The first step is to recognise that, despite your best efforts and with support of loved ones, for some undiscovered reason, you are simply not recovering or able to move forward. Patients can feel embarrassed, uncomfortable, nervous and perhaps even sceptical about seeing a psychiatric doctor. This is sometimes due to the lack of understanding of what psychiatry is, or due to a public misconception about mental health issues, but can also be down to the depression, anxiety or other mental health illness convincing you, with negative distorted thoughts, that there is no way out and nothing can be done.
The act of engaging in assessment and starting treatment can go some way to reversing these thoughts, and as treatment advances and patients start to feel better, they are glad that they made the decision to step into a doctor’s office to talk about how they are feeling.
I am well aware that it can take a few sessions before you are able to open up to a complete stranger and ‘unpack’ your struggles and concerns.
Before seeing me for your initial medical assessment, it may help for you to sit down and write, in bullet points, what has been happening to you in your life recently, how you are feeling, how you are affected in your personal and work lives, and what you feel will or won’t help you.
If you are on any medication or have been diagnosed with any health problems, it’s helpful to bring the medication, over the counter medication and any hospital/GP letters, to the appointment.
The assessment takes the form of an introductory discussion, followed by a structured consultation, in which I will ask you lots of questions in a simple, conversational style. As well as exploring your symptoms and possible triggers, I will enquire about:
Your physical health
Medications you are prescribed
Help you’ve sought before
Treatment you’ve tried in the past
Your relationships, childhood and later years
Enquire about you personality, your current work and private/family situation
If you find it too difficult to talk about some of these things we can explore those delicately at a later date, if relevant and helpful. It should be a safe environment where you are not judged and can discuss any subject.
We will discuss the treatment options available, the pros or cons of each treatment path and how this may progress in the short to long term. Don’t worry if you don’t understand everything we talk about because it is my job to answer your questions and address any worries in future follow-up appointments.
I usually see patients by themselves first, but collateral information provided by a friend or family can be crucial.
If I determine that you need specialised psychological treatment or talking therapy, I will refer you to the most appropriate person/therapist. Often the best treatment plans are those that combine medication and a talking therapy.
Once the assessment is complete, I will discuss various treatments and then see you for as many outpatient appointments as needed. We will also discuss how often we should ideally meet to monitor and review your treatment and how many more sessions you might need.