When to Refer Clients to Psychiatry

Rula offers psychiatry services in select states to clients interested in medication management. If you believe a client could potentially benefit from psychotropic medication, you can follow these steps HERE to refer them for a psychiatric evaluation. 

If Rula is not currently offering psychiatry services in the client’s state, our care coordination team will provide the client with outside referrals. 

Knowing when to refer for medication management

Sometimes it’s necessary to refer a client for an evaluation to explore pharmacotherapy options related to any provisional diagnosis and associated symptoms. 

It's important to approach the decision to refer to a psychiatrist collaboratively with the client, involving them in the process and addressing any concerns or questions they may have. 

Additionally, maintaining open communication with the psychiatrist and coordinating care effectively can contribute to the client's overall treatment success.

Such situations include when a client:

  • Has not had success improving symptoms or functioning after trying multiple psychotherapies.
  • Has had limited success improving symptoms or functioning with psychotherapy but is still experiencing symptoms that are distressing or interfere with the person's functioning.
  • Wants to be abstinent but has had difficulty stopping substance use (especially the use of opioids or alcohol).
  • Reporting/demonstration of moderate to severe symptoms - evidence shows that for moderate to severe depression, anxiety, etc., a combination of therapy and medication has the best outcomes.

Has (or is suspected to have):

  • Psychotic symptoms (e.g., hallucinations, delusions).
  • Schizophrenia.
  • Moderate/Severe depression (especially with suicidal thoughts, behaviors, or attempts).
  • A diagnosis of Generalized Anxiety Disorder, Obsessive Compulsive Disorder, ADHD, Bipolar disorder, or symptoms of mania.

Equally Important Is knowing to whom you should refer clients for medication evaluation. Refer to primary care or behavioral health professionals with prescribing privileges, such as:

  • A physician.
  • A psychiatrist.
  • An advanced practice registered nurse (especially a psychiatric/mental health nurse practitioner).

Lack of Progress

If the client is not making significant progress in therapy despite consistent efforts and appropriate interventions, a consultation with a psychiatrist may be helpful. Psychiatrists can provide additional insights and treatment recommendations that may facilitate progress in therapy. Note that for moderate to severe depression, anxiety, etc., a combination of therapy and medication is indicated as the best practice for best clinical outcomes. 

Medical Considerations

If there is a need to get lab work and/or if there are concerns that an underlying medical condition may be contributing to the client's mental health symptoms (such as thyroid disorders, neurological conditions, or substance use disorders), a referral to a psychiatrist can help in addressing both the medical and psychological aspects of the client's condition.

Client Preference

If the client expresses a preference for medication management or is open to exploring pharmacological interventions alongside therapy, a referral to a psychiatrist can be made based on their preferences and goals for treatment.

Clinical reasons to consider when deciding to refer a client

Severity of Symptoms

If the client's symptoms are moderate to severe and significantly impairing their daily functioning. Psychiatrists are trained to assess and manage severe mental health conditions effectively. If a client's symptoms are not adequately managed through therapy alone, or if there's a need for pharmacological intervention (such as antidepressants, mood stabilizers, or antipsychotics), a referral to a psychiatrist can be beneficial. Psychiatrists can prescribe and monitor medication regimens tailored to the client's specific needs.


NOTE: For any safety-related issues (suicidal thoughts with intent/planning, severe psychosis such as commanding auditory/visual hallucinations) you can consider referring to a higher level of care such as IOP, PHP, or consider whether or not the individual might benefit from an in-person setting based on continued symptoms severity.


Medication Management

Therapists frequently work hand-in-hand with psychiatrists. Psychotherapists are trained in clinical psychology and provide counseling and psychotherapy, but they are unable to prescribe medications. On the other hand, psychiatrists and nurse practitioners are medically trained and specialized in psychopharmacology with the ability to prescribe medications. Oftentimes, both therapists and psychiatrists prefer that you are also seeing a therapist if you'll be taking medication. Medication can help ease the symptoms your clients are experiencing while therapy will help them develop more effective coping skills and tools to overcome obstacles in their recovery. Since therapy works well with medication, therapists, and psychiatrists can also (with the client’s consent) communicate with one another to ensure the best care for their client. This way the therapist and prescriber work together with the client as a treatment team.

Documenting Clinical Rationale

When requesting/referring your client for any adjunct or higher-level care service, it’s imperative that you provide as much detail as possible regarding the reason for your referral.

Please see HERE for examples and information about documenting clinical rationale in progress notes and on the Care Coordination Form.

Collaborating with Rula Providers

Please click HERE for best practices when it comes to consulting with other Rula providers through the provider portal. 

Referring non-Rula clients to our psychiatric evaluation: You can refer non-Rula clients to receive psychiatry services at Rula by having them fill out an intake form that can be found on our website. Simply have the client navigate to the following link: https://www.rula.com/psychiatry/


For information regarding Kaiser Psychiatry Referrals, see HERE.

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