• Determine the urgency of any referral by assessing the risks to the individual and others.
• Admit urgently those people who are considered to be a danger to themselves or others.
• If admission is thought to be necessary but the person refuses, see Compulsory admission.
• Refer urgently for specialist mental health assessment:
• People for whom the degree of risk is increasing such that they are likely to become a danger to themselves or others.
• People with severe depression.
• People in a mixed episode.
• People with rapid cycling.
• For people on anti-manic medication, check that they are taking their medication at the prescribed dose and encourage adherence.
• For people with moderate depression and no increase in the degree of risk to self or others:
• Arrange a prompt specialist mental health review.
• Contact a mental health specialist for advice on initial management whilst the person is waiting to be seen.
• For people with mild depression:
• Provided the person's previous episodes of mild depression have not developed into chronic or more severe depression (and a more severe depression is not likely), an initial period of watchful waiting may be appropriate.
• Arrange for repeat further assessment in primary care or by their mental health professional within 2 weeks (1 week in children and adolescents).
• If the person's previous episodes of mild depression have developed into chronic or more severe depression, or a more severe depression is otherwise likely:
• Seek specialist mental health advice and consider an early specialist mental health review.
• All pregnant women presenting with depression should be referred. For more information, see Depressive episode in pregnancy.
• Whilst awaiting specialist assessment, alter or start treatment only on specialist advice.
• Children and adolescents should only be treated by specialists.

In depth