A System for Determining the Priority of Referrals within a Multidisciplinary Community Mental Health Team

The high level of demand for community mental health services implies a need for allocating priority to referrals. Pressure to achieve this has been apparent in the British national health and social services since reorganisation in 1991. What has been less clear Is how this could be carried out within individual services.

The project arose in response to increasing referrals to a local community mental health team from general practitioner fund holders, leading to unacceptable waiting times for clients. A questionnaire was sent to all 49 general practitioners serving the area, of whom 35 responded. The survey was designed to gain information about the factors influencing referral to the service and the levels of satisfaction with the intervention provided. The results highlighted an urgent need to reduce waiting times and to target clients with greatest need more effectively. This information led to the development of a system to assess priority of referral.

The system, still in use, assesses five components: level of distress, level of functioning, suicidal intent, motivation and contact with other services. Scores are allocated to each section. An overall score determines the client's starting point on the waiting list. Additional points are accrued during waiting times ensuring that movement up the list is continuous.