STEP 4: treatment resistant, recurrent, atypical and psychotic depression, and those at significant risk



Patients may enter directly at this step if they are assessed as requiring specialist services



























Referral to specialist mental health services
Specialist mental health professionals, including GPs with a Special Interest in mental health, provide assessment, treatment and consultancy services for this group of patients.


Contact details for secondary care services can be found at

















Single Point of Access Triage

(Threshold Assessment Grid, TAG )
Categorise: Crisis/Urgent/Routine

















  • Full assessment of symptom profile and suicide risk and, where appropriate, previous treatment history in accordance with local guidance (e.g. care coordination).

  • Unless assessment dictates otherwise, patient should be considered for enhanced level care co‑ordination.

  • Complete nationally recognised outcome measure which are currently:

    • HoNOS

    • EuroQoL

  • Consider social factors. 

  • Consider needs of carer.

















Severely depressed and at high risk of self harm or suicide?