GP referrals to adult psychological services: a research agenda for promoting needs-led practice through the involvement of mental health clinicians.

General practitioners' responses to psychological problems presented in the surgery have a significant impact on the care that their patients will receive. Importantly, their referral behaviour has a knock-on effect on the shaping of psychological treatment services. The present paper summarizes the types of influences that impact on GPs' referral decisions and investigates the possible role that mental health clinicians may play in facilitating these processes. GPs' referral decisions are shown to be affected by a large number of factors which fall within the following domains: patients' help-seeking behaviour and their representations of mental ill-health; the ability of GPs to detect psychological disorders; GPs' attitudes towards psychological problems and their management; service criteria for appropriate referral; and links with mental health services. For each of these domains, methods by which mental health clinicians can promote better referral practice are suggested. Recommendations are made for further research into the efficacy and clinical utility of these methods.