Many referrals to southern mental health services from primary care fall below the standard specialists can accept, researchers have found.
Primary care practitioners play an important role in the early detection of mental illness and, apart from in emergencies, are required to provide a referral to specialist services.
Recently published research examining four months’ worth of referrals in the Dunedin urban area found in the 92 cases documented almost half of referrals were adequate, 14% were good, but 37% were rated poor.
"Some key items of clinical information were regularly not included in referral letters," the study, by Cath Allwood, Anthony O’Brien and Paul Glue and published in the Journal of Primary Health Care, said.
"Risk information was completely absent in 42% of cases."
Further omissions included other health issues, substance or alcohol disorders and evidence of attempts to treat the patient.
The quality of referrals has been highlighted as an issue before, notably in a 2017 report by the Auditor-general which highlighted the risk posed by patients discharged without identified follow-up.
"Despite policy commitments to improving services so that the needs of the people are met, the recent New Zealand mental health inquiry suggests that the reality is somewhat different and there is considerable room for improvement," the authors said
Specific information which should be routinely gathered in general practice infrequently appeared in referrals, and that information was vital for triage and was of benefit to patients.
While a small sample in a single area, the study suggested that more attention was needed nationwide to the quality of mental health referrals, the authors said.
"The strategic directions of national and local healthcare services both identify improvements in technology systems as being key to the improved integration of services, ultimately improving patient experience of healthcare and leading to better outcomes.
"As referrals are a central part of the healthcare journey, any system aiming to improve referral quality will impact on both health outcomes and patient experience."
The study’s findings were consistent with international research, and noted that as part of the Government response to the mental health inquiry more resources had been allocated to better integrating primary and specialist mental health services.
"Changes to the referral system should be part of a wider effort towards systems integration, thereby ensuring that referrers are more confident of when to refer as well as what information is required.
"If at the point of referral, the range of treatment options and services available across both primary and secondary sectors is understood, the number of inappropriate or incomplete referrals may decrease."
