poisoning. They must be referred for urgent medical review. Once this is done they must be assessed for ongoing suicide risk, ideally by mental health specialist.
- People presenting with seizures should (if available) be managed by paediatrics or medicine. Ideally, they should be assessed by a specialist doctor (a physician or neurologist) before they start to take regular anticonvulsant medication.
Remember that when you refer someone always write a referral note explaining the background to the problem and what treatments you have already tried.