Seeking medical help if you’re concerned about your mental health is a positive step forward towards feeling happier and healthier, but going for that initial consultation can feel intimidating.
While most of us are familiar with the process of seeing a doctor for a cough - after all, we attended those appointments with our parents from childhood - seeking support for your mental health is a different kettle of fish.
But according to Dr Kate Lovett, general adult psychiatrist and dean of the Royal College of Psychiatrists, receiving a diagnosis is nothing to be afraid of.
“Mental health services are designed to empower patients to live as independently as possible,” she tells HuffPost UK.
“Being diagnosed with a mental illness isn’t the end. For many, it’s the beginning of a fresh start.”
To mark World Mental Health day, we asked experts what to expect when you seek medical help for your mental health to demystify the process once and for all.
What should you do if you’re worried about your mental health?
Dr Antonis Kousoulis, an expert in evidence-based interventions for public mental health at the Mental Health Foundation, says if you’ve noticed changes in the way you are thinking or feeling, your GP should be your first port of call.
“Before the appointment it might be helpful to write down what you’d like to talk about to make sure that you don’t forget anything,” he told HuffPost UK.
“Write down any symptoms of how you’re feeling and how your mood might be affecting your day-to-day life. Write down key personal information, including upsetting events in your past and any current major stressful events.”
If you feel that you may struggle to express your problems, Dr Kousoulis advises booking a double appointment.
If you’re feeling suicidal and need immediate support, the NHS advises calling Samaritans on 116 123.
What happens at a GP appointment about mental health?
According to Dr Kousoulis, your GP will ask you questions about your feelings and thoughts and your personal history.
“These will feel like a conversation but are assessed through standardised clinical scales, the results of which inform the GP of the likelihood of a diagnosis,” he explains.
“They may also ask you about any medication you are currently taking and other physical conditions you may have a diagnosis for.”
Your GP will also likely order some blood or other tests to rule out physical conditions that may cause confusing symptoms, and will give you a general physical examination.
They might also ask you questions about your lifestyle, such as how much exercise you do.
“This is so that they can recommend simple lifestyle changes that can improve your mental health,” Dr Kousoulis adds.
How is mental illness diagnosed and categorised?
Using all the information gathered in your initial appointment, your GP may prescribe you with treatment based on what they believe your diagnosis to be, or refer you to a specialist for further consultation and diagnosis.
Under the NHS, mental health conditions are split into two categories when diagnosed: Common Mental Disorders (CMDs) and Severe Mental Illnesses (SMIs).
CMDs usually comprise of different types of depression and anxiety, which can cause emotional distress and interfere with daily function, but “do not usually affect insight or cognition”. These may be linked to a particulalry distressing life event, for example, experiencing depression after bereavement. The care of CMDs is usually overseen by a GP, also known as “primary care”.
In contrast SMIs are longstanding conditions where a sufferer will experience symptoms with multiple elements, potentially leading to significant disability.
Examples of SMIs include schizophrenia or bipolar disorder. The conditions usually included psychotic symptoms, such as hallucinations, delusions and not being able to recognise that you are unwell.
Patients believed to be suffering from a SMI are usually referred to a psychiatrist. This option is also known as “secondary care”.
What is a psychiatrist and what will happen at your appointment?
If your GP believes you are displaying symptoms of a SMI they will arrange your referral to a psychiatrist. A psychiatrist is a doctor that specialises in mental health.
Dr Kate Lovett explains: “Psychiatrists are the only medically trained mental health professionals and are vital to the diagnosis, treatment and management of severe and enduring mental health conditions.
“For example, although a GP may suspect a patient has bipolar disorder, only a psychiatrist can diagnose the condition.”
According to Dr Lovett, you’d also expect to be referred to see a consultant psychiatrist if:
:: Your GP was concerned about your risk - most commonly that you might harm yourself.
:: Your mental health condition was complex and they wanted advice about diagnosis.
:: The initial treatment wasn’t working or the condition was recurring.
:: There were complicating factors such as physical health conditions.
Similar to a GP appointment about mental health, an initial psychiatrist appointment will be based around talking.
“Psychiatrists will have a conversation about what the person is experiencing, their current situation and life stresses and more about them as a person, their upbringing, social networks, interests and what makes them tick,” Dr Lovett explains.
Your psychiatrist may also request the opportunity to learn more about you from someone you’re close to, such as a family member or friend.
“Psychiatrists also go through medical history and other relevant reports such as psychological assessments to try and piece together the puzzle,” Dr Lovett adds.
“Sometimes there are small incidents across a number of years that seem meaningless in isolation but put together suggest a certain diagnosis.”
Again like GP testing, diagnosis under a psychiatrist is likely to include tests to rule out physical illnesses such as brain scans, blood or urine tests. You may also be asked to fill out a questionaire specific to your suspected mental illness.
How is mental illness treated?
Both GPs and psychiatrists may prescribe various talking therapies and medication to help you manage symptoms of mental illness and improve your overall mental health.
Mental health is complex so treatment will vary from person to person, depending on your diagnosis, lifestyle, general health and specific symptoms.
Common treatment prescribed by a GP can include referral to cognitive behavioural therapy - talking therapy designed to help you break down problems into more manageable parts - or anti-depressive medication.
Dr Kousoulis points out: “Unfortunately, talking therapies often carry a long wait.
“Initially, though, many GPs, in conversation with you, may suggest an individual self-help course, mindfulness or a local peer support group.”
If primary care treatment prescribed by your GP does not appear to be successful, they may refer you to the Improving Access to Psychological Therapies (IAPT) programme, which provides alternative primary care.
The programme aims to help patients with depression and anxiety better access treatments they might find helpful. For example, you may find an alternative talking therapy more useful than CBT and the programme can help you find what’s available in your area.
For those who’ve been diagnosed with a severe mental illness, a psychiatrist may prescribe psychiatric medications which are known to be effective for certain conditions, for example antipsychotics for patients with psychosis or bipolar disorder.
What after-care is available?
Whether your care is being overseen by your GP or a psychiatrist, your diagnosis is just the first stage towards better health.
According to Dr Lovett, a psychiatrist leads an entire team who will support you through follow-up appointments.
“A psychiatrist leads what is called multi-disciplinary team, which is made up of psychologists, nurses, social workers, occupational therapists and others. This wide-ranging expertise of this team is vital for people’s care and recovery,” she explains.
“After diagnosis, patients will be given a main point of contact in the team who will coordinate their care, but the consultant psychiatrist will oversee and review every decision made.
“Once someone is stable, they will be transferred back to the care of their GP who will check in regularly to ensure they are safe and doing well on their own.”
Dr Kousoulis says your GP will usually ask you to stay in touch after you’ve visited them about your mental health and recommend when to book in future appointments.
This is particulalry important when taking new medication, as your GP will be able to determine how effective it is being.
“For example, if after an initial decision to follow a specific treatment plan your mental health deteriorates, your GP may provide alternative advice or decide to refer you to specialist services,” he says.
“Even if you are receiving treatment through mental health services, you may find it more difficult to stay physically healthy, hence it is important to remember that your GP remains your first point of contact to look after your general care needs and physical health.”
What are the waiting times for mental health services?
While the above advice should help you navigate NHS mental health services in a best-case scenario, reports have repeatedly indicated that access to any NHS medical treatment is sometimes a “postcode lottery” due to strains on the service.
A previous report by the NHS into mental health services confessed “there is considerable variation in services, with a waiting time of just over six days in the best performing areas and 124 days in the worst performing areas in 2014-15”.
According to the Mental Health Foundation, how long you need to wait to get an appointment to see a GP can vary and depends on how busy the surgery is.
“If you need to be seen urgently, then you may be able to arrange and emergency appointment through the surgery’s reception,” the website advises.
“If you prefer to see someone particular then you might have to wait until an appointment with that person becomes available.”
Meanwhile if you’ve been given a referral to a specialist by your GP, consultant-led mental health services are covered by the NHS 18-week maximum waiting time system. NHS England is actively working to reduce the maximum waiting time for mental health referrals and has developed the Five Year Forward View for Mental Health plan, to reduce maximum waiting times by 2021.
