A specific question
State what you want answered rather than only naming a diagnosis. "Is this treatment-resistant depression or an undertreated bipolar diathesis?" directs the consultation. "Depression, please evaluate" does not.
BH
Brooke Harbor Health System
PMHNP Clinical Learning Environment
Health-System Resource
System ResourceCare coordination, referral, diagnostic, or team-based practice support.
Referral Directory
A referral transfers part of the care to another clinician or service. Match the destination to the clinical question, the level of acuity, and what the person can realistically access.
Clinical application
Using this resource
Apply these prompts within the simulated clinical context. They support—but do not replace—clinical judgment, supervision, consultation, current guidance, local policy, law, or emergency procedures.
Use this when
- A defined need cannot be fully addressed by the current clinician, service, or setting.
Clarify first
- Name the decision or service needed and the barrier most likely to prevent follow-through.
Act now
- Send relevant information, define interim ownership, and plan for delay or nonattendance.
Document and communicate
- Record the referral question, destination, urgency, information shared, consent, known barriers, and interim responsibility for care.
- Document how the loop will close, including confirmation, recommendations received, follow-up ownership, and unresolved needs.
Where to refer
Match the destination to the clinical question
Available services vary by system, geography, insurance, and waitlist. Confirm current availability rather than assuming a listed service can be accessed promptly.
DestinationWhat it providesWhen to consider it
Outpatient psychiatry and medication managementOngoing diagnostic clarification, prescribing, and monitoring.Stable enough for scheduled follow-up, with medication needs that exceed what primary care is managing.
Individual psychotherapyStructured, modality-specific treatment such as CBT, ERP, DBT, CPT, or prolonged exposure.A diagnosis with an established psychotherapy indication, adequate engagement, and a person willing to commit to a course of treatment.
Group programming, IOP, and PHPHigher-intensity structured treatment without overnight admission.Symptoms or risk exceed weekly outpatient care but do not require inpatient safety or medical monitoring.
Inpatient psychiatryContinuous observation, rapid stabilization, and medical oversight.Acute risk, inability to maintain safety outside a supervised setting, or a treatment need that cannot be met at a lower level.
Crisis services and mobile crisisUrgent evaluation, de-escalation, and disposition support outside scheduled care.Acute deterioration between visits, or when evaluation cannot safely wait for the next appointment.
Addiction treatment and medication for opioid use disorderWithdrawal management, buprenorphine, methadone, extended-release naltrexone, and recovery supports.Substance use disorder needing pharmacologic treatment or a level of care beyond the current setting.
Primary care and medical evaluationDiagnostic workup, chronic disease management, and cardiometabolic monitoring.Medical contributors are suspected, monitoring is due, or an unexplained finding needs evaluation.
NeurologyEvaluation of seizure, movement, cognitive, or focal neurologic findings.Neurologic signs, atypical course, abnormal examination findings, or diagnostic uncertainty at the psychiatric-neurologic boundary.
Specialty psychiatric consultationPopulation- or presentation-specific expertise: perinatal, geriatric, child and adolescent, eating disorders, treatment resistance.The clinical question exceeds general psychiatric scope, or the population carries distinct risk and evidence considerations.
Case management and community supportsHousing, benefits, transportation, food access, and system navigation.Social conditions are limiting treatment access, adherence, or stability.
Peer support and recovery servicesLived-experience support, engagement, and community connection.The person would benefit from support that complements rather than replaces clinical treatment.
School, vocational, and occupational supportsAccommodations, functional assessment, and return-to-work or return-to-school planning.Functioning in a school or work role is affected and formal supports would help, with appropriate consent.
Making the referral useful
What the receiving clinician needs from you
Urgency and interim plan
Say whether this is routine, expedited, or urgent, and state who is managing the person while they wait. An unstated waiting period is where referrals fail.
What has already been tried
Medications, doses, durations, response, adverse effects, and the reason each was stopped. Psychotherapy modalities attempted and how engagement went.
Current risk picture
Present risk, recent changes, protective factors, and any safety planning already in place. See Safety & Risk Assessment.
Records and consent
Confirm what information may be shared and with whom. Send the relevant notes, medication list, laboratory results, and collateral rather than expecting the receiving clinician to reconstruct them.
How the loop closes
Name who follows up, by when, and what happens if the person does not attend. A referral without a follow-up mechanism is a handoff into silence.
Access and barriers
A referral the person cannot use is not a plan
Before finalizing a referral, account for insurance coverage and network status, out-of-pocket cost, waitlist length, transportation, childcare, work schedule, language and interpreter needs, technology access for telehealth, and prior experiences that may affect willingness to engage. Where a barrier is likely, document it, address what can be addressed, and name what remains unresolved rather than treating the referral as complete.