Referring a child or adolescent for psychiatry

A GP referral lets the family claim Medicare rebates for psychiatric attendances under MBS items 291 (initial consultant assessment, ≥45 minutes, with management plan), 293 (consultant attendance ≥45 minutes), 296 (subsequent attendance ≥45 minutes), 297 (subsequent ≥75 minutes) and 299 (review of management plan). The referral can be open-ended or limited; the consultant decides which item applies based on the encounter length and content.

No. A Mental Health Care Plan (MBS 2715/2717) is required for psychology rebates under Better Access, not for psychiatry. A standard GP referral letter is sufficient for child and adolescent psychiatry under items 291–299. Many GPs prepare an MHCP at the same visit so the family can also access psychology if needed.

Refer to a child and adolescent psychiatrist when the primary concern is mental health (anxiety, depression, suicidality, OCD, eating disorders, complex ADHD with comorbidity, psychosis, severe behavioural disturbance) or when psychotropic prescribing is likely. Refer to a developmental/general paediatrician for uncomplicated ADHD, autism diagnostic assessment in younger children, developmental concerns, and physical-health-overlapping conditions. In NSW, paediatrician waitlists are commonly 6–18 months — psychiatry can be a faster pathway for moderate-to-severe presentations.

Urgent (within days to two weeks) referrals are appropriate for active suicidality with intent or plan, recent suicide attempt, severe self-harm, first-episode psychosis, severe eating disorder with medical compromise, or rapid clinical deterioration. For acute risk, contact the local CAMHS / Acute Care Team or send to the nearest paediatric ED. Document the risk assessment and current safety plan in the referral.

A useful referral covers: presenting concerns with examples and timeline; developmental and birth history; current and previous medications and trials; prior psychology/paediatrician/psychiatry input; school context and any reports; family mental-health history; current safety; relevant medical history and investigations; and a clear question (e.g., diagnostic clarification, medication review, treatment planning). Attach school reports and previous assessment letters where available.

Stimulants for ADHD must be initiated by an authorised prescriber (in most states a paediatrician or psychiatrist holding state stimulant authority); GPs typically continue prescriptions under shared-care arrangements once stable. State rules vary — NSW, Victoria, Queensland, WA, SA and the ACT each have their own stimulant authority frameworks. Recent reforms in NSW and Queensland are expanding GP roles in continuation prescribing.

Children are eligible for telehealth psychiatry under the same MBS items as in-person care provided the consultation meets the relevant requirements (e.g., video-only for some items, established relationship rules where applicable). Telehealth is particularly useful for regional and remote families and for follow-up review, and is widely used for Australian child and adolescent psychiatry.

For ADHD: Vanderbilt (parent and teacher) — free and well-validated. For autism: M-CHAT-R (16–30 months) and Social Communication Questionnaire. For mood: PHQ-9 modified for adolescents and SMFQ. For anxiety: GAD-7 (≥11 years) and SCARED. For general psychopathology: SDQ. Including completed scales with the referral materially shortens the diagnostic pathway.