This article highlights the importance of timely referrals to psychiatry as part of a comprehensive mental health care approach. It provides guidance on when to consider medication management, how to use measurement-informed care (MIC) data to support treatment decisions, and the benefits of collaboration between therapists and psychiatric providers. Additionally, it outlines severity- and diagnosis-based referral recommendations to ensure clients receive the specialized care they need for optimal outcomes.
Timely Referrals to Psychiatry
As mental health professionals, we strive to provide the most comprehensive and effective care for our clients. We know that combining therapy with medication management can be one of the most powerful tools to address complex mental health conditions (based on diagnosis and/or severity level), which may require more than therapy alone to manage symptoms. Here’s how:
- Medication management by a psychiatric specialist can help regulate mood, reduce symptoms, and enhance the effectiveness of therapeutic interventions, while therapy can assist with changing cognitions and encouraging behavioral change to enhance quality of life.
- Seeking the perspective and expertise of another mental health professional can be invaluable, contributing to a more well-rounded client conceptualization and treatment plan, as well as a source of support and creative problem-solving.
Severity-Based Referrals to Psychiatry
One of the tools we use at Rula to better understand clients and their experiences is our measurement-informed care (MIC) surveys, which include the GAD-7, PHQ-9, C-SSRS, CAGE-AID, and therapeutic alliance questions. These scores offer information about a client’s mental health symptoms over a period of time and serve as an objective indicator of the severity of their suffering.
Rula’s recommendations below for how to utilize MIC data to inform treatment plan recommendations are informed by evidence-based clinical practice guidelines, including those provided by the American Psychiatric Association (APA), Veteran’s Administration (VA), and the National Institute for Health and Care Excellence (NICE).
Guidelines for Using MIC in Treatment Planning
In addition to MIC scores, timely psychiatric care is critical for clients experiencing severe symptoms, such as suicidal ideation or psychosis. Research indicates that medication management can stabilize acute symptoms and reduce the risk of hospitalization or harm.
Diagnosis-Based Referrals to Psychiatry
Because mental health conditions involve the dysregulation of neurotransmitters, the APA’s clinical practice guidelines for some diagnoses strongly recommend a treatment approach that includes both psychotherapy and medication management. Here are some examples of some diagnoses that therapists might see at Rula, and how medication may enhance treatment outcomes:
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Major Depressive Disorder: a meta-analysis of psychotherapy treatments for depression showed that a collaborative plan of care that includes therapy and medication management not only helps in reducing symptoms more effectively, but also contributes to preventing relapse and improving overall well-being. Additionally, this research from The British Journal of Psychiatry demonstrated that patients with depression who received both psychodynamic psychotherapy and medication had significantly higher remission rates compared to those treated with only one modality.
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Bipolar Disorder: cognitive-behavioral therapy (CBT) has been shown to have a beneficial effect when used alongside mood stabilizers. It helps patients manage symptoms, reduce relapse rates, and improve psychosocial functioning. Similarly, The STEP-BD study demonstrated that medication combined with therapy significantly reduced relapse rates in bipolar disorder patients.
- Schizophrenia: For schizophrenia, medication (primarily antipsychotics) is essential for managing symptoms, but research emphasizes the positive effects of combining these with psychotherapy. A review of treatment strategies highlighted that integrated approaches, including cognitive therapy and family interventions, improve patient outcomes by addressing both symptoms and social functioning. The combination also enhances medication compliance.
Rula provides a network of skilled psychiatric providers who specialize in treating clients with complex needs. By partnering with Rula’s nurse practitioner team, therapists can:
- Ensure clients receive timely care tailored to their unique needs, making care more effective.
- Promote best care practice and client safety.
- Focus on therapeutic work while knowing clients are receiving expert medication management.
Referring clients for medication management is a vital step in providing holistic care for individuals with certain diagnoses and/or severe symptoms. By embracing a collaborative approach and leveraging resources like Rula’s psychiatry network, therapists can enhance treatment outcomes and support clients on their journey to wellness.
Do you have a client in mind that could benefit from medication management? You can refer to them here.
Additional resources:
- Wiles, N. Thomas, L., Abel, A., Barnes, M., Carroll, F. et al (2014). Clinical effectiveness and cost-effectiveness of cognitive behavioural therapy as an adjunct to pharmacotherapy for treatment-resistant depression in primary care: the CoBalT randomised controlled trial. Health Technology Assessment, 18, 1-167.
- Richards, D. A., Hill, J. J., Gask, L., Lovell, K., Chew-Graham, C., et al. (2013). Clinical effectiveness of collaborative care for depression in UK primary care (CADET): cluster randomised controlled trial. British Medical Journal, 19, 347:f4913 . doi: 10.1136/bmj.f4913.
- Fernández-Arias, I., Labrador, F.J., Estupiñá, F.J., Bernaldo de Quirós, M., Alonso, P, et al. Does adding pharmaceutical medication contribute to empirically supported psychological treatment for anxiety disorders? Psicothema, 25, 313-318. doi: 10.7334/psicothema2012.238.