Your son has been acting strangely, staying in his room for days, barely eating or caring for himself. You have been really down, feeling hopeless like life if not worth living, and having trouble concentrating, sleeping and eating. Your daughter has lost an incredible amount of weight and exercises ceaselessly saying she is too fat. Your spouse is a veteran who awakes in the night in a sweat from nightmares and has anger outbursts during the day.
You know something is wrong. You want to consult a psychiatrist or a mental health professional to understand what is going on and get help. There comes a time when many a person or family faces this question. I encounter it frequently. Here is what I say.
First and foremost is that you want to recognize that mental health problems, including addictions, are among the most common medical problems that exist! More than one in five people every year, in this country, will have a mental health problem that causes serious suffering and interferes with functioning. Mental health disorders are common and can be readily diagnosed -- and we have treatments that work, if those affected get care and stick with it. So, there is good reason to seek help and be hopeful.
The best way then to search for a doctor is to ask people you trust for a referral. There may be no better way to find a good doctor than by word of mouth. Families and patients know more about doctors than anyone else. If you know someone getting help, ask them. If not, ask your family (primary care) doctor who almost always has a psychiatrist colleague he or she works with.
Don't be shy about asking details about a mental health professional from other medical or mental health professionals. Ask if the psychiatrist listens, explains, and tries to develop a set of common goals with his or her patients (or clients or consumers -- since all these terms are used). Ask about the clinician's training and experience. Ask if he or she believes in combining medication with therapy and techniques that build skills for school, work or family life, instead of being myopically focused only on medication if they are a psychiatrist or only on therapy if they are not. Ask if that clinician appreciates the importance of family and friends, of school and community, of hope for recovery and having a life one can be proud of.
If you cannot find a psychiatrist by word of mouth or through your family doctor then see if there is a mental health center, medical group practice or hospital near to you that provides services. Some state or local psychiatric associations will assist with a referral. Many advocacy organizations like a local chapter of the National Alliance on Mental Illness (NAMI) or the Mental Health Association (MHA) have help lines that may also provide a referral for mental health care, though maybe not for a psychiatrist.
Go online and see what you can find and learn about the services in your area that offer psychiatrist or mental health services. If choosing a psychiatrist, try to find one who is board certified, which means a fully trained psychiatrist who has passed a rigorous specialty examination. If you know you may need specialized services then seek those from the start, like for a child or adolescent, or senior, or a doctor who specializes in depression or anxiety, or bipolar disorder, or eating disorders, or trauma, who works with people with alcohol and drug abuse problems, or whatever the problem area you believe you or your loved one is suffering from.
There are also the practical matters -- namely money and insurance. What insurance plan do you have, and which psychiatrists does it include? If you can afford to not use your plan, you are fortunate, since getting appointments with psychiatrists enrolled with any given insurance plan is often a tough road. A long list of doctors provided by your insurance plan does not mean any are offering appointments, as you may discover after a few calls. Some psychiatrists join insurance panels but limit the number of people they take on because these companies pay poorly and drive doctors crazy with their unending demands for information and paperwork, which challenge the doctor's judgment and burn up time.
If you are covered by Medicaid, the state insurance for people living in poverty, that means you will need to see a psychiatrist at a mental health clinic or hospital in your community since virtually no psychiatrist (and very few mental health professionals) in private practice will take Medicaid because the fee paid is less than what it costs to fill the gas tank of a small car. Keep in mind that many clinics have good teams of mental health professionals, which include a psychiatrist, and often can provide the comprehensive psychiatric and therapeutic care that a serious mental illness requires.
If you are covered by Medicare, the Federal insurance for seniors and the disabled, your chances of getting an appointment with a psychiatrist are usually better since fees are a little higher and there are few(er) hassles with managed care or payment.
Insurance coverage -- or out of pocket payment -- probably influence whether, when and which doctor you may see more than any other factor, sadly, in this country.
Next, ask yourself if seeing a psychiatrist is necessary, or if a licensed mental health professional is a good alternative. Psychiatrists are the only mental health professionals who can prescribe medications (with the exception of some advanced practice psychiatric nurses) but that may not be what you or your loved one needs. Psychologists, social workers, advanced practice nurses or counselors, who are independently licensed, are mental health professionals who can assess a mental health problem, make informed recommendations and provide a variety of effective therapies.
These mental health professionals are in greater supply and therefore more available than psychiatrists, especially in rural areas of this country. If you see someone other than a psychiatrist it does help if that person has a working relationship with a psychiatrist if further evaluation and treatment, especially medication, is needed.
Take the time and prepare for the meeting with the doctor. Create a list of what concerns you (or your loved one) so you will know what you want to say when you go to the appointment. Get someone you trust to help you. Summarize what has happened to you, over time, leading to the troubles you have. Be honest. Don't leave things out because of guilt or shame. Everything will come out in time, so if you get to it sooner you will speed up the process of getting help. Summarize this information on a single side of a piece of paper you can refer to when you meet.
How can you judge if the doctor is right for you? When you meet, see if the doctor listens and accurately reflects back to you what you are saying and what you want. If you sense a gap between what you are saying and what the doctor seems to understand, then say so; you want to know sooner than later if you can close the communication gap or work out differences.
If the doctor talks more than listens or has a plan that does not have a lot to do with why you are there or what you want to accomplish then you are likely not to return. Patients who experience that they have been heard, respected and that their goals are recognized stay in treatment, which is what you need to do if you or your loved one is going to get better. Mental health professionals are getting better at what is called "shared decision-making" (an approach championed by Dr. Pat Deegan) in which patient and doctor are both responsible for being clear about goals and what each of them can and is willing to do. Not all mental health clinicians have adopted this technique so some may need your help to get there. But your heart will tell you, especially if you have prepared and are clear and honest, if you have found someone that can help you in the hard work of recovery from a mental illness.
Finally, as you meet with the psychiatrist, or other mental health professional, keep in mind that he or she is human -- just like you. Psychiatrists are not gods and they don't know everything -- nor do other mental health professionals. Good doctors and clinicians are modest about themselves and the art of clinical care. They should put your interests first and offer realistic hope. They should consider and respect you, just as you will consider and respect them. Take the time to find and choose a doctor. You will be glad you did because then the important work of diagnosis and treatment can begin with a focus on what needs to be done, rather than wondering if you are in the right person's office.
The opinions expressed herein are solely my own as a psychiatrist and public health advocate.
Dr. Sederer receives no support from any pharmaceutical or device company.
Visit Dr. Sederer's website at www.askdrlloyd.com for questions you want answered, reviews and stories.