referral criteria from primary care - bipolar disorder

Last edited 08/2018

With respect to adults with bipolar disorder:

  • if new or suspected bipolar disorder:

    • when adults present in primary care with depression, ask about previous periods of overactivity or disinhibited behaviour. If the overactivity or disinhibited behaviour lasted for 4 days or more, consider referral for a specialist mental health assessment
    • refer people urgently for a specialist mental health assessment if mania or severe depression is suspected or they are a danger to themselves or others.
    • ask about hypomanic symptoms when assessing a patient with depression and overactive, disinhibited behaviour

  • patients with existing bipolar disorder:
    • refer urgently a patient with bipolar disorder if there is:
      • an acute exacerbation of symptoms - particularly mania or severe depression
      • an increase in the degree (or change in the nature) of risk to self or others

    • if bipolar disorder is managed solely in primary care, re-refer to secondary care if any one of the following applies:
      • there is a poor or partial response to treatment
      • the person's functioning declines significantly
      • treatment adherence is poor
      • the person develops intolerable or medically important side effects from medication
      • comorbid alcohol or drug misuse is suspected
      • the person is considering stopping any medication after a period of relatively stable mood
      • a woman with bipolar disorder is pregnant or planning a pregnancy


  1. NICE (July 2006). Bipolar disorder
  2. NICE (April 2018). Bipolar disorder