Mental Health Triage

We like to conceptualize mental illness treatment in the Primary Care setting by categorizing cases into red, yellow, and green categories. This reflects the complexity of the diagnosis and treatment, and degree of dysfunction.

“Green” cases include common psychiatric problems without comorbidities, such as ADHD, depression, anxiety, simple phobias, Oppositional Defiant Disorder, and behavior plans (toileting, night-time routines). It is hoped that the primary care physician would have received some training during residency about the diagnosis and treatment of these illnesses. The patient is currently only suffering a minor degree of dysfunction, if any. Our goal with collaboration is that primary care doctors would treat as they normally would. They would utilize a GATE referral as needed, or can bring up case examples to review during educational outreach sessions at the primary care clinics. Over time, the primary care practices would gain skill in treating these cases independently without need for oversight by a Child Psychiatrist.

• “Yellow” cases would be patients with comorbidities; suspected bipolar or psychosis; a Green-level problem not responding to treatment-as-usual; families in crisis, but not yet at the breaking point; patients with passive suicidal ideation but no plan and who are able to contract for safety; or complex patients.

• These families could be referred for a “GATE referral” via the website, to be reviewed with the GATE physician. By design, this physician to physician dialogue process can take 24 hours, so emergencies should not be referred.

“Red” cases would be patients with active suicidality, who are actively psychotic, or are in need of a more restrictive setting. These patients need to be triaged immediately for possible inpatient hospitalization. These patients would be best served by an immediate crisis assessment, either done in an emergency room, or via a crisis line at the psychiatric hospital. These are not patients that should wait for the GATE referral process, as their needs are immediate.