6 Signs Your Patient Needs a Mental Health Referral

No matter your nursing specialty or the patient's chief complaint, all nurses can possess the skills to recognize if their patient needs a mental health referral. This article contains 6 signs to look for when deciding if your patient needs additional intervention.

6 Signs Your Patient Needs a Mental Health Referral

Nurses. There’s something about our title or uniform that puts people at ease. How many times have you heard “Oh, you’re a nurse? You know, I’ve been having a hard time concentrating/sleeping/eating…”? With few exceptions, patients feel they can confide in us and trust us with their stories and are confident we have a solution. This trust is for good reason. Nurses are known for treating patients holistically and for digging until they find solutions that align with their patients’ needs. No matter your area of expertise every nurse should be able to recognize when a patient needs mental health services. But what do you do if mental health isn't in your ‘wheelhouse’? Well, according to the National Institute of Mental Health(NIMH) these 6 signs mean it’s time to do a patient referral for mental health services:

6 Signs Your Patient Needs a Mental Health Referral

1. Trouble sleeping

2. Change in appetite

3. Difficulty getting out of bed in the morning

4. Trouble concentrating

5. Disinterested in activities previously found to be enjoyable

6. Unable to do usual daily activities or responsibilities

If your patient reports one or more of the above signs as "severe or distressing symptoms that have lasted for two weeks or more”1 they may benefit from a mental health referral.

1. Trouble sleeping

It can be difficult to get to the root cause of sleep issues or insomnia. Trouble sleeping may simply be linked to the current health issue. If you’re treating a patient who’s just had surgery their sleep issues may be due to an inability to get comfortable or pain, and will resolve as they heal. What we’re talking about here is trouble sleeping as a result of depression or anxiety. It is common for people with depression or anxiety to experience trouble sleeping. If your patient tells you they don’t get enough sleep, have difficulty falling asleep or staying asleep, or experience daytime drowsiness that’s been going on for a while, it could be time to refer them.2

2. Change in appetite

Another sign your patient may be struggling mentally is a change in appetite. Of course, we‘re not talking about the occasional tummy ache or missing a meal because they’re busy. When your patient comments that they don’t have much of an appetite, they consistently skip meals or crave sweets these can be a sign of depression. Changes in appetite may lead to either weight loss or gain because mental health issues can lead to “...nutrition that is far from adequate…[and making] poor food choices and selecting foods that might actually contribute to depression”.3 Sussing this out for your patient can be tricky as patients dealing with depression or anxiety may have trouble with recall in order to be accurate historians. If you ask “Any recent weight gain or loss?” they might not have a true sense of what their weight has been doing. Instead, try asking something like “Have you noticed that your clothes fit differently lately?” This type of question may be easier for them to answer and can be just as telling.  

3. Difficulty getting out of bed in the morning 

We all have the occasional day where we need to sleep in or catch up on sleep. However, if your patient complains that they can't get out of bed in the morning due to their mood, this could indicate a serious problem. For your patients suffering from depression or anxiety, the simple act of getting out of bed can seem daunting. Think about it: what awaits as soon as you’re out of bed? Responsibility. Chores. Self-care. Work. Kids. These things can make it hard to face the day if you’re struggling with depression or anxiety. If difficulty getting out of bed is a persistent problem for your patient they may need a mental health referral.

4. Trouble concentrating

Trouble concentrating may be another sign a patient needs mental health services. Taken in isolation we wouldn't conclude that trouble concentrating is indicative of depression or anxiety. Nurses are amazing at treating patients holistically and wouldn’t make that leap. Studies like this one in the Lancet show that  “… depression can actually change your ability to think. It can impair your attention and memory, as well as your information processing and decision-making skills.” 4,5 So, if your patient states they have been having trouble concentrating for a while and other causes are not to blame this could be an indication they need mental health intervention.

5. Disinterested in activities previously found to be enjoyable

Depression or anxiety can interfere with a patient’s desire to participate in the activities which they typically enjoy. The clinical term for this is anhedonia. The APA Dictionary of Psychology defines anhedonia as “n. The inability to enjoy experiences or activities that normally would be pleasurable.” So if your patient tells you it’s been a long time since they’ve wanted to garden, work or spend time with family, it might be time to intervene.

6. Unable to do usual daily activities and responsibilities

Lastly, being unable to accomplish daily activities and responsibilities may indicate a deeper problem. The signs may jump out at you if it’s clear your patient hasn’t been showering or brushing their teeth for quite a while. You might have to dig a little to discover your patient hasn’t been taking their meds, paying their bills or going to work.  Either way, if your patient has been struggling with their responsibilities for an extended period of time, they may benefit from a mental health referral.

It’s important to remember these aren’t hard and fast rules and each patient will present individually and with varying levels of functionality. Ruling out other medical reasons for these signs should always be part of the diagnostic process. There are stigmas attached to mental health issues so a gentle persistence may work best when encouraging patients to seek help as they may feel embarrassed. A nurse offering to contact their doctor may give them a feeling of legitimacy that they need to move forward with care. It’s good to remind them that delaying help may lead to their problems worsening over time. This infographic may help them start a conversation with their doctor. Educate patients to call 911 in a mental health emergency and that they can call The National Suicide Prevention Lifeline at 1-800-273-TALK(8255). As a nurse I like having more tools in my orificenal to help my patients get well no matter what they’re fighting. Being able to spot a need for mental health services can make a huge difference in a patient's life. 6

References

1.  Caring for your Mental Health.

2. .Patient education: Insomnia(Beyond the Basics).

3. Understanding nutrition, depression and mental illness.

4.  More than sad: Depression affects your ability to think.

5.  Effect of antidepressant treatment on cognitive impairments associated with depression: a randomised longitudinal study.

6.  Caring for your Mental Health.                                     

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Diane Covel

About Diane Covel, RN

Diane Covel, RN is a freelance health content marketing writer for hire who specializes in pediatrics, mental health, and safety. Her unique background also includes teaching preschool which means she can handle a demanding and discerning crowd. She was asked to create a video testimonial for the “RN2writer” course because of the value she added to the live coaching sessions with her thoughtful questions and positive and kind participation. Diane reads everything with an eye for edits and proper grammar as if her life depends on it. She has 2 sons in college, 2 Labrador retrievers on the couch and 1 husband with whom she lives in North Carolina. You can find Diane on LinkedIn.

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I love this article.  ?

I agree wholeheartedly with this.   The challenge I guess for me would be implementation.  For instance, when planning to admit or dealing with an admission this is the time that I generally get to ask the most questions about a patient's health history and wellbeing.  However, while a lot of patients answer truthfully, when asked if they would like to speak with the SW or BH rep they often say no.  It's either because they feel like it's not that big of a deal or they only want their medical problem treated.  It could also be a stigma or the insurance costs IDK. 

When passed on to the doctor, I've seen doctors touch on the subject but then the patient really brushes it off like it's not a big deal.  I guess it can also seem scary at the time, not sure.

Also, the only time a psych consult is done is if they fail the suicide screening. questionnaire.   

I think we should have like inpatient spa health treatment programs behavioral with a multidisciplinary approach while also teaching people how to cope with real life issues and stressors, (fin advisors/ housing ppl/job reps, etc) or something.  This may work, as long as we refrain from calling it mental.

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