Medical Versus Nonmedical Mental Health Referral: Clinical Decision-Making by Telephone Access Center Staff

Myron L. Pulier, Donald S. Ciccone, Cherie Castellano, Karen Marcus, Steven J. Schleifer

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)444-451
Number of pages8
JournalJournal of Behavioral Health Services and Research
Volume30
Issue number4
DOIs
StatePublished - Oct 2003

All Science Journal Classification (ASJC) codes

  • Health(social science)
  • Health Policy
  • Public Health, Environmental and Occupational Health

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