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 public misconception about mental health issues, but can also be due to the depression, anxiety or the illness itself convincing you with negative distorted thoughts that there is no way out and nothing can be done. The act of the engaging in assessment and starting on treatment can go some way to reversing these thoughts and as treatment advances and patients start to feel better they are glad they made the decision to step into a doctor’s office to talk about how they feel. 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 the initial medical assessment, it may help for you to sit down and write down, 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 life, and what you feel will or won’t help you. It need only be a list of things that come to mind.
If you are on any medications or have been diagnosed with any health problems, it’s helpful to bring the medication, over the counter meds 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 simple conversational style. As well as exploring your symptoms and possible ‘triggers’, I will enquire about your physical health, what medications you are prescribed, what help you’ve sought before, what treatment you’ve tried in the past, your work, your relationships, your childhood and later years, enquire about personality, your current work and private/family. 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.
It’s useful to bring paper and a notepad with you so you can jot down what treatment options we discuss, what the pros or cons are of each treatment path and how this may progress in the short to long term. It can be difficult trying to recall what was discussed after the consultation is over as so much is said, so it’s helpful to recap our discussions by reading your own notes when you get home. 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 often be crucial. If you are able to bring someone whom you trust to support you that is even better. If you would like me to speak with your loved one or friend in future about your health and treatment, I will need written consent/permission from you as I am not allowed to disclose anything to anyone else without this.
Initial appointments last for an hour (1hr) to one and a half hours (11/2hrs) with a letter to your NHS GP or private GP summarising the consultation and what work we will be doing. If you don’t want the assessment and treatment plan to go on to your GP records then provided it is safe to do so I will not write back to your GP. I will discuss this at the beginning of your consultation.
More often than not, I am able to assess and generate a treatment plan within the space of an hour. One of the main advantages of private healthcare is having the time and space to discuss your problems comprehensively. If the problem is complex and needs more than an hour, rather than rushing you, I may need to see you for another session before properly formulated treatments plan can be devised and explored with you. You may also need time to go away and consider a range of treatment paths we consider together.
I don’t usually need to do any blood tests or investigations unless I wish to rule something out.
If I determine that you need a 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. I usually liaise with the therapist from time to time to get a better understanding of you psychologically and how your recovery is progressing.
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.