How do you know when and whether you need a psychiatrist or a psychologist?
For many people, stigma is still an obstacle to accessing the right mental health care for them, at the right time. Experiencing psychiatric symptoms is challenging enough. We don’t need the judgement of others or self stigma standing in the way of getting the correct treatment. So we need to change the way we think and speak about accessing mental health care. And we need to understand the different levels of care we can expect from different professionals.
I saw my psychologist and my psychiatrist a couple of weeks ago. These two professionals are the pillars of management for my Bipolar Disorder. Yet they support me in different ways.
If an acute Bipolar flare up were a broken leg, my psychiatrist would be the orthopaedic surgeon and my psychologist would be the physiotherapist. Going to the physiotherapist with a broken leg is a waste of everyone’s time. It needs surgical repair before a physiotherapist is of any value.
For me, attempting to see my psychologist during a manic, psychotic, or depressive episode is worse than useless. My symptoms (no short-term memory or concentration, pressured thoughts and speech, among others) interfere with getting anything out of psychological therapy.
Going to a psychologist with psychiatric symptoms (especially if they are depressive) can make you feel worse, because you can come away from the visit thinking you should be able to fix your illness by applying psychological tools, when medication may be necessary to first get you well enough to benefit from an appointment with a psychologist.
My psychologist becomes lifesaving in the aftermath of the psychiatric symptoms. When my Bipolar Disorder explodes into action, I am snatched from my life and I inhabit an alternate universe where I have no control over my thoughts and need to be quarantined from the world.
By the time it is done with me I am a psychological wreck. I finally stagger out of the hospital into a void. I have to rebuild myself, often from zero. I never get back to my old self. In the early days, the threat that this illness can blow me apart anytime, sits heavy in my head.
When I go to see my psychologist, I am broken. But she reminds me I’m still in there somewhere, and I am strong, and kind and passionate, and driven. She reminds me that with each rebuilding comes an opportunity for growth, and that I have rebuilt and grown many times.
When I am well, regular consultations with my psychiatrist and psychologist constitute maintenance therapy. They help me stand guard. One supplies lifesaving medications and monitors their effects. The other reminds me to pull back and not let my drive and perfectionism upset the balance. My psychologist coaches me to sit with my vulnerability and become more comfortable with a lack of control. She is also my go to person for objective life advice. If I’m struggling with a parenting, relationship, or work issue, I know I can depend on her for the truth.
So where does a general practitioner (GP) fit into mental health care?
For me, except for writing a script for one of my medications if I run out before seeing my psychiatrist, they don’t.
For anyone seeking help for a mental health issue for the first time, a GP has one important role:
A good GP should reach for their referral pad not their prescription pad. Just as they would if their patient presented with a heart murmur. They should have the skills to assess whether their patient needs to be seen by a psychologist, a psychiatrist, or both, and whether they need hospital admission. That’s it.
We don’t expect our GPs to perform cardiology diagnostics or open-heart surgery on us. Psychiatry is also a medical specialty for a reason.
Like any other specialist, psychiatrists have undergone years of additional training after finishing their medical degree. An initial psychiatric consult will often last up to an hour to get a thorough history and begin making an assessment. A GP who is running on fifteen or thirty minute consultations doesn’t have the time to be this thorough or the specialist knowledge to prescribe psychiatric medications.
Whether it is taking an occasional Xanax or Valium or whether you are on a full-scale program of antidepressants, antipsychotics, mood stabilisers, sleeping tablets with occasional anxiolytics like I am, prescribing psychiatric medications is not like prescribing a course of antibiotics. (check out Treatment for why)
We need to put seeing a psychiatrist in the same category as seeing any other medical specialist, and not expect our GPs to shoulder a load they are not qualified for.