Quality of Psychiatric Referrals to Secondary-Level Care (Report‪)‬

Quality of health care is strongly influenced by efficient communication between different levels of care. Appropriate clinical knowledge and skills, guided by clear policies, are essential to this process. (1) The Free State Province Department of Health has a well developed mental health care policy to support implementation of the Mental Health Care Act. (2) The policy sets the framework for rendering services according to a decentralised model. Referrals are done in line with the policy from primary to secondary, and secondary to tertiary level. The majority of patients needing psychiatric care are treated at primary level, and patients must pass through a number of filters before being referred to specialised mental health care services. (3) Primary care practitioners therefore need to have extensive knowledge of various conditions--including psychiatry. Referrals have considerable implications for patients, the health care system and health care costs. (4) It is essential to adhere to guidelines for good medical practice during the referral process, as incomplete assessments and poor quality of referral could have detrimental consequences for both the person referring the patient as well as for the practitioner receiving the patient. A recently published case in the Medical Protection Society Casebook illustrates this point clearly. (5) In this particular incident, which occurred in the UK, a Mental Health Trust was involved in a claim to account for acceptance of a patient without a proper referral, that resulted in poor risk assessment by the receiving doctor. The psychiatric evaluation was further compromised by an incomplete recording of the patient's relevant psychiatric history. The case report concluded that, in the case of referrals, all relevant patient information must be provided by the referring practitioner, including a medical history and information about the patient's clinical status. (5)