4 November 2026 · 7 min read

Referring Non-Monogamous and Kink Patients: A Guide for GPs

By Meg Wilson, Director, Unison Mental Health

For the purposes of this guide, I'm writing for Australian GPs referring adults into psychology, counselling or psychotherapy, where the patient is polyamorous, in another kind of non-monogamous relationship, or involved in kink. It covers the terms you'll hear, what is and isn't clinically relevant, how to ask, what to put in the referral, and how Medicare applies.

These patients often hold back the details until they've worked out how a clinician will react. Someone might mention "my partner's other partner" in passing and then see what you do with it. If they decide not to say more, the referral goes out missing context, and the psychologist at the other end can spend the first two sessions finding it.

What do the terms mean?

You don't need the whole vocabulary. These come up most:

The most useful habit is to use the patient's own words back to them. If they say "girlfriend", say "girlfriend". If they say "my partners", don't say "your husband and his friend".

How common is this?

More common than most clinics assume. In two national samples of single American adults, a little over one in five had been in a consensually non-monogamous relationship at some point (Haupert et al., 2017). Australian figures for non-monogamy are thinner. For kink, the Australian Study of Health and Relationships interviewed more than 19,000 people and found that 1.8% of sexually active adults had taken part in BDSM in the previous year (Richters et al., 2008).

Practically, that means you already have patients in both groups. Many of them haven't told you.

Is the relationship structure the problem?

Usually not. Broadly speaking, the polyamorous and kink-involved adults who come to us need the same things everyone else needs: help with anxiety, depression, trauma, burnout, grief or communication. The relationship structure is part of their life, and so it's part of the context, but it's rarely the presenting problem.

What is common is delay. Plenty of our clients tried a mainstream service first and were told, in some form, that the relationship was the issue. So they waited longer before trying again, and arrived more unwell than they needed to be. A referral that treats their life as ordinary context helps undo that.

There are times when the structure is central. A couple opening their relationship after an affair. A hinge (the person in the middle of two partners) burning out from managing both. A new metamour moving into a shared house. Those are relationship issues, and worth naming in the referral. They are not evidence that non-monogamy is the cause.

Is kink a diagnosis?

No. To be clear, consensual kink is not a mental disorder.

• DSM-5 separates a paraphilia (an atypical sexual interest) from a paraphilic disorder. A disorder requires significant distress or impairment for the person, or involvement of someone who hasn't consented or can't consent.
• ICD-11, the World Health Organization's current classification, removed consensual sadomasochism, fetishism and fetishistic transvestism altogether. Its paraphilic disorders now centre on non-consent.
• The Australian data points the same way. In the Richters study, people who had done BDSM were no more likely to have been sexually coerced, and no more likely to be unhappy or anxious, than people who hadn't. Men who had done BDSM scored lower on psychological distress than other men.

So "patient is involved in BDSM" doesn't belong in a referral as a problem. If it's relevant to the presentation, describe how. For example: "shame about sexual interests since a religious upbringing" tells the therapist something. "Engages in BDSM" on its own just tells them the patient was honest with you.

What about risk and consent?

This is the safety floor, so I'll be direct. Consensual kink is not abuse. Non-consent is abuse, in any relationship, kink or otherwise.

Screen for family violence exactly as you would with any patient. Kink relationships aren't a reason to skip the questions, and they aren't a reason to assume the worst either. Questions that work well:

• Is everything that happens something you've agreed to?
• Can you stop or change things when you want to, and does that get respected?
• Do you feel safe with each of your partners?

If the answer to any of those is no, that's a family violence disclosure. Manage it the way you would any other.

On sexual health, a patient with several partners may need more frequent STI testing. The Australian STI Management Guidelines set testing frequency by risk, not by relationship label, so ask about what people actually do rather than what they call their relationship.

How do I ask without making it awkward?

Ask the way you'd ask anyone about their support network. A few openers that tend to land:

• "Who are the important people in your life at the moment?"
• "Are you seeing anyone? One person, or more than one?"
• "Is there anything about your relationships or sex life that would help me understand what's going on?"

Then follow their lead. Ask what's clinically useful and stop there. A patient who has just told you they're polyamorous doesn't need to explain how their calendar works. They do need to know you're not going to write something in their file they'd be uncomfortable reading.

What should go in the referral?

Everything you'd usually include: the treatment plan or funding details, provisional diagnosis, medications, history and current risk. Our GP referrers page has the full list we ask for.

For these patients, three additions help.

Ask before you include the relationship structure. Patients can ask to read their referral, and some hand-deliver it. "Would you like me to mention your relationships in the letter?" takes ten seconds and keeps their trust.

Describe it plainly, in their words. Something like: "Patient is in a consensual polyamorous relationship with two partners and describes both as supportive. Presenting with anxiety since a job loss in August." That's enough. It tells the therapist the structure isn't the presenting problem, which is useful information in itself.

Say who might come to sessions. If the patient wants relationship therapy, note whether it's likely to be them and one partner, or three or more people. Sessions for three or more usually need a longer appointment, and not every clinician offers them.

How does Medicare work here?

A Mental Health Treatment Plan covers individual sessions under Better Access, up to 10 a calendar year, with a psychologist, clinical psychologist or accredited mental health social worker.

Medicare rebates don't apply to relationship therapy, whether there are two people in the room or five. A common arrangement is individual sessions under the plan, with any relationship sessions paid privately. Some private health funds cover counsellors and psychotherapists, and some EAPs will fund relationship therapy where Medicare won't.

If you name a clinician type in the referral, check it matches the clinician you're referring to. A referral to a "psychologist" for someone seeing a mental health social worker can get a Medicare claim rejected.

How do I find the right clinician?

Look for a clinician who names these clients explicitly on their profile, not just "inclusive" or "all welcome". Then ask one question before you refer: "How often do you see polyamorous or kink-involved clients?" A clinician who works with them regularly will answer easily. One who doesn't will usually tell you so, and that's useful too.

Directories worth knowing:

• The Victorian Pride Centre directory lists LGBTQIA+ and relationship-diversity-affirming services.
• Kink Aware Professionals lists clinicians who've stated they work knowledgeably with kink and non-monogamy, including in Australia.

At Unison, this is everyday work. We see adults in Carlton and by telehealth anywhere in Australia, with polyamory and ENM therapy, relationship therapy for two people and for three or more, kink-aware sex therapy, and LGBTQIA+ affirming therapy. You can refer directly, or call first to check fit and waitlists. Details are on our GP referrers page.

The short version

If you only keep one part of this, keep this list:

1. Use the patient's own words for their partners and practices.
2. The relationship structure is context. It's rarely the presenting problem.
3. Consensual kink isn't a diagnosis. Non-consent is family violence, and gets screened for like any other.
4. Ask before putting the relationship structure in the referral, then describe it plainly.
5. Medicare covers individual sessions under a plan. It doesn't cover relationship therapy.
6. Refer to someone who names these clients on their profile, and ask them one question before you do.

Many of these patients have had at least one appointment where saying who they love cost them something. A referral that treats it as ordinary information takes no extra time to write, and it means their first session can start on the problem they came in with.

Header photo: Vitaly Gariev / Unsplash.