Red Flags when Scheduling w/ a Psychiatrist, Therapist or other Mental Health Provider
Choosing a mental health provider (whether a psychiatrist, psychiatric nurse practitioner, or psychologist) can be daunting. In the past, individuals may have had only a couple of choices for psychiatrists or therapists, based on a small # of local providers with brick-and-mortar offices in their hometown. Patients could simply ask their primary care provider, OGBYN or friends, “who do you recommend?” Chances were, that their PCP or friends knew the local psychiatrists and psychologists well, and they could give a detailed and honest report of who they recommended and why.
Choosing a psychiatrist or psychologist is now much more challenging. Online psychiatric providers offering telemedicine appointments have increased access of mental health providers throughout the country (which has particularly been wonderful for helping individuals in rural areas and towns with mental health shortages to receive psychiatric treatment). However, with increased options for psychiatric care, individuals now have to be more thoughtful than ever, about who they schedule a psychiatric evaluation with. Psychiatry is complex, and having a long-term psychiatric provider who understands your illness, personality, behaviors and life-story (and will always work to prioritize your care), is in your best interest.
5 Red Flags when Scheduling with a Psychiatrist
#1) A provider talking about themself: If you are working with a psychiatrist or psychologist, who spends a great deal of time talking about themselves, or if appointments feel like you’re “chit-chatting” with a friend, consider working with a new provider. The purpose of meeting with a mental health provider is for them to focus on your specific illness and situation, and for them to be 100% dedicated to improving your mental health. It’s unlikely that a psychiatrist or therapist discussing where they vacation, having lengthy discussions about their families, filling time discussing local restaurants or even chatting about their favorite sports team – will benefit you. It also may be an indication that the provider lacks the medical knowledge to fill time in a purposeful way.
#2) Phone appointments without regular in-office or video sessions. There may be times where phone appointments are appropriate (here-or-there), but the standard of care is that a psychiatrist or psychologist can see their patient or client during their visits. Even if by telemedicine, there’s a great deal that can be learned by patient body language AND important medical signs for providers to look out for, that may affect treatment decisions. Phone appointments tend to feel more casual as well, which can have a negative impact on professional work and outcome. Psychiatrists also need to monitor for symptoms of withdrawal, substance use and intoxication, neurological disease, serious side effects of psychiatric medications and even psychosis. If your provider consistently has phone conversations with you, both they and you, may not be taking your care seriously, and your physical and mental health may suffer as a result.
#3) Providers Writing the Same Medications for Most Patients: This one may seem strange, “how would I know if my provider writes others for the same medication?” However, it’s not uncommon for certain populations (for example, college students) to talk about their providers, and learn about their prescribing habits. If friends at school, or within your social network say things like, “if you see Dr. X, he’ll write you for Adderall,” that’s a problem. It’s even more serious, if a patient knows several friends who are not only quickly prescribed the same medication, but prescribed the same (usually high) dose of that medication. We’re unfortunately seeing this issue regularly, when patients transfer from online “ADHD or Anxiety Specialists,” to our psychiatric practice. Mental health treatment is complex, and NOT one-size-fits-all. If a mental health provider only knows how to treat one or two conditions, or write for one or two medications – and if those medications have high abuse potential, they either do not have expertise regarding various treatment options within their field, or they are not taking the time to sort out the best treatment for your specific condition. They may also simply just be trying to write as many prescriptions as possible, serving essentially as a “pill-mill.”
#4) Providers not screening for Substance Use Disorders or Bipolar Disorder: When choosing a psychiatrist, psychologist or therapist, we recommend that patients seek treatment from providers who take the time to perform thorough initial evaluations. This is especially important, when choosing a psychiatrist who may prescribe medications for your medical or psychiatric condition. Part of a thorough psychiatric evaluation includes both a screen for substance use disorders (especially if a patient is being treated for conditions such as ADHD or Anxiety, where a controlled medication with abuse potential may be part of treatment) and bipolar disorder (in this case, especially if a provider is considering treating a patient with an anti-depressant). Many treatments in psychiatry should be avoided (or monitored incredibly closely) if a patient has either a history of substance use difficulties and/or bipolar disorder.
#5) Providers Asking “What do you Want?”: This may be the most clear-cut and obvious of our “5 Red Flags” when choosing a psychiatrist, therapist, psychologist or mental health provider. If a provider simply asks a patient what they want, without performing a comprehensive psychiatric evaluation, and then discussing risks and benefits of several treatment options, that’s a big red flag. Patients seek out psychiatrists and psychologists for their medical and psychiatric expertise and recommendations. If a provider simply asks their patients what medication they want, and gives them an Rx, we’d argue that they’re not much different than a drug dealer, and we’d highly recommend finding a new mental health provider, who truly cares about your best interests.
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