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Mental Health Problems in Hospital-Based Clinics: Patient Profile and Referral Patterns

Carol E. Blixen, RN, PhD, CS

Nancy I. Mallasch, LSW

Sara L. Douglas, RN, PhD

BACKGROUND: Although several investigators have suggested that the primary care setting has become the "de facto" mental health provider, few researchers have docu mented the psychiatric referral practices of providers in these settings.

OBJECTIVE: In this study, the psychiatric referral patterns of hospital-based outpa tient clinics and the needs and characteristics of the referred patient population were examined.

DESIGN: After a 4-year retrospective log audit, 2, 678 written referrals were examined for patients 18 years of age and older from a large urban medical center's outpatient clinics to the outpatient psychiatry clinic at the same site.

RESULTS: Findings revealed a predominately middle-aged, white, female, Medicaid popu lation referred by physician providers in primary care clinics for signs of depression and associated symptoms. However, of the patients scheduled in the psychiatry clinic, only 56% actually had visits. The average number of visits was five or less. CONCLUSIONS: Early assessment and triage by advanced practice psychiatric nurses can minimize the length of time between psychiatric referral and intervention. By iden tifying those persons in crisis and intervening in a timely fashion, failed appointements may be reduced. U Am PSYCHIATR NURSES Assoc [1995]. 1, 140-145)

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