Seeking the Opinion of a Psychiatrist?

A local therapist contacted me this week and asked what my philosophy was about when he should get a psychiatrist involved in the care of his patients. 

It’s an interesting question. When should a psychiatrist, a mental health physician, get involved in the care of a mental health patient? When an assessment is needed for a medical diagnosis? To help develop a treatment plan? When medications are indicated? When the patient is complicated? All of these?

One could argue that an assessment with a psychiatrist is a staple of any thorough mental health assessment, but there would be several problems with sending everyone with a mental health issue straight to a psychiatrist. First, there is a serious shortage of psychiatrists. The Hogg Foundation notes that in 2009, 171 Texas counties did not have a single psychiatrist. Due to the shortage, securing an appointment with a psychiatrist is difficult. Wait times in my county can exceed 6 months, especially for appointments with child and adolescent psychiatrists. Even for those capable of securing an assessment with a psychiatrist, there remains the problem of professional bias. The fact is, doctors prescribe medical treatments. It’s what we are trained to do. Only rarely do physicians provide reassurance and recommend that patients not take treatment for an illness. Involving a physician often means beginning down the road of prescription drugs, and in some cases medications are unnecessary (or even harmful).

So in answer to my therapist colleague, I said, “When a patient needs medication. Or when the situation is complicated and you need help from another professional.”

But this answer is disheartening. We are taught in medical schools that psychiatrists should be the leaders of mental health assessment teams, that we should be the experts who develop diagnoses and then work with teams of professionals to provide appropriate care. In the real world, we are impossible to connect with. When our patients see therapists, we rarely coordinate with them. When we treat patients in the hospital, we too often fail to talk with the outpatient providers to coordinate care.

If you’re a patient or family member experiencing behavioral or emotional problems, my advice is that you first seek guidance from a counseling professional. Counselors are readily accessible and if your problem is beyond a counselor’s expertise, he or she will make a referral to an appropriate professional. 

For counselors, I say find the psychiatrists (and other mental health providers) in your community who collaborate well, and develop team relationships so you can make referrals when necessary.

Posted on January 19, 2015 .