When should a patient be referred to a mental health provider?

Psychological comorbidity in functional respiratory disorders is common and, if not fully appreciated, may lead to inaccurate investigations, treatments, and diagnosis. For this reason, it is important to recognize that comorbid psychological conditions may interact with functional respiratory symptoms for a prolonged period of time without identification by patient or clinician. We propose a model of care that uses screening questions and assessment tools early on in the investigation of the respiratory presentation that uses both patient and clinician time efficiently. A range of simple tools are available for use in primary care to help inform the decision about whether referral to a mental health professional is appropriate. In addition, the severity, age of patient, and/or complexity of the presentation of symptoms are other factors to consider when deciding whether to refer to a mental health professional. Many focused psychological strategies can be delivered successfully in primary care, and the ultimate decision about referral will depend on a range of factors including the ability, competence, remuneration, and willingness of primary care staff to deliver these approaches. Because patients with functional respiratory disorders often have a psychological component to their presentation, it is important to address psychological issues in primary care early through treatment strategies or mental health-care referral.