Referrals to Mental Health Services: Exploring the Referral Process in Genetic Counseling

Abstract

Genetic counselors (GCs) are trained to identify and attend to distress; however, GCs may have patients with distress better managed by mental health professionals (MHPs). To understand the GCs' role in mental health care, we explored patient cues prompting GCs to refer to MHPs and where GCs thought their expertise in managing patient distress ended. We recruited GCs who have referred a patient for mental health services within the last year to participate in an interview study. A twelve-question interview guide explored GC demographics, reasons for referrals to MHPs, the obstacles to referrals, and perceived differences in counseling competencies between GCs and MHPs. Twenty-eight semi-structured interviews were conducted, recorded, and transcribed verbatim. Transcripts were analyzed using an inductive approach, consisting of reading a subset of transcripts and assigning codes to meaningful segments of text. Common reasons for referral included the GC's perception of the patient having limited social support, or when the patient indicated significant anxiety related to their at-risk status or recent diagnosis. GCs felt they referred when they were limited by time and training to provide adequate psychosocial services. The participants in this study acknowledged that their scope of practice is limited to short-term, client-centered counseling. Our findings are a first step in helping increase GCs' awareness of factors that contribute to the referral process to MHPs.

Psychosocial problems in women attending French, German and Spanish genetics clinics before and after targeted or multigene testing results: an observational prospective study

“…A recent study observed that genetic counsellors define their role regarding psychosocial problems as short term, referring counselees to mental health services when they perceive limited social support or significant anxiety related to a high-risk status or recent cancer diagnosis. 58 Psychological care after the test result receipt was associated to higher negative emotions, suggesting that more distressed counselees received psychological care or that this was ineffective in reducing negative emotions 2 months after the receipt of test result. Less than 15% of counselees received psychological care after testing, and among these, about 40%-60% of them had been referred by genetics clinicians depending on the country setting.…”

“…Distress was strongly related to all domains of psychosocial problems 2 months after the receipt of the test result,32 48 highlighting the many facets underlying distress that may be targeted for counselling. The role of genetic clinicians, psychologists or psychosocial workers with regard to psychosocial problems specific to the genetic context is not clearly delineated 58. The effect of genetic testing on psychosocial problems related to hereditary predisposition concerns suggests that genetic clinicians played a main role in that domain.…”

“…The effect of genetic testing on psychosocial problems related to hereditary predisposition concerns suggests that genetic clinicians played a main role in that domain. A recent study observed that genetic counsellors define their role regarding psychosocial problems as short term, referring counselees to mental health services when they perceive limited social support or significant anxiety related to a high-risk status or recent cancer diagnosis 58. Psychological care after the test result receipt was associated to higher negative emotions, suggesting that more distressed counselees received psychological care or that this was ineffective in reducing negative emotions 2 months after the receipt of test result.…”

“…The role of genetic clinicians, psychologists or psychosocial workers with regard to psychosocial problems specific to the genetic context is not clearly delineated. 58 The effect of genetic testing on psychosocial problems related to hereditary predisposition concerns suggests that genetic clinicians played a main role in that domain. A recent study observed that genetic counsellors define their role regarding psychosocial problems as short term, referring counselees to mental health services when they perceive limited social support or significant anxiety related to a high-risk status or recent cancer diagnosis.…”

Leveraging electronic health records to inform genetic counseling practice surrounding psychiatric disorders

“…surrounding psychiatric disorders has provided tremendous insight to increase the efficacy of attending to behavioral healthcare needs for patients and recognizing necessity for referral (Austin & Honer, 2007;Cunningham et al, 2018;Hippman et al, 2013).…”