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Generally speaking, referral of a patient or client to another health care worker or service is indicated (called for) if the care needed is beyond the scope of your own training, or if the necessary care cannot be provided.
Knowing your own limitations is of course important in this sense. Experience will be the best guide of this. General signs of the need for a further opinion include lack of progress, failure to delineate the problem, an obvious need for more specialised care, or counselling (for example, counselling for drug addiction, counselling of a spiritual nature, or counselling for grief, death or dying).
Referral is best made to a familiar agency or a colleague known to be receptive to the needs of your client. If in doubt, consultation with a more experienced colleague or co-worker is the simplest way of seeking a second opinion. The listings of services and agencies in the directory section of this handbook may be an aid in this process.
Of course, when referring, some form of communication must be made to the chosen service or health care worker. A written note or telephone call will usually be adequate. Written referrals may have advantages in a medico-legal sense and will also circumvent phone contact difficulties, but can be misplaced, or read and misconstrued by the patient or client. It is important to ensure that the communication is received, particularly if the client is unreliable, and/or important information is contained in it. The health care worker receiving the referral should promptly respond to the referring person, with appropriate arrangements being made for further follow-up.
Note that consent from the client must be obtained before the release of confidential information to any third party. Any information given by a client to a health care worker must always be regarded as confidential. This release of information is normally implied with a standard referral, but you may wish to consult the client if sensitive material is involved. It is important to note that release of information to non-health care-workers requires the full written consent of the client.
In exceptional circumstances, for example if public safety or the client's own safety is threatened, information about a client may be released to the appropriate authorities (for instance the police) without the client's permission, but not without consultation with peers and with the appropriate professional board. The client should be notified before this is done.
If any doubt exists about the release of information, do not release it without making further appropriate enquiries.