Reasons against referral to the psychiatrist.

Consultants practising clinical specialties other than psychiatry in six general hospitals were asked by questionnaire about reasons which might prevent the referral of patients to a psychiatrist. The purpose of the enquiry was to find out the causes of the discrepancy between the prevalence of psychiatric disorder among medical and surgical patients and the low rate of referral. Forty-five per cent of the consultants were influenced by the patient's dislike of referral; there was also evidence of marked dissatisfaction with existing psychiatric services at certain hospitals, felt chiefly by the younger consultants. Part-time consultants gave more reasons for non-referral, but there was no significant difference between medical and surgical specialties despite reported variations in referral practice. It is concluded that general hospital psychiatric units have a role to play in improving the relationship between psychiatrists and other specialties so that referral practice can meet the needs of the patient.