Medical versus nonmedical mental health referral: Clinical decision-making by telephone access center staff

A database review investigated decisions of clinicians staffing a university-based telephone access center in referring new adult patients to nonpsychiatrists versus psychiatrists for initial ambulatory behavioral health care appointments. Systematically collected demographic and clinical data in a computer log of calls to highly trained care managers at the access center had limited predictive value with respect to their referral decisions. Furthermore, while 28% of the 610 study patients were initially referred to psychiatrists, billing data revealed that in-person therapists soon cross-referred at least 20% more to a psychiatrist. Care managers sent 56% of callers already taking psychotropic medications to nonpsychiatrists, 51% of whom were then cross-referred to psychiatrists. Predictive algorithms showed no potential to enhance efficiency of decisions about referral to a psychiatrist versus a nonpsychiatrist. Efforts to enhance such efficiency may not be cost-effective. It may be more fiscally efficient to assign less-experienced personnel as telephone care managers.The work described in this article was jointly performed by The Delegated Care Management Project, an enterprise of the Department of Psychiatry of UMDNJ-New Jersey Medical School, Newark NJ 07103-3000; and the UMDNJ-University Behavioral HealthCare Access Center, Edison, NJ 08817-2600. UMDNJ is the University of Medicine and Dentistry of New Jersey, and operates medical schools and other facilities throughout the state.This article was presented in part as a New Research poster at the Annual Meeting of the American Psychiatric Association, Toronto, Canada, May 30–June 4, 1998.