Am I allowed to see a psychiatrist?

[Iwishiwerefromtheshire]

I'd seen the GP again today for the millionth time in the last 15 years about my long time and debilitating low mood and fatigue etc and...same old same old - want to swap medication again or go for talking therapies again?

So I actually asked ChatGPT and it said I can ask the GP for a referral to a psychiatrist? Is this true? If so, why has it never been offered to me before? I know they probably can't help me but it would nice to get a more specialised professional's opinion on what's wrong with me.

Anyone had any experience with this?

Don't rely on Chat GPT. Look up the referral criteria in your area. For example, I've just googled one in London and the referral criteria is 2 antidepressants and psychological therapy hasn't helped. That's the referral criteria for the service, not for a psychiatrist. Once in secondary care, they'd decide if you needed a psychiatrist.

I have only seen a psychiatrist when under the care of the crisis team.

I think a GP can refer you if they feel they've reached the limit of what they feel comfortable prescribing you, but I suspect there would typical be additional concerns about your mh too.

Depression and anxiety and comorbid with neurodivergent conditions, which we all now know is underdiagnosed in women so it might be worth seeing if you feel you meet the criteria for these.

I’m a therapist in MH services. It takes a lot to be referred to psychiatry. Multiple meds and therapies tries. Significant prolonged impact etc.

what do you hope to gain from seeing a psychiatrist?

Yeah, you can definitely ask for a referral to a psychiatrist. It’s not unreasonable at all, especially after 15 years of feeling stuck in the same loop. GPs often handle depression themselves, which is probably why it’s never been offered, but that doesn’t mean you can’t ask. Wanting a specialist to take a proper look at things just makes sense, you deserve more than “try another tablet.”

GPs usually try meds and therapy first, but if it’s been long-term and not improving, a specialist review is reasonable.

I am not a MH professional but have been under 6 psychiatrists in my life, been an inpatient and under a crisis team. I have bipolar, PTSD and anxiety. When not unwell I am actually a functioning helpful member of society. I’m well qualified in the field I work in.

Psychiatrist's give a diagnosis and tweak meds. You are only going to get to see one if seriously unwell. Then unless you are an inpatient a standard appointment is 30 minutes. Having been round lots of very unwell people in my life having low mood and fatigue in my humble non professional opinion doesn’t fit the criteria. But you can obviously ask. The most frightening thing about MH services is being around other service users. I am not saying they are horrible people but their illness can be horrible and means they engage in very odd behaviour that can sometimes be very dangerous.

The most useful MH professionals I have engaged with are therapists when I had long term therapy, 4 years every single week.

Do you know why you have issues and low mood? I do, I saw myself as a victim and I was but as an adult though it was not according to therapists my fault due to abuse I acted out. Actually admitting the part I play as an adult in my own occasional downfalls was the complete key to improving my situation enormously.

Good luck with whatever happens.

Agree with @scoobysnaxx - you can ask ofc but strap in for a long wait. NHS services tend to be tied up with crisis cases in urgent need rather than long term low mood/fatigue, debilitating though that is. While you wait, it's worth looking into private services if you can stretch to that, and it may not be as much as you'd think if you just want to see someone eg for an assessment and follow-up. But agree you'd need to think about what you hope to get from it because the answer may still be the same meds, talking therapy, exercise as GP has tried.

GP can refer it will take over a year
Go privately

You can ask

But most GP cant directly referred to a psychiatrist.

They can only refer to the mental health team and they decide who you will see.

Usually it's a mental health practitioner.

I agree with this re. private psychiatrist. It only costs around £400 for an initial review and then about £200 for folllowup appointments. Well worth it if you are really struggling with your daily life.

This. All they can do is refer you into the MH service, which is overwhelmed with patients with mental illness that the service also has to look after in the community. You’re unlikely to see a psychiatrist on the NHS just with low mood - usually only seriously unwell and complex cases.
Have a look at the local criteria. How many meds have you tried? It might be worth considering some private therapy to help you get to the bottom of your low mood instead. This might be more individualised than the NHS CBT and may be more helpful than a one off consult with a psychiatrist

There are referral criteria in to Mental Health Services, same as any other speciality, and they generally operate in different levels or tiers.

I would imagine Psychiatry sits in a higher tier for referral, for more specialist disorders such as psychosis, schizophrenia, eating disorders etc. Low mood and tiredness will likely be a lower tier, which is probably self care, GP led, CBT etc.

Google the referral criteria for your local NHS board?

I currently see a psychiatrist on a regular basis because I have bipolar and am unstable at the moment - I see them once every 6 weeks for a medication review and my care coordinator calls me every other day.

I started seeing the mental health team after a breakdown - to be fair they saw me quite quickly but I didn't see a psychiatrist for awhile because the practioners felt they hold me. It was only when my condition got worse that the psychiatrist saw me and put me on meds.

I've been bouncing backwards and forwards ever since.

I guess what I'm trying to say is that unless your in crisis you might not get to see an NHS psychiatrist.

It's also worth thinking about what you would hope to achieve by seeing a psychiatrist. Is it that you think you need a different medication, or that you think your diagnosis is wrong, or something else? I think the answer to this question should help your GP to help you and hopefully get you to the right person, which might be secondary mental health services but not necessarily. If you are looking for a change of medicine, it might well be quicker to do that via your GP.

I'm bipolar and have been under psychiatrist on andd off since I was 18 with periods in the middle where I have been managed by just my GP. I am on medication that the GP can only make minor changes too so if I'm stable and just need my annual bloods and repeat prescriptions issuing I'm usually under the care of the GP. If I need medication adding or removing I need psychiatric input. This can be through a referral into appropriate mental health team or get prescribing advice from a psychiatrist without a referral. .

Different areas have different thresholds, in one area I was referred as I was hypomanic, the psychiatrist saw me once put my meds up and then discharged me back to the GP saying as I have been in employment I can't be that unwell. Thankfully the medication adjustment was enough to stabilise my mood.

Antidepressants can cause me to have high moods so when I'm depressed these moods can only be controlled by a psychiatrist as they need to be ensuring that there is balance in prescribing they are also more knowledgeable about side effects. I'm currently under them at the moment and we are increasing my antidepressants much slower than you would in general practice and there is the possibility of reducing my mood stabiliser as it can make you numb at higher doses.

What would you want the psychiatrist to do that the GP can't?

It might be worth making a time line of you mental health episodes and what treatments you have tried and what has helped/not helped. Also what tests you have had for the tiredness too. See if there are any patterns. Doing this has been helpful for me. There is definitely a seasonal component to my moods as nearly every one of my depressive episodes have started between August and October. I had manic/hypomanic episode every May for 4 years in a row. SSRIs either make me manic or do nothing. Mirtazapine works better for me but not always enough on its own. I would say the psychiatrist is much more aware of what class each medication is from I no longer get prescribed any SSRIs, the psychiatrist has noted other patterns and they won't prescribe some other medications as they are never effective for me.

I have had therapy on and off for years and there is stuff in my childhood and the relationship with my mother. This stuff is there in the background but my psychiatrists have never asked about this they are very much focused on the medication and what is needed there.

Asking for a Dr to take a step back and review how you are now in the context of how you have been previously would be worth it, I wouldn't get hung up on a referral though. It might be that the GP contacts the psychiatrist and puts across your history and asks for advice. It might be that there's a different GP at your practice that would be better. I was fortunate in one gp practice to get a gp who as a jr Dr worked with my psychiatrist. She was probably the GP the best GP I have ever had for managing my mental health

Hi OP

You've had some great advice here. Yes of course you can request a referral 😊.

I second pp about thinking about exactly why you want to see a psychiatrist. What do you want to achieve by that?

If you get referred to secondary care just bear in mind it's unlikely to be a psychiatrist, at least first off. The practitioners are very experienced and in my area all can prescribe.

Best of luck.

I saw a phyc after mental health teams basically droppef me,months of dbt cbt emdr,no joy ,she was utter crap and i left with no diagnosis ive now appealed to cmht to see someone else outside of area,waiting game now

Well you can ask for a referral. Your GP can make a referral. But in our area you would be refused from the community mental heath team (which is the only way to see a psychiatrist) for not meeting the risk/ complexity threshold which is very high essentially almost entirely limited to schizophrenia or illnesses of similar severity. I am afraid you’d have to pay for a private psych to get seen for this kind of issue in our area. I am not saying that is right but that’s how it is. ChatGPT is living in LaLaLand

The options are largely limited to medication and psychotherapy in any case. Neurostimulation options again are largely not available on the NHS so the psychiatrist would only be able to suggest different medications not likely a whole new approach. If you want eg rTMS you need to go to a clinic that does that and it will cost a lot. Psychiatrists are not the expert on therapies you need a psychologist for that and then you usually have to pay for any therapy much beyond short term CBT. I personally really dislike people wanting a diagnosis for £400 from a one off appointment because outside of very obvious stuff that sometimes is not realistic and needs more of a therapeutic relationship with the person and a collateral history before giving out diagnoses such as cPTSD, BPAD or personality disorder. I am not sure that just paying for a one off private appointment is really a very good idea and would suggest budgeting for 3 or 4. Also ASD/ ADHD have their own separate assessment pathways that not all psychiatrists are trained in is that’s what you suspect.