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Recommended content of referral letters from general practitioners to specialised mental health care: a qualitative multi-perspective study

Miriam Hartveit12*, Olav Thorsen2, Eva Biringer13, Kris Vanhaecht14, Benedicte Carlsen5 and Aslak Aslaksen67

Author Affiliations

1 Research Network on Integrated Health Care in Western Norway, Helse Fonna HF, Valen Hospital, N-5451, Haugesund, Valen, Norway

2 Department of Public Health and Primary Health Care, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway

3 Section of Mental Health Research, Helse Fonna HF, Haugesund, Norway

4 School of Public Health, KU Leuven, University of Leuven, Leuven, Belgium

5 Uni Rokkan Centre, Bergen, Norway

6 Department of Radiology, Haukeland University Hospital, Bergen, Norway

7 Institute of Surgical Sciences, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway

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BMC Health Services Research 2013, 13:329  doi:10.1186/1472-6963-13-329

Published: 19 August 2013



In most Western countries, the referral letter forms the basis for establishing the priority of patients for specialised health care and for the coordination of care between the services. To be able to define the quality of referral letters, the potential impact of the quality on the organisation of care, and to improve the quality of the letters, we need a multidimensional definition of the ideal content. The study’s aim was to explore what information is seen as most important and should be included in referral letters from primary care to specialised mental health care to facilitate prioritisation and planning of treatment and follow-up of the patients.


Based on purposive sampling, four mixed discussion groups, which included general practitioners, mental health nurses from primary health care, psychiatrists and psychologists from specialised mental health care, managers and patient representatives, were formed; they were asked to identify the information they considered important in a mental health referral letter. In line with the Delphi technique, the importance of the themes was later individually rated by the participants. The study was conducted within The Western Norway Regional Health Authority.


The four groups identified 174 information themes. After excluding themes that were assessed as duplicates, replaceable or less important, 40 themes were suggested, organised in seven units. A set of check-off points of essential information is recommended as an introduction in the referral letter.


Compared with general guidelines and guidelines for somatic care, the results of this study suggest that the referral letter to specialised mental health care should have a larger emphasis on the overall treatment plan, on the specific role of specialised health care in the continuum of care, and on patient involvement. Further research should evaluate the validity of these findings for other patient groups in need of integrated care and investigate how the quality of referral letters affects patient-related and organisational outcomes.

Trial Registration

Trial Registration number: NCT01374035

Referral and consultation; Mental health; Health services; General practice; Group interview