“How do I say it?”

The challenges of referring patients with mental health issues in primary care to the Psychiatry service (For tonight’s #Healthxph Tweetchat)

A few days ago, a respected individual learned announced on his Facebook wall that he was going to throw in the towel, and was going to say goodbye to the world. By virtue of his status update, he was able to call to attention his readers, students and friends, who became alarmed at implicit declaration that he was going to end his life. They all became extremely worried, and exhausted all means to reach him before he could do something to harm himself. One of his friends called a psychiatrist for an opinion, and they were advised certain steps to take, and eventually, after everything, the situation was deescalated.

After the incident, his posts took on a more positive note, which made people believe that the worst was over. In a series of “likes” and positive posts, it seemed all was well. Yet, that unfortunate crisis left his friends frantic at the time, not knowing what to do, and hanging their head at the burden of the possibility…”What if he had really done it? I wouldn’t have been able to do anything!”

Well, this is not something uncommon. With social media being ingrained in our lives, it is commonplace to see people dealing with mental health issues online. For the aforementioned individual, all was well and good, because someone reached out to him. But what of the distressed relative, or non-health care practitioner who does not know how  or where to go for help? Or, in practice, what of the physician who has a patient who walks in his clinic “hearing voices” when there is no one there, or who wants to kill himself/herself? Or what of the in-patient attending who encounters a challenging patient who one day, suddenly refuses to eat, sleep, talk, or worse, refuses treatment outright?

All these are legitimate reasons for referring to mental health professionals, psychiatrists in particular, for further management. However, it is never as easy as ushering your patient on to the nearest psychiatrist’s door. Or telling the patient to see one outright, the way you would refer to the, say, ophthalmologist, or the otolaryngology specialist, among others. There is a certain ‘flavor” with referring to a psychiatrist that is met with some initial hesitation, or in extreme cases, vehement disagreement outright.  The stigma of mental illness is particularly strong in our present society and time.

In a study by Ballester and group,(2015), it was agreed upong that general practitioners indicated that they perceived the mental health problems among their clientele, but the diagnosis and treatment of these problems are still seen as a task for specialists. This is not a surprise, because of in a study of 531 general practitioners (Phongsavan), Mental health problems recognised by general practitioners at least once per week were psychosomatic (93%), emotional (89%), addiction (79%), social/economic (71%) and family (69%), two-thirds recognised sexual problems, sexual abuse and major psychiatric problems less frequently than once per week. Sixty-four per cent of general practitioners reported that patients felt uncomfortable about being referred to psychiatrists; 53% complained that that referral service waiting lists were too long; 51% deemed that they were insufficient local mental health services; and 25% indicated that communication difficulties between referring general practitioners and mental health specialists obstructed optimal care.

These are things we have had experiences with, at one point or another in our careers. How do we do this? What do we say? Which brings us to our topic for tonight’s tweetchat:

T1 In your experience, what are the usual reasons/factors that would make you decide to refer to a psychiatrist?

T2. What factors particularly hinder your referral to a psychiatrist?

T3. What are your recommendations to facilitate ease of referral by practitioners to psychiatry service?

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For everyone, this tweetchat is a weekly event (Saturdays, 9PM) on Twitter, hosted by members of #Healthxph, with different participants,  discussing relevant medical topics using the social media platform Twitter. To join in the discussion, type #Healthxph on search and stay with the latest posts.