CMHTs assess and support people with moderate–severe mental health presentations. The conditions below outline typical referral thresholds.
Referral criteria by condition
Complex, moderate–severe symptoms carrying risk and directly impacting daily functioning, relationships or vocational opportunities.
Moderate–severe, including treatment-resistant. Trial of at least two antidepressants advised prior to referral (NHS D&G depression prescribing management guidance).
Where it is impacting daily functioning, relationships or vocational opportunities, and specialist input is required for risk, medication or management.
Including drug / alcohol related. Exclude significant physical illness before referral. First-episode psychosis — see EIP (Early Intervention Psychosis) pathway on DGRefHelp.
Where complex case management is needed for support, risk or medication.
Physical health assessment must be done in primary care (per Eating Disorder integrated care pathway). CMHT assessment may then indicate need for specialist eating disorder service input.
Where symptoms are impacting daily functioning and are so distressing that psychological intervention (first-line) is not possible without specialist support.
Impacting daily functioning, choices, coping, relationships or vocation. CMHTs offer specialist evidence-based intervention for Emotionally Unstable PD, including consideration of Structured Clinical Management group therapy.
Severe, impacting daily functioning, where psychological intervention alone is not practicable.
Lower referral threshold applies. Previous perinatal illness or bipolar diagnosis increase risk; family history and significant social risk factors should be considered. Referrals also accepted from Midwives, Health Visitors and Child Protection Advisors — see Perinatal pathway on DGRefHelp.
Priority assessment offered for war veterans (NHS D&G Mental Health Directorate); CMHT will support this.
Dementia / Suspected Dementia
Complete physical health work-up and delirium screen before referral. CMHTs provide assessment, diagnosis, treatment, and facilitate one year of Post Diagnostic Support (PDS). See separate Dementia pathway on DGRefHelp.
Cognitive Impairment (non-dementia)
Where linked to other mental health concerns. Complete delirium screening prior to referral.
Body Dysmorphia / Gender Issues
Where significant associated disturbance of mental state requires secondary care input.
Moderate–severe mental illness with concurrent substance use. Assessment determines appropriate service, or joint working (in line with MAT Standard 9).
ASD with psychiatric co-morbidity
CMHTs will work with people with an existing ASD diagnosis where psychiatric co-morbidity warrants intervention. See "Who not to refer" for ASD diagnostic assessment.
ADHD with significant mental disorder
Where significant symptoms of mental disorder are present. Refer to Primary Care Mental Health Nurses for initial baseline assessment, or to CMHT. See "Who not to refer" for non-specific / diagnostic-curiosity presentations.
Complex Capacity Assessment
Consultant Psychiatrist may assess / offer second opinion in particularly complex situations (e.g. family conflict, borderline or unclear capacity). State "Assessment of Capacity" as reason for referral, identify the specific decisions being considered, and describe what makes the situation complex. See D&G Capacity pathway.
Dementia Fast Track Back — a patient already diagnosed with dementia who presents with new stress/distress or psychotic symptoms (not explained by physical health issues — consider delirium screen) can be discussed by phone with the CMHT for consideration of Fast Track Back.
DGRefHelp - NHS Dumfries & Galloway
