Encouraging Professional Help: When and How to Refer

Why referral is part of Psychological First Aid

Psychological First Aid (PFA) is short-term, supportive care. Referral means helping someone access specialized or ongoing help when their needs exceed what informal support can safely provide. A good referral is not “handing someone off”; it is a respectful bridge to the right level of care while you continue appropriate support.

(1) Indicators for referral: thresholds for professional care

Use referral when distress is persistent, worsening, or significantly interfering with life, or when specialized treatment is likely needed. The goal is to match the level of support to the level of need.

Referral indicators to watch for

• Persistent symptoms: distress, anxiety, low mood, intrusive memories, sleep disruption, or irritability that lasts beyond a few weeks, or does not improve with time and basic supports.
• Functional impairment: difficulty working, attending school, caring for children, managing daily tasks, maintaining relationships, or keeping up with hygiene, meals, or bills.
• Trauma exposure with ongoing impact: direct exposure to violence, serious accident, assault, disaster, or sudden loss with continued hypervigilance, avoidance, nightmares, or emotional numbing.
• Panic recurrence: repeated panic attacks, fear of having another attack, avoidance of places/situations, or frequent urgent-care visits due to panic symptoms.
• Complicated grief patterns: intense yearning and preoccupation that remains severe over time, inability to re-engage with life, persistent guilt/blame, or feeling “stuck” in grief months after the loss.
• Substance misuse: increasing use of alcohol/drugs to cope, withdrawal symptoms, risky behavior, blackouts, or substance use interfering with responsibilities or relationships.
• Safety concerns: any concern about self-harm, harm to others, inability to care for self, severe disorientation, or psychotic symptoms (e.g., hallucinations, paranoia) warrants urgent professional evaluation.

A practical “referral threshold” decision tool

Use this quick check to decide whether to recommend professional help now, soon, or monitor:

Tip: You do not need a diagnosis to refer. You only need a reasonable concern that the person would benefit from more support than you can provide.

(2) How to introduce professional help without stigma

People often resist referral because they fear being judged, labeled, or forced into treatment. Your job is to normalize help-seeking and keep the person in control.

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Principles for a respectful recommendation

• Link help to goals: connect professional support to what they want (sleep, focus, fewer panic episodes, getting through workdays).
• Use non-pathologizing language: describe experiences rather than labels (e.g., “your stress response has been on high alert”).
• Offer collaboration: “Would you be open to exploring options together?”
• Emphasize choice and privacy: clarify they can choose providers and decide what to share.
• Frame it as skill-building: “A counselor can teach tools that work faster than trying to white-knuckle it.”

Stigma-reducing phrases you can use

• “A lot of people find it helpful to talk with someone trained in this—especially when it’s affecting sleep or work.”
• “This is a common response to a hard situation. Getting support is a practical step, not a sign of weakness.”
• “You deserve more support than one person can provide. A professional can be part of your support team.”

What to avoid

• Threats or ultimatums (unless safety requires emergency action).
• “You need therapy” as a blunt directive.
• Overpromising (“They’ll fix this quickly”).
• Using labels casually (“You’re traumatized,” “You’re an addict”)—stick to observed impacts and concerns.

(3) Offering choices: matching the person to the right support

Present a menu of options. Choice reduces shame and increases follow-through.

Common referral options and when they fit

• Primary care / family doctor: good first step for sleep issues, panic-like symptoms that need medical rule-out, medication discussions, referrals, and documentation for workplace/school accommodations.
• Therapist (psychologist, psychotherapist, clinical social worker): for ongoing anxiety, trauma-related symptoms, depression, complicated grief, relationship strain, coping skills.
• Counselor (community, school, college, faith-based counseling): accessible support for stress, adjustment, mild-to-moderate symptoms, and problem-focused counseling.
• Psychiatrist / psychiatric nurse practitioner: when medication evaluation is needed, symptoms are severe, or there is complex mental health history.
• Crisis lines / text lines: for immediate support, safety planning, and connection to local services; also useful when someone is alone at night or overwhelmed.
• Grief groups / bereavement programs: for loss-related support, normalization, and community; helpful when isolation is driving distress.
• Substance use services: outpatient programs, mutual-help groups, harm-reduction services, detox/medical support when needed.
• Workplace or school supports: Employee Assistance Programs (EAP), HR accommodations, disability services, school counselors, academic advisors.

How to present options in a simple way

Use a “two-path” approach: one clinical option and one lower-barrier option.

• “We could start with your doctor to check sleep and anxiety symptoms, and also look at a counselor who can meet weekly.”
• “If calling a therapist feels like too much today, we can start with a crisis text line tonight and schedule an appointment tomorrow.”

(4) Warm referral skills: making follow-through more likely

A warm referral is active support that reduces barriers. It is especially helpful when someone is exhausted, anxious, grieving, or overwhelmed by logistics.

Step-by-step warm referral process

1. Ask permission: “Would it be okay if we look at a couple of options together?”
2. Clarify the need: summarize the specific reason for referral in plain language (e.g., “panic is recurring and it’s affecting work”).
3. Identify barriers: cost, transportation, childcare, time off work, fear, past bad experiences, language, cultural fit.
4. Offer 2–3 tailored choices: include at least one low-barrier option (telehealth, EAP, community clinic).
5. Do one concrete action now: call together, fill out an online form, draft an email, or locate the clinic hours.
6. Support scheduling: help find appointment times; discuss what to say when booking.
7. Plan the first visit: what to expect, what to bring (ID, insurance, medication list), and how to describe concerns.
8. Arrange practical supports: ride, childcare, time off, reminder text, quiet space for telehealth.
9. Follow-up plan: agree on a check-in time (“Can I text you tomorrow to see if you got an appointment?”).

Scripts for helping someone schedule

Booking call opener (you can rehearse with them):

Hi, I’m calling to set up an appointment. I’ve been having repeated panic episodes and it’s affecting my sleep and work. I’d like an evaluation and to discuss treatment options. What’s your earliest available appointment?

Email template (copy/paste):

Subject: Appointment request (anxiety/panic and sleep disruption)  Hello, I’m looking to schedule an appointment. Over the past [timeframe], I’ve experienced [brief symptoms] and it’s impacting [work/school/daily life]. I’m available [days/times]. Please let me know next steps and any intake forms.  Thank you, [Name] [Phone]

Accompanying someone: when it helps and how to do it well

• When it helps: first appointment anxiety, transportation barriers, cognitive overload, language barriers, or when they request support.
• How to do it: let them lead; ask what role they want (waiting room, joining first 5 minutes, note-taking); respect confidentiality; avoid speaking for them unless asked.
• Boundaries: you are support, not a substitute decision-maker; the clinician and the person decide clinical care.

(5) Handling refusal: maintaining support while reinforcing safety

Refusal is common. People may fear cost, stigma, being hospitalized, or reopening painful memories. Your task is to keep the relationship intact, keep doors open, and be clear about safety limits.

Step-by-step response to refusal

1. Stay calm and curious: “What worries you most about getting professional help?”
2. Reflect the barrier: “It makes sense you’d hesitate after that past experience.”
3. Offer a smaller next step: “Would you be open to one phone consultation?” or “Could we start with your primary care doctor?”
4. Offer choice and control: “You can decide what to share and you can stop if it doesn’t feel like a good fit.”
5. Keep support active: schedule a check-in, help with daily structure, encourage supportive contacts.
6. Reinforce safety expectations: if safety concerns arise, explain you will seek urgent help.

Language for reinforcing safety without threats

• “I respect that you’re not ready. If you start feeling unsafe or like you might hurt yourself, I’m going to help you get immediate support because your safety matters.”
• “We can take this one step at a time, but I don’t want you carrying this alone.”

Sample referral conversations

Conversation 1: Persistent symptoms and functional impairment

You: “I’ve noticed you’ve been sleeping only a few hours and you’ve missed several workdays. That sounds exhausting. Would you be open to getting some professional support so you don’t have to push through this alone?”

Them: “I don’t want to be labeled.”

You: “I hear that. Seeing a clinician doesn’t mean you’re ‘broken.’ It can be a practical way to get tools and, if needed, medical support for sleep. We can start with your primary care doctor or a counselor—your choice. Want to look at two options together?”

Conversation 2: Trauma exposure and panic recurrence

You: “Since the incident, the panic keeps coming back and you’re avoiding places you used to go. That’s a sign your nervous system is still on high alert. A trauma-informed therapist can help reduce these reactions. Would you prefer in-person or telehealth?”

Them: “Telehealth, maybe.”

You: “Okay. Let’s find two trauma-informed providers who take your insurance. We can send one email today and see who has availability.”

Conversation 3: Complicated grief and isolation

You: “Your grief is real, and it’s also been months of feeling stuck and alone with it. Many people find a grief group helps because you’re with others who understand. We could also look for a grief counselor for one-on-one support. Which feels less intimidating to start with?”

Them: “A group might be okay.”

You: “Let’s check meeting times and whether it’s drop-in or requires registration. I can go with you the first time if you want.”

Conversation 4: Substance misuse as coping

You: “You’ve said drinking is the only way you can sleep, and it’s increasing. That’s a heavy burden. I’m not here to judge you—I’m concerned because alcohol can worsen anxiety and sleep over time. Would you be willing to talk with a doctor or an addiction counselor about safer options?”

Them: “I can handle it.”

You: “I hope you can, and you shouldn’t have to do it alone. How about a first step that keeps control with you—one confidential call to a support line or an appointment with your doctor to talk about sleep?”

Conversation 5: Refusal with ongoing support

Them: “I’m not talking to a therapist.”

You: “I respect that. Can I ask what makes it a no right now?”

Them: “I don’t trust them.”

You: “That makes sense if trust has been hard. What if we focus on a provider who specializes in your background and offers a short consultation first? If you still don’t want it, we’ll pause. In the meantime, can we set up a plan for tonight and a check-in tomorrow?”

Resource checklist (customizable)

Use this as a fill-in template you can keep on your phone or print. Customize it for your location and community.

Emergency and urgent support

• Local emergency number: __________
• Nearest emergency department / urgent psychiatric evaluation site: __________
• 24/7 crisis line (call/text/chat): __________
• Mobile crisis team (if available): __________

Clinical care options

• Primary care clinic: Name __________ Phone __________ Address/Website __________
• Community mental health clinic: __________
• Therapist directory / referral service: __________
• Psychiatry / medication evaluation: __________
• Low-cost/sliding scale services: __________
• Telehealth options: __________

Specialized supports

• Trauma-focused services: __________
• Grief counseling / grief groups: __________
• Substance use services (harm reduction, outpatient, detox): __________
• Domestic violence / sexual assault services: __________
• Support for caregivers / parents: __________

Workplace and school supports

• EAP contact: __________
• HR accommodations contact: __________
• School counselor / student services: __________
• Disability services / academic accommodations: __________

Practical barriers plan

• Transportation plan: __________
• Childcare plan: __________
• Cost/insurance notes: __________
• Preferred language / interpreter needs: __________
• Preferred provider characteristics (e.g., cultural fit, gender, faith-informed, LGBTQ+ affirming): __________

Warm referral action steps (check boxes)

• □ Asked permission to explore options
• □ Identified top 2 barriers
• □ Selected 2–3 referral choices
• □ Completed one action now (call/email/form)
• □ Scheduled appointment or next step
• □ Planned logistics (transport, time, reminders)
• □ Agreed on follow-up check-in time