Abstract
BACKGROUND AND OBJECTIVE: Mental disorders significantly impact quality of life and life expectancy, representing a leading cause of global disease burden. Healthcare systems worldwide face challenges in meeting mental health service demands, particularly due to specialist shortages and geographical barriers. Saudi Arabia has implemented an innovative nationwide electronic referral system (SMARC) as part of its digital health transformation strategy to enhance mental healthcare accessibility. This study examined SMARC's effectiveness in facilitating mental health service access by analyzing patient transfer acceptance rates between healthcare facilities and identifying factors influencing these rates. METHODS: This retrospective cross-sectional study analyzed 9722 mental health electronic referrals within SMARC from January 2020 to December 2021. Descriptive statistics characterized referral patterns, while bivariate and multivariable logistic regression analyses identified factors associated with referral acceptance, calculating adjusted odds ratios (aORs) and 95% confidence intervals. RESULTS: The system achieved an overall acceptance rate of 82.5%, with different patterns across age groups and regions. Lower acceptance rates were observed for ages 15-25 years (aOR = 0.84; 95% CI = 0.70-0.99) and 46-65 years (aOR = 0.83; 95% CI = 0.70-0.99) compared to ages 26-35 years. Life-saving referrals showed the highest acceptance (aOR = 2.60; 95% CI = 1.51-4.48), while psychiatrist availability significantly influenced acceptance rates (aOR = 1.36; 95% CI = 1.17-1.58). External referrals were half as likely to be accepted as internal ones (aOR = 0.51; 95% CI = 0.42-0.64). CONCLUSION: SMARC demonstrates effectiveness in optimizing mental healthcare access through strategic matching of patient needs with available resources. The system's selective acceptance patterns reflect its capability to prioritize care based on clinical urgency and resource availability. These findings provide valuable insights for policymakers to keep enhancing digital health infrastructure and mental healthcare delivery. The SMARC model offers a promising framework for implementing similar digital referral systems globally to improve mental healthcare coordination and accessibility.