Referring patients with common mental illnesses

You should always refer a person who you suspect may have epilepsy, possible psychosis, depression and anxiety, substance use disorders and dementia to the nearest health centre or hospital for further diagnosis and management. Early diagnosis is important because early treatment can help to stop the problem from getting worse.

Refer urgently if a patient:

• Has been chained or tied up by the family.
• Is aggressive, violent towards others or harming themselves.
• Seems confused.
• Complains many of the depressive symptoms.
• Has suicidal thoughts or plans, or may even have attempted to harm themselves.
• Is believing, seeing or hearing things that are not true or real.
• Has developed a severe withdrawal reaction when alcohol is not available – feeling sick, trembling, headache, confusion, seeing things that aren't there. 
• Has a co-morbidity of alcohol use and serious medical condition like diabetes, liver disease or a heart condition.
• Has a co-morbidity of substance use and serious mental illness, like psychosis or depression or suicidal behaviour
• is drinking alcohol during pregnancy or breastfeeding.

Referring a patient with Hypertension:

• If the blood pressure is beyond the normal range (i.e. B/p >140/90 or un-controlled).
  

Referring a patient with Diabetes Mellitus if:

• The patient is with uncertain diagnosis
• Patient symptoms are aggravated even though he is on anti-diabetic medications.
• The patient develops complications like foot ulcers, vision problem & numbness of the extremities.

Referring a patient with suspected cancer:

• A woman with breast lamp and tenderness.
• A woman with sexually transmitted infection.
• A man with the difficulty of urination and retention of urine.