Many of us have been following the debate resulting from the open letter to psychiatrists written by Dr Andrew Leech asking why so many of his referrals are being rejected.

His dismay is one I share — referrals being rejected for patients at serious risk, those with unstable, brittle or difficult to treat disorders. Patients with unrelenting depression, unstable bipolar disorder, debilitating PTSD or personality disorders. Some with serious risk of escalation to potential harm.

“These are people we know well and for whom we have used everything in our general practice ‘toolkit’ to manage,” Dr Leech writes.

“By this point we’ve usually already tried the first, second and third-line treatments just to avoid the need to refer.