Access to service by General Practitioner
Mental Health One Door Access (Older People)
People over the age of 65 with a psychological/emotional/severe or enduring mental health problem, including dementia.
Cognitive Impairment
- Evidence of memory impairment. Please:
- consider and exclude delirium, particularly if history is less than 6 months
- include recent cognitive screening and routine physical investigations*
- Stress and distress which may cause harm to self or others, or affect quality of life (previously known as challenging behaviour)
- Family education and support
- Management of functional impairment (including OT assessment)
- Medication review
Severe or Enduring Mental Health Problems
- Psychosis including schizophrenia
- Bipolar affective disorder
- Obsessive compulsive disorder
- Enduring and severe anxiety and/or depression
- Difficulties related to pervasive personality issues
Other Mental Health Difficulties
- Moderate to severe anxiety disorders e.g. GAD, panic, agoraphobia, health anxiety
- Moderate to severe depression
- Trauma reactions – including PTSD, sexual/emotional/physical abuse in childhood or adult life
- Adjustment difficulties – including to physical health problems, prolonged or atypical bereavement reactions
- Single psychotic episode
- Thoughts/ideas of self harm/suicide in conjunction with any of the above criteria
High priority/urgent referrals should be followed up by a phone call to the relevant locality team to discuss degree of urgency, timescale for appointment etc.
* Routine Physical Investigations
A standard physical examination guided by symptoms +/- : BP, MSSU if indicated by history, CXRay if indicated by history, ECG if indicated by history etc.
Neuro-imaging is NOT expected/required to be ordered prior to referral.
NICE/RCPsych guidance on blood tests recommends full blood count, ESR or C-reactive protein (CRP), vitamin B12, folate, thyroid function, urea and electrolyte, calcium, liver function and glucose tests, with blood tests for syphilis, lipids and HIV listed as ‘optional’. (Royal College of Psychiatrists, 2005b).