When to Consider Referral to Psychiatry
- Youth under age 18, especially under 16; patients over 65 or with neurocognitive disorders (or refer to memory clinic/geriatrics)
- Consideration or modification of medications such as valproate, clozapine, lithium; initiation of long-acting antipsychotics
- Community Treatment Orders or Assertive Community Treatment, usually for patients with psychotic disorders and repeated hospitalizations, to support community living and prevent rehospitalization
- Subspecialty care such as for obsessive-compulsive disorder that has not responded to first-line management
- Perinatal mental health care (planning pregnancy, during pregnancy, postpartum mental health concerns).
How to Address Acute Psychiatric Emergencies and Safety
- Consider driving safety, including mandatory reporting for psychiatric symptoms or diagnoses (e.g., acute psychosis).
- Consider the need for a Form 1 (Ontario). Physicians should complete this Application for a Psychiatric Assessment if there is a safety concern with a patient (e.g., threats to self/others, failure to care for self).
- Past/present test: What is the safety issue (e.g., ran into traffic, attempted overdose, waved knife in clinic)?
- Future test: What are the symptoms of a mental health disorder (e.g., yelling at wall, demonstrating a thought disorder, feeling hopeless)?
- Consider the need for emergency services (EMS/police) if there is a risk to staff or other patients. A police wellness check is an option if a Form 1 is not possible or appropriate.
Treatment of Concurrent Disorders and Stimulant Use Disorder in RAAM Clinics, Outpatient Settings and Bed-Based Programs © 2025 Centre for Addiction and Mental Health.