Psychiatric referral practices of the clergy, primary care physicians, and mental health care specialists are examined in relation to the three stages of the referral process: the identification of a mental health problem, the decision to refer, and the selection of a treating professional. Referral practices within health maintenance organizations are also described to illustrate how organizational structure affects this process. Based on a literature review, the authors identify and discuss ten major factors that shape and define all referrals. They are the practitioner's capacity to recognize and define mental illness, the availability of resources, economic incentives, the amount of clinical information available, patient attitudes toward referral, the practitioner's therapeutic background, the practitioner's role perception, practitioner-patient interaction, interpractitioner relations, and provider group influences. The authors end with a critique of current mental health referrals.