When is Psychiatric Care Indicated?

So you know you’re depressed and have been for months. You have spoken with your family doctor about it and haven’t found much improvement. When is it appropriate to request a referral to a psychiatric specialist?

In general, I believe people and primary care givers are waiting too long to take the step from treating a mental health problem in a general practice setting to making a psychiatric referral.

Often, people come to me who have been depressed or anxious for many years but have never seen a psychiatrist. This is inappropriate.

Can you imagine a person living with diabetes or heart disease for that length of time without seeing a specialist? Of course not, and yet, psychiatric illnesses often carry with them similarly increased risks of disability and even premature death.

Depression alone costs roughly $60 billion every year in direct health costs and lost productivity. Also, depression is considered an independent risk factor for heart disease just as high cholesterol, obesity or smoking.

And heart disease is only one chronic condition that can be affected by the presence of a mental illness. Others include cancer, diabetes, epilepsy and osteoporosis. For example, diabetic individuals who also suffer from depression are twice as likely to suffer complications such as heart disease, nerve damage and blindness.

Mental illness is not something that should be shrugged off, taken lightly or ignored. Anyone who is missing work for psychiatric reasons should see a psychiatrist. This is usually required by disability insurance carriers, but patients and doctors often wait until it is demanded before taking action when it would be better to take a proactive approach.

Children who are doing poorly at school as a result of psychological issues should be seen by a specialist as soon as possible to avoid worsening of symptoms or increased disruption to school and social functioning.

As with many chronic illnesses, the key to successful psychiatric treatment is early diagnosis and intervention. This is the best way to reduce disability and ensure full remission of symptoms.

A referral from a physician is necessary when seeking specialist care, but even when the family doctor is reluctant, patients can be assertive about getting a second opinion. It is important to be proactive about your health.

Many times, people feel that the wait for specialist services will be too long or think that they are not truly sick enough to warrant seeing a psychiatrist. Often, patients arrive for appointments and are apologetic about taking up my time with their problems – this can reflect poor self-esteem that is the result of the illness.

There is no need to be apologetic if you are suffering with mental illness – if the specialist feels his or her services are not necessary, there is no doubt that the specialist will tell you that after an initial assessment.

In my opinion, a person should seek psychiatric assessment any time his or her function—at work, school or in social situations—is significantly impaired for more than a few months as the result of a mental health issue.


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