Treating depression: psychiatrists and other mental health professionals

Psychiatrists

People can get to see a psychiatrist through a referral from their GP, or if they are in hospital. Common complaints about getting a psychiatrist were that GPs were reluctant to refer and people had to wait too long to see a psychiatrist when already distressed. One woman said she felt fortunate that her GP knew his limitations and so referred her to a psychiatrist. People who are thought to be a danger to themselves or others should be able to get an urgent referral to psychiatric care.

Had a long wait to see a psychiatrist while suicidal, and so the psychiatrist’s concern about his…

Age at interview 33

Gender Male

Age at diagnosis 24

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Her GP knew he did not have the skills to manage her and referred her to a psychiatric team. They…

Age at interview 40

Gender Female

Age at diagnosis 37

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All psychiatrists can make diagnoses about mental health conditions and prescribe medication. Several people felt that psychiatrists were very good at selecting and adjusting medication. For example, one man believed that he would not have got through his severe depression without a psychiatrist who had the skill and authority to prescribe the right ‘mind bending drugs.’ However, another was convinced that her psychiatrists only prescribed drugs that were heavily promoted by drug companies.

Experiences of psychiatrists were mixed. Some were anxious about the referral but were relieved when the psychiatrist turned out to be human and took their problem seriously. Many psychiatrists were described in positive terms e.g., ’eminent’, ‘very down to earth so it was easy to be real’, ‘we get on like a house on fire’, or ‘very gentle, very sympathetic’. And an advantage of the authority of psychiatrists was that they had the clout to rule out conditions that people did not have or classify a condition as due to a chemical imbalance, meaning the patient did not feel they were at fault.

Saw psychiatrists in London after dissatisfaction with local psychiatrists, who ruled out…

Age at interview 35

Gender Male

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Her psychiatrist told her she had a chemical imbalance that caused anxiety and depression, which…

Age at interview 50

Gender Female

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Some psychiatrists are helpful in allowing people to talk through issues. One man in his seventies was relieved when his psychiatrist showed a real understanding of how he felt.

Although he denied being depressed, he was referred to a psychiatrist who understood how he felt,…

Age at interview 75

Gender Male

Age at diagnosis 35

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Several psychiatrists are also trained to provide talking therapies. Those who found a psychiatrist they liked in the NHS were sometimes frustrated that they seemed to see a different psychiatrist every time. They emphasised the need to build up rapport and trust over time with psychiatrists. One woman managed to convince her mental health team that because her condition was severe and ongoing, she should have only one psychiatrist.

She felt she was on ‘crop rotation’ seeing a different registrar every time she visited…

Age at interview 39

Gender Female

Age at diagnosis 18

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Several psychiatrists were described as aloof, pompous and judgemental, and people felt they had to fight to be heard. The advice for those with such doctors was to write down things you want to say, take a friend along, argue your case if you can, and/or keep diaries of medication and suspected side effects.

Did not like her consultant psychiatrist who did not seem to listen to her complaints about…

Age at interview 58

Gender Female

Age at diagnosis 20

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Felt misunderstood by his psychiatrist who assumed he had something like ‘schizophrenia’, and…

Age at interview 37

Gender Male

Age at diagnosis 22

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Criticisms of psychiatrists also included that they jumped to inappropriate conclusions, or gave advice based on non-therapy training and ‘homespun wisdom.’ One organised and rational woman who had experience of running a large department at work said her mental health team were disorganised and her psychiatrist ‘wet’. She reported obtaining her medical notes after she had made complaints about her hospital treatment, which the NHS later apologised for. She found that a psychiatrist had labelled her as having a personality disorder because ‘she thinks the NHS is against her.’ Another person said his ‘faith in psychiatrists went zooming out the window’ when one told him his hair loss was due to stress, when in fact it was due to the lithium he was on. Some people did not want to talk about uncomfortable issues with psychiatrists: for example, one woman acknowledged that she had been reluctant to admit how her childhood had affected her life.

Did not like talking about feelings that were hard to pin down, and found her mental health team…

Age at interview 39

Gender Female

Age at diagnosis 33

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She found a psychiatrist’s manner off-putting, so she put up barriers and denied that she had any…

Age at interview 33

Gender Female

Age at diagnosis 24

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Other professionals and mental health teams

A range of non-medical professionals are involved in mental health care. For instance, clinical psychologists, community psychiatric nurses (CPNs), occupational therapists and social workers. Some of these professionals can help support people in the community, particularly through difficult periods of their illness when problems might occur.

Some people have a community mental health team supporting them, and if so, they will have a key worker (any member of the team) who coordinates the services they need (for more information see MIND’s website). The help of mental health professionals and teams was invaluable to some, particularly those with less social support.

Finds that when she needs help, she can rely on her mental health team, including her doctor,…

Age at interview 54

Gender Female

Age at diagnosis 32

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Mental health professionals help people to complete tasks, act as go-betweens with psychiatrists, help with medication, talk through problems with clients, educate clients and carers, and help sort out practical issues. One woman had a CPN who helped her when she developed panic attacks after leaving hospital and had to live in the community again. However, a few were dissatisfied at times when the services of professionals did not meet their needs.

A social worker visited his home and helped his father to better understand depression, as well…

Age at interview 35

Gender Male

Age at diagnosis 17

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A Community Psychiatric Nurse (CPN) or social worker helped her to do everyday tasks at home when…

Age at interview 60

Gender Female

Age at diagnosis 27

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Found it difficult to cope back in the community after being in hospital and had panic attacks,…

Age at interview 43

Gender Female

Age at diagnosis 40

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When she left work due to work pressure, her GP arranged for a CPN (Community Psychiatric Nurse)…

Age at interview 33

Gender Female

Age at diagnosis 24

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Feels that the occupational therapists set her challenges that were too hard, and so this…

Age at interview 50

Gender Female

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GPs and depression

There are a range of healthcare professionals who can help people with depression. For many people their general practitioner (GP) is the first port of...