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Medicare Part D

Choosing a Psychiatrist

People seek psychiatric help for many reasons. Life's usual round of trials may seem harder to handle than usual. Relationships may become troubled, or the pangs of anxiety -- easily dismissed before as simple butterflies -- may grow sharper and last longer. The fresh-faced young newcomer down the hall at work may seem to threaten a secure job, and headaches may start to come literally one after the other. The emotions that rise in reaction to everyday stresses and strains may blow badly out of proportion, or may be strangely absent. Eating may become a refuge, and sleep may begin to seem either irresistible or elusive. Alcohol or drug use may get out of control.

Or the problems can be more severe, such as frightening hallucinations, thoughts of suicide, or "voices" that whisper intrusive and incomprehensible things. Or they may be more long-term -- such as pall of gloom that never seems to life, causing everyday life to feel distorted and out of control.

Many people with such problems decide they need psychotherapy. But there is more to many emotional problems than you might think. Often, they are linked to other medical problems, flagged by other symptoms -- like headaches. The first step, therefore, is to identify the problem and then decide on appropriate treatment. That's where a psychiatrist can help.

Anyone experiencing emotional problems or changes in thinking, feelings, or behavior should undergo a thorough physical and mental examination. Psychiatrists are trained medical doctors who are uniquely qualified to access both the mental and physical aspects of emotional distress. Their medical education has given them a full working knowledge of the many causes for the patient's feelings and symptoms, and they know how to direct the tests and evaluation needed to make a complete, accurate diagnosis.

Armed with this understanding, psychiatrists can then recommend or render treatment.

If you need help right away, you should seek emergency treatment from a hospital emergency room. Also, many psychiatrists offer such treatment. If, however, you feel you can take the time to do some research when you choose a psychiatrist, the following suggestions may help:

1. Begin with your own physician. Tell your doctor what you are feeling. The doctor will probably want to perform a thorough physical examination to check whether any physical problems may be contributing to your symptoms. If the doctor recommends psychiatric treatment, ask for a referral to two or three psychiatrists who would work well with you. You should also request a copy of your medical records for the psychiatrist to examine. Psychiatrists' training enables them to diagnose and treat a wide range of problems. There are many good therapists in practice, but psychiatric physicians are specially equipped through their medical training to understand how the body functions and the complex relationship between emotional illness and other medical illnesses. As physicians, psychiatrists also can determine whether there is a need for any of the medications which have proven effective in successful psychiatric treatment today.
2. The local medical society, psychiatric society, community mental health center, and medical school are also good sources for referrals to psychiatrists. You should feel free to specify age, sex, race, or religious background of the doctor if that is important to you. Medical and psychiatric societies also can tell you where psychiatrists went to medical school, took residency training, and whether they are certified by the American Board of Psychiatry and Neurology. Except for checking geographic location, the phone book is not a good referral source.
3. Check your health insurance to see if it will cover treatment of mental and emotional disorders. Many policies have arbitrary limits and may only cover 50 percent of the costs of a fixed number of visits per year. If your policy does not adequately cover you, talk to your employer's employee benefits representative or insurance agent about improving the coverage. Many employers offer several health care options, and you may be able to switch to a coverage that allows for greater flexibility with psychiatric treatment. All health insurance policies should include non-discriminatory coverage for mental illness treatment. Unfortunately, many do not.
4. Select two or three possible psychiatrists and phone for information about appointment availability, location, and cost of the first visit. Then schedule an appointment.
5. When you visit the psychiatrist, the doctor will ask you some general questions about your background, family, habits, your general health, and will ask why you think you need treatment. The psychiatrist will want to know when you last had a complete physical examination, may ask to see your medical records, and may ask your permission to consult with your personal physician. If you have noted a recent physical, the psychiatrist will probably perform one or send you to your own or another doctor. The psychiatrist knows how to interpret all the laboratory results and other findings of the examination. You should feel free to ask questions about fees, appointment flexibility, cancellation policy, and insurance form processing.
6. Good psychiatrists select from among many forms of psychotherapy and other treatments depending upon your needs. There are psychotherapies that help patients to change behaviors or thought patterns, psychotherapies that help patients explore the effect of past relationships and experiences on present behaviors, psychotherapies that treat troubled couples or families together, and others tailored to help solve other problems in specific ways. And because psychiatrists are medical doctors, they can also determine whether there is a need for medication to help restore imbalances in body chemistry that are often a large part of mental problems. Beware of any psychiatrist or other therapist who espouses one brand of treatment as the only one that works. Today's psychiatrist has a multitude of ways to help you and will work with you to create a treatment program that fits your needs. As with any other physician, feel free to ask about the benefits and risks of the treatment program the psychiatrist outlines.
7. After this initial session, reflect on how you felt about the doctor. What was it like to talk to someone you've never met before about problems troubling you? Did the psychiatrist listen and seem to have a sense of your feelings? Is this a person you could trust? Did you like the office location and setting? Remember, your comfort -- both with the doctor and the surroundings -- are important considerations.
8. 8. If the mix doesn't feel right to you -- and there are no hard and fast rules here -- you should pay for the visit and move on to the next psychiatrist on your list. When the chemistry does feel right, you've finished the first part of the work. The second part -- working together with your psychiatrist to understand and overcome your problems -- is about to begin.

The Warning Signs of Mental Illness

1. Marked personality change.
2. Inability to cope with problems and daily activities.
3. Strange or grandiose ideas.
4. Excessive anxieties.
5. Prolonged depression and apathy.
6. Marked changes in eating or sleeping patterns.
7. Thinking or talking about suicide.
8. Extreme highs and lows.
9. Abuse of alcohol or drugs.
10. Excessive anger, hostility, or violent behavior.

A person displaying one or more of these warning signs should be evaluated by a psychiatrist or other physician as soon as possible. For more information, contact the American Psychiatric Association.