How to refer a patient to psychiatry

When to refer to psychiatry

Primary care handles a large share of depression and anxiety well, and most people never need a psychiatrist. Referral earns its place when a case moves past routine. The usual triggers: symptoms that are moderate to severe, or that haven't improved after a reasonable trial; a diagnosis that's unclear or shifting; a suspicion of bipolar disorder or a psychotic illness, which change the whole treatment approach; a medication plan that's becoming complex, high-risk, or is failing; treatment resistance; and any real concern about safety. When in doubt, the evaluation itself is the deliverable: a good psychiatric evaluation answers the diagnostic question and hands you back a plan.

Urgent, or routine?

Sort the referral by time before anything else. If the patient is in immediate danger, that's an emergency: call 911 or send them to the nearest emergency department. If they're in crisis or thinking about suicide, call or text 988 for the Suicide and Crisis Lifeline. Acute suicidality does not belong in an outpatient referral queue. Below that line, decide whether the referral is urgent, needing to be seen within days, or routine, and say which on the referral so it's triaged correctly.

What a psychiatrist needs from you

The difference between a referral that moves quickly and one that stalls is the packet. Send:

• The question. Name what you want answered: diagnostic clarification, a medication decision, a second opinion, or ongoing management.
• The medication history. Current medications with doses, and the past ones with the dose, how long, the response, and why they stopped. This is the single most useful thing you can send.
• The clinical picture. The working diagnosis, relevant history, and current symptoms and function.
• A current risk assessment. Suicidal or homicidal ideation, and what you've already done about it.
• Recent labs where relevant (thyroid, metabolic panel, levels).
• Records with a signed release. Attach a completed authorization so the psychiatrist can request and share records without a delay.
• Logistics. How to reach the patient, their insurance or pay situation, and how you'd like the consult note sent back.

Two of our free templates cover the paperwork: a psychiatry referral form example and a release of information example. They're educational examples; confirm them against your own compliance and payer requirements.

Consider collaborative care, not just referral

A referral isn't the only path. The Collaborative Care Model (CoCM), developed at the University of Washington, keeps the patient in your practice while a behavioral health care manager and a psychiatric consultant support treatment through a shared registry and regular case review, with measurement-based treatment to target. It gives you psychiatric backup without handing the patient off, and it's well-suited to the common conditions primary care already manages. Medicare and many payers reimburse it through dedicated codes. For how it works and how it's paid, see what the evidence shows on collaborative care and the collaborative care billing codes explainer.

The access reality, and how to plan for it

Be honest with the patient about the wait. Psychiatry is in a national workforce shortage, and many psychiatrists don't take insurance, so time-to-appointment can be long. Our data on psychiatrists per capita by state and how much mental-health need is met by state shows how uneven access is. The practical implication: decide who holds the patient in the meantime. Often that's you, with a clear interim plan and a safety net, until the psychiatric visit happens.

How to actually get your patient seen

There's rarely one right door. The usual options, roughly in order:

1. The patient's insurance panel. The in-network route is cheapest for the patient; expect a wait, and check that the directory is current.
2. Community mental health, an FQHC, or an academic clinic. These take public insurance and offer sliding-scale care, though waits can be long.
3. Collaborative care in your own practice, if you can stand it up, keeps common cases with you and psychiatric input close.
4. A telepsychiatry practice. One option is shrinkMD, an independent telepsychiatry practice in The Shrink Network that accepts provider referrals for adults in the states where it's licensed. It's private-pay, so it doesn't take Medicare, Medicaid, or commercial insurance, and it's non-controlled, so it won't be right for a patient who needs stimulants or benzodiazepines. It sends a consult note back with the patient's authorization. Disclosure: shrinkiatry and shrinkMD share a founder, Shariq Refai, MD. We take no referral or affiliate commission, and we name shrinkMD here as one transparent option, not a recommendation above other qualified clinicians.
5. In a crisis, don't wait for any of the above. 911, 988, or the emergency department.