Deciding if referral is needed
Referral means recommending or directing a person in need of more advanced care to a facility where that care is available.
In order to decide if referral is necessary, it helps to learn more about the problem, family, current situation and related information about the person’s life. This can be done by asking the person directly or by asking family members. The goal is to gain enough information to determine if the person should be referred to a specialist. If there is any doubt, it is safest to refer the person, so that the specialist can determine if the person needs treatment. Diagnosing a mental health condition should be done by a mental health professional; the role of general health staff is to recommend an evaluation and to inform the person affected and their family about the need for referral. It is important that the purpose of referral is made clear to the individual who is referred and that there is follow-up after the referral.
In many countries, access to specialised mental health care is poor and referring will not be an option for the general health staff. Some basic instructions for helping people cope with mental health problems can be found in chapter 2.
How to refer someone
The health worker needs a list of referral sources. The table below can help determine whether to refer and who to refer to.
| Specialist to refer to | Suspected issue |
| Mental Health professional |
|
| Physician |
|
| Social worker |
|
| Legal professional |
|
| Police |
|
| NGO |
|
Table 1. Referral
An important decision when deciding to refer a person is whether or not this is an urgent problem that needs quick attention because something bad can or did happen. This is called an emergency referral. Some of the times to make an emergency referral are when the person:
- Has had a very long convulsion or seizure (longer than 5 minutes).
- Has tried or threatened to kill him/herself.
- Has plans to hurt others or him/herself.
- Is experiencing domestic violence or physical, sexual or emotional abuse.
- Suffers from severe depression, delusions or panic attacks.
Follow-up
Referring someone does not guarantee that the person or their family will go to get an evaluation or more advanced care. It is important to check after a few days. If a person has not sought care yet:
- They may need additional information or explanation of how to go for an evaluation.
- They may be afraid of what will happen if they go. People may be afraid of being stigmatised if they seek care. People may also be afraid that going to get care means that they will be forced to get an injection or be locked up in a ‘crazy home’. More education and reassurance about the process can address misconceptions and fears.
Exercise 3: Connecting cases to interventions
In this exercise you can practice deciding what intervention is the most appropriate in a given context. Several case studies are given and you have to decide what would be the most appropriate intervention. Critical thinking is crucial! See Guide 2 Annex 1: Training exercises and tips for further details.
Exercise 4: Critical thinking exercise
In this exercise you will be able to practice critical thinking, which is a crucial skill for a ‘helper’. The trainer will show you several statements about this Guide and you are asked if you agree or disagree with them. See Guide 2 Annex 1: Training exercises and tips for further details.