Medical versus nonmedical mental health referral: Clinical decision-making by telephone access center staff

  • Myron L. Pulier
  • Donald S. Ciccone
  • Cherie Castellano
  • Karen Marcus
  • Steven J. Schleifer
Brief Reports


A database review investigated decisions of clinicians staffing a university-based telephone access center in referring new adult patients to nonpsychiatrists versus psychiatrists for initial ambulatory behavioral health care appointments. Systematically collected demographic and clinical data in a computer log of calls to highly trained care managers at the access center had limited predictive value with respect to their referral decisions. Furthermore, while 28% of the 610 study patients were initially referred to psychiatrists, billing data revealed that in-person therapists soon cross-referred at least 20% more to a psychiatrist. Care managers sent 56% of callers already taking psychotropic medications to nonpsychiatrists, 51% of whom were then cross-referred to psychiatrists. Predictive algorithms showed no potential to enhance efficiency of decisions about referral to a psychiatrist versus a nonpsychiatrist. Efforts to enhance such efficiency may not be cost-effective. It may be more fiscally efficient to assign less-experienced personnel as telephone care managers.


Mental Health Behavioral Health Care Manager Psychotropic Medication Clinician Staffing 
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Copyright information

© National Council for Community Behavioral Healthcare 2003

Authors and Affiliations

  • Myron L. Pulier
    • 1
  • Donald S. Ciccone
    • 2
  • Cherie Castellano
    • 3
  • Karen Marcus
    • 4
  • Steven J. Schleifer
    • 2
  1. 1.Department of PsychiatryNew Jersey Medical School, BHSB F-1560Newark
  2. 2.Department of Psychiatry at UMDNJ-New Jersey Medical SchoolNewark
  3. 3.Cop 2 Cop at UMDNJ-University Behavioral HealthCarePiscataway
  4. 4.Access Center at UMDNJ-University Behavioral HealthCareEdison

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