When to refer to mental health services

Personality disorder integrated care pathway
NHS Highland

For patients already involved with mental health services, any existing care plan should be followed except in exceptional circumstances. Care plans should be made easily available in the case notes or other patient information systems. Patients who have no current involvement with mental health services and who are assessed as needing the input of these services should be directed to the appropriate service according to whether they represent an emergency or not.

Emergency referrals (those patients who require to be seen the same day for reasons of significant risk) should generally be directed to the Mental Health Assessment Team (MHAT) at New Craigs Hospital. MHAT can assess which treatment, including inpatient treatment is most appropriate. Non-emergency referrals should be made to the sector Community Mental Health Team (CMHT) via the single point of referral. Sometimes it can be difficult to establish if a presentation is related to a mental state condition or a personality disorder (or both). In these circumstances, referral to the CMHT for clarification of diagnosis is reasonable. Other situations when referral to the CMHT might be considered include when the patient is unable to be managed solely in primary care because of issues of severity, complexity, co-morbidity or risk; or when the person’s personality appears to be acting as a vulnerability factor to mental illness.

Just as it would be inappropriate for all people with depression to be referred to secondary care mental health services, so it would also be inappropriate for all people with personality disorder to be referred; matched care should be the aim. Regular communication and discussion between primary care and community mental health services is likely to be of benefit in maintaining the referral threshold at the most appropriate level.


Useful referral information includes:

  • whether the general criteria for personality disorder are met, with some description of severity
  • an outline of the difficulties experienced by the patient in the four main domains:
    • cognitive-perceptual
    • affective
    • interpersonal
    • relationship with self including sense of self
    • interpersonal relationships
    • relationship with society
    • behavioural/impulse control (including self-harm and suicidal behaviour)