Psychiatry is a specific medical specialty that focuses on the diagnosis and treatment of mental disorders, which are also referred to as psychiatric disorders. Psychiatrists are not the only mental health specialists who diagnose and treat these disorders, but they possess particular skills and licensing authority that separates them from other mental health providers.
There are several different specialties, or disciplines, involved in mental health service, so it can become confusing among mental health consumers to know who to consult and what to expect from these different professionals. In this article, we’ll find out about the practice of psychiatry and what to expect, along with a better understanding of how psychiatrists differ from other professionals in the mental health field.
Who are Psychiatrists?
Generally, psychiatrists are doctors who are certified to practice psychiatry, just as other doctors may specialize in different areas of medical practice. For example, a doctor who treats bone and joint problems is an orthopedist. A doctor who treats diseases of the foot is known as a podiatrist. A psychiatrist treats mental disorders and other mental health conditions. They are typically trained in medical school and receive degrees either as a Doctor of Medicine (MD) or as a Doctor of Osteopathic Medicine (DO).
Both have very similar training and can be licensed in all 50 states. DO’s, however, have additional training in manual manipulation, which focuses on musculoskeletal issues, but these are rarely used in psychiatric practice. MD’s have traditionally focused more on disease treatment while DO’s emphasize prevention and holistic health. Again, both types of physician can practice in similar ways.
Along with doctors, nurse practitioners can specialize in psychiatry, and thus provide many of the same services as psychiatric physicians. These Psychiatric Nurse Practitioners (PNP) receive their education in nursing school, but then go on to obtain additional training in the practice of psychiatry. In this article, our discussion of psychiatrists will include nurse practitioners.
Because psychiatrists are medical professionals, they are well versed in various aspects of the body—especially the brain and central nervous system—and how mental health problems can affect the body and vice versa. They possess knowledge of biology, physiology, neurology and chemistry, and they integrate these areas into developing treatment for mental disorders from a medical perspective.
In some states, psychologists may be available to prescribe medications. Psychologists with the proper education and credentialing can be given authority to prescribe psychiatric medications in Iowa, Idaho, Illinois, New Mexico, and Louisiana, as well as in the Public Health Service, the Indian Health Service, the U.S. military and the territory of Guam.
What Do Psychiatrists Do?
Psychiatrists have been a part of medical practice for a very long time. Until recently, psychiatrists often provided all aspects of mental health care, from medications and other various medical treatments, to psychotherapy, including psychoanalysis. In modern mental health care, other licensed professionals can be trained and credentialed to provide psychotherapy, which allows psychiatrists to focus more specifically on the medical side of care.
Typically, patients requiring some form of medical treatment for their specific condition will receive medication and ongoing medication management from a psychiatrist while receiving psychological testing, psychotherapy, or other mental health services from other providers.
Psychiatrists practice in many different clinical settings, including inpatient hospitals, residential treatment centers, outpatient treatment facilities and offices, and through telemental health (video conferencing). People in need of psychiatric care either self-refer (they reach out directly to a psychiatrist), are referred by a friend or family member, or are referred by another professional.
Those other professionals may be mental health providers, non-mental health, or other medical professionals. Parents or caregivers may also contact a psychiatrist to set up an appointment. Oftentimes, people are concerned that a first meeting with a psychiatrist will automatically mean they will get on medications. This is not always the case.
Like any first doctor’s appointment, the most important thing is to receive a thorough assessment, then a diagnosis if possible, followed by a discussion of treatment recommendations and options. Sometimes, a diagnosis cannot be entirely figured out in the first session, so possibilities may be explored to see how a firm diagnosis can be obtained and what to do while sorting out all the factors in someone’s specific condition.
If medications are indicated, meaning it appears necessary to treat the condition, then a psychiatrist can explain to the patient, parents, and/or caregiver the reasons for medication treatment. But it’s also likely that therapy services would be recommended, too, with or without a medication prescription. If medications are prescribed, follow-up appointments will be needed to evaluate for any possible side effects and to see if the prescribed medication is ultimately effective.
Similar to some other medical specialists, many psychiatrists will focus on certain patient populations. Some may work with children and adolescents, and be known as pediatric psychiatrists. Others may work with the elderly, or with veterans. Others still may specialize in particular mental disorders, such as schizophrenia, ADHD, or mood disorders, or provide assessments for the court system, such as in forensic psychiatry.
If you’re searching for the right psychiatrist, it’s good to find out their particular specialties. But if you don’t know what may specifically apply in your situation, that’s okay, too. Psychiatrists typically provide at least initial evaluation and/or treatment, and if you may be better served by another psychiatrist, you can be referred to someone known to focus on your particular ongoing issues.
Psychiatrists not only prescribe medications specifically for depression, anxiety, and other mental disorders, they also perform many functions similar to other physicians. For example, a psychiatrist may need a further evaluation into a patient’s overall health to determine a possible physical cause for a patient’s depression. He or she may then order a blood serum test to check for such things as low thyroid hormone, which may result in a depressed mood.
Psychiatrists also may prescribe certain medications that are indicated for other medical conditions, but may be useful for psychiatric ones. One example is using medications for high blood pressure (hypertension) for the treatment of anxiety. Their knowledge of medical conditions overall helps to insure that people with multiple medical problems will receive psychiatric treatments that don’t interfere with treatments for other ailments. This is particularly important for elderly patients and those who develop psychiatric disorders as a direct result of medical or disability problems.
Psychiatrists are also equipped to understand the whole health needs of their patients. In addition to medications and other psychiatric treatments, psychiatrists can work with patients to improve diet, exercise, and other self-care needs to improve mental health. They can often include vitamins and nutritional supplements that have scientific backing and often assist in the overall medical treatment plan. This is certainly important for everyone, but especially with mental health patients.
People with mental health disorders of all kinds can often neglect their self-care, thus worsening their particular condition. This can be often the case with substance abuse and eating disorders. Psychiatrists can monitor an individual’s dietary needs and work with other specialists to improve mental functioning along with physical well-being.
How are Psychiatrists Different from Other Mental Health Providers?
There are several different disciplines within mental health practice that can make shopping for the right providers confusing. Other than psychiatrists, there are clinical psychologists, clinical social workers, marriage and family therapists, licensed professional counselors, certified alcohol counselors, licensed mental health counselors, and several other licenses and distinctions depending on specific training and state regulations.
You may also see professionals with training and credentials to provide counseling services in specific places for particular groups. Examples include school psychologists who offer assessment and counseling for students, or clergy providing pastoral counseling to church members. But searching for a professional who provides psychotherapy, mental health therapy or counseling should typically involve a licensed therapist or a registered intern who works under the supervision of a licensed therapist.
Among therapists, there can be a wide range of specialties, as well. Most therapists will work with individuals. Others may also work with couples and families, or with children and/or adolescents. Some work in various kinds of group therapy. Therapists may also have subspecialties, too. For example, some may focus entirely on LGBTQ patients, or with women’s issues or men’s issues exclusively. Other examples can include working with veterans, the elderly or people with disabilities.
There are also a wide range of specialties based on clinical disorders and related issues. These include people with substance use disorders, mood and anxiety disorders, psychotic disorders, attention deficit disorder, personality disorders, dissociative disorders, PTSD, learning disabilities, relationship dysfunction, domestic violence, childhood and developmental disorders, and many others.
Therapists also have different approaches and techniques in therapy. These include psychodynamic therapy, cognitive behavioral therapy, psychoanalysis, dialectical behavioral therapy, emotionally focused therapy, existential therapy, and several others. No matter what kind of technique is used, the quality of the therapist and the sense of rapport between therapist and patient usually result in the best outcomes for the patient’s ultimate well-being.
When it comes to treatment by psychiatrists, people can get easily confused about how she or he will interact with them. “Will I be asked embarrassing questions about my personal life?” “Will the psychiatrist be my therapist, or will someone else work with me on my deeper issues?” It’s important to know that psychiatrists may or may not provide psychotherapy within their part of the overall mental health treatment plan, so how they interact, especially after the initial psychiatric evaluation will likely depend on whether or not they are providing therapy along with medications.
When they do provide psychotherapy, it can be performed along with discussions about a possible medication prescription or following-up on how an existing medication is acting for that patient. If the psychiatrist is not performing psychotherapy, he or she will probably still want to know how life is going for that individual, but may not delve too deeply into that person’s current life issues. Instead, they may make a referral to a therapist for that purpose, or simply inquire how the therapy is coming along with an existing therapist.
Of all mental health disciplines, it’s likely that psychiatry and clinical psychology are most often confused. In part, this may be because clinical psychologists who hold either a Ph.D. (Doctor of Philosophy in clinical psychology) or a Psy.D. (Doctor of Psychology) would be addressed as “Doctor,” just as a psychiatrist with either an MD or a DO.
Between the two disciplines, there are other similarities, but some important differences, nonetheless. Both disciplines can provide assessment, diagnosis and therapy for mental health disorders. Clinical psychologists are also trained to provide psychological testing instruments, which can assist in providing a more accurate diagnosis and evaluation of an individual’s psychological profile.
Some tests that are shorter in duration and scope can be used as initial screenings for a variety of reasons, including the assessment of depression and anxiety symptoms. Longer tests can find out more extensive sets of information that are useful in the assessment process. For example, personality inventories are used to describe a larger picture of how individuals see themselves and others in the world around them. Neuropsychological tests can uncover the extent of someone’s brain injury and its effect on the person’s functioning.
Psychiatrists generally do not provide psychological testing as clinical psychologists do, but they certainly can use the information provided from the clinical psychologist in the total assessment and diagnostic process. Therapists likewise may use information provided by psychological tests to help determine how the patient may respond to therapy and perhaps even anticipate particular needs and challenges as the course of therapy progresses.
As mentioned earlier, some psychologists in a few states and regions are given the authority to prescribe psychiatric medications, provided they have the training and credentials to do so. This may help offset a shortage of available psychiatrists for medication treatment in rural or less densely populated areas.
What to Expect from Psychiatric Care
If you’re considering psychiatric help or you’ve been recommended to seek help, choosing the right psychiatrist can seem overwhelming. It can also be just plain scary when you don’t know what to imagine. Upon the first meeting with a psychiatrist, a person seeking help for mental health problems can usually expect an initial psychiatric evaluation for the purposes of assessment of problem areas, a clinical diagnosis, and the beginnings of a treatment plan.
Different psychiatrists have different approaches to initiate this evaluation process—not everyone has the exact same procedures. But there are some basic items you can generally expect from starting psychiatric care.
Just as with other doctors, you would be expected to fill out paperwork that would involve your demographics, including home address, phone number, date of birth, etc. It will likely also include the reasons for seeking treatment and some questions regarding basic mental and medical health information.
Also, and very importantly, there will be disclosure forms, which are mandated to be read and signed, essentially to show that you are aware of treatment regulations and privacy laws. This means you are providing informed consent for the psychiatrist to treat you. Caregivers who have medical power of attorney can sign on behalf of the patients. Parents would sign on behalf of their children. However, in some states, children of a certain age may be able to consent on their own behalf without their parents involved.
Psychiatrists will typically want as much information as they can reasonably obtain before the first session and possibly what can be acquired soon after the session. This can involve medical records, psychological testing, or reports or discussions with other mental health providers. In some cases, other professionals, such as attorneys, teachers, or anyone else who has worked with a specific patient and may have some interest in their treatment.
But remember this: Generally speaking, no information can be released or discussed without the written consent of patients or those who have the authority to sign releases on their behalf. And such exchanges are designated clearly and precisely between two distinct parties (e.g., a psychiatrist and previous therapist).
For many people, the thought of anyone discussing their mental health issues can provoke anxiety and uncertainty. If you feel uncomfortable with this kind of request, it’s a good opportunity to ask questions about how any authorized exchange will be used and how it will ultimately serve your mental health needs.
It’s good to know that in most cases, a person at any time can refuse any part or all of the recommended treatment by a psychiatrist. The exception is when a person presents an imminent danger or threat to harm self or someone else. In this matter, an individual can be involuntarily hospitalized, and remain so until it’s demonstrated that the person no longer poses such a threat.
It’s vital that a psychiatrist, or for that matter any mental health professional, immediately assesses for suicidal or homicidal thoughts or potential actions. That does not mean that all people with suicidal thoughts will be immediately hospitalized. It simply means that a level of risk must be examined, and then recommendations can follow that can help that individual stay safe, whether in outpatient or inpatient care.
The assessment process continues from paperwork to meeting with the psychiatrist face-to-face, or by video conference if that is the only available means. Now the psychiatric interview begins. This basically involves a discussion about the presenting problems as the patient sees them and experiences them, with specific questions by the psychiatrist about the history and depth of these problems.
From there, the psychiatrist can develop further inquiry into a person’s total mental health history, whether or not any such treatment has taken place before. It may also be relevant for the psychiatrist to ask about a person’s family medical and mental health history, particularly since some mental disorders are genetically-based and, thus, hereditary in origin.
Also, psychological and physical trauma histories can prove to be critical in understanding how certain mental health problems have originated, and what kind of treatment would be appropriate. Since certain barriers to communication between the psychiatrist and patient can be disruptive to the process, it’s good to know if an assistant to the patient, such as a family member or an interpreter, can be present to make sure that the exchange of information is as thorough and accurate as possible.
As the interview proceeds, psychiatrists will typically ask questions about certain clinical symptoms to shape a specific diagnosis. Some questions may include, “How have you been sleeping?” “How is your appetite these days?” “Do you find yourself getting more irritable than usual?” “What kinds of activities do you usually enjoy, and have you been doing them lately?” A wide range of other questions may be asked, all to guide the evaluating psychiatrist to the right conclusions.
The initial session can also provide patients an opportunity to assess their own thoughts and feelings about their particular psychiatrist and how the session is proceeding. A first session alone doesn’t always provide enough information for patients to get a complete sense of the quality of treatment and the psychiatrist providing it.
It may take a few sessions to understand whether or not the psychiatrist is “a good fit” for that person. But one should expect a developing sense of care, sensitivity, and drive to make sessions feel emotionally safe and relevant to their needs. For many first-time patients, the very issues they bring to treatment center around the fear of trusting others, including doctors. This issue is very important to discuss and explore in the initial evaluation, both so that important information can be obtained and that a healthy sense of rapport and emotional safety can be established.
Once a psychiatrist believes enough information has been obtained in the interview, a clinical diagnosis can be provided. There may be varying degrees of certainly with any one diagnosis, so a psychiatrist may state a “provisional” diagnosis, which is another way of saying that it’s subject to change with additional information. Or one may say a certain diagnosis can be “ruled out,” which means more information could exclude that diagnosis. In any case, a proper diagnosis can lead a psychiatrist to the right course of treatment for the best outcomes, while limiting problems along the way.
But as important as a good diagnosis can be, people in psychiatric care are more than just a diagnosis. The person’s particular life story, present and past, is ultimately what good mental health care is all about. In the formulation of a solid treatment plan, a person’s specific concerns, feelings and values can be also included, which will build confidence that unique treatment needs will be addressed. From here, recommendations within a treatment plan can form and be shared with the patient, and if needed, the patient’s family.
Psychiatrists will suggest certain medications if they believe it is appropriate for the specific condition and does not present undue problems for the individual. There are a variety of medication options available, and it’s good to ask questions about proposed medications, especially because there’s so much misinformation and misunderstanding about psychiatric medications within our society.
Fears about medications and the stigma often associated with them can keep people away from getting relief from the symptoms of psychiatric disorders. For others who have previously tried psychiatric medication and found it to be unhelpful or had side effects, they may not be too interested in trying something else. But a complete discussion about these issues may lead both psychiatrist and patient to a better medication, or some alternative approach that can yield better results.
Some of these alternatives could include over-the-counter supplements. One popular example is melatonin to aid in sleep. One recent development in the treatment of depression is transcranial magnetic stimulation (TMS), and it is often thought of as an alternative to medication. Another alternative is typically reserved for people who have had little or no success with medications for severe, long-standing depression. This is known as electroconvulsive therapy (ECT), which is often considered the treatment of last choice.
What is ultimately important is to discuss options with the psychiatrist, and know that the recommendations will likely start with what is believed to be the most effective and least invasive interventions available.
Psychiatrists generally recognize the great potential benefits of psychotherapy and other kinds of mental health therapies that can improve psychiatric symptoms, daily functioning, and long-term well-being. With or without medications involved, psychiatrists will either provide psychotherapy on their own or make a referral to a therapist who would closely fit the assessed needs of the patient.
As the treatment plan is initiated, psychiatrists will likely schedule ongoing follow-up sessions to assess how the treatment is progressing, especially where medications are concerned. The truth of the matter is that medication adjustments are almost always a given reality.
It’s typical for psychiatrists to start with medications they believe can be the most effective for a specific condition while having the least amount of side effects. So it’s not unusual for psychiatrists, especially outpatient providers, to start with a lower dose to see how their patients are tolerating the prescribed medications.
If all is well, then an increase in dosage may occur. Or another medication may be more suitable. Adding and subtracting medications is not unusual, at least until a person’s treatment appears to be going well. Another important fact to know is that some psychiatric medications may take several days to weeks before the desired effects are obtained. This makes continuing contact with both the psychiatrist and the patient’s therapist particularly important during the initial phase of care.
Psychiatrists often determine when treatment should be increased, reduced or discontinued, but would likely do this in collaboration with the psychotherapist or other providers involved. In certain cases, patients may require lifelong care depending on their conditions and overall health needs. But in any case, ongoing communication is essential to meet treatment goals and chart a plan for long-term success.