Finding a Psychiatrist: When and How
Psychiatrists are medical doctors who specialize in mental health. This guide covers when you need one, how to find one, and what to expect.
What Is a Psychiatrist?
Training and Credentials
- Medical doctor (MD or DO)
- 4 years medical school
- 4 years psychiatry residency
- Optional fellowship in subspecialty
- Can prescribe medication
- Can provide therapy (though most focus on medication)
What They Do
- Diagnose mental health conditions
- Prescribe and manage psychiatric medications
- Coordinate care with therapists and primary care
- Treat complex or severe mental illness
- Some provide psychotherapy
When You Need a Psychiatrist
You Likely Need Psychiatrist If:
- You need medication for mental health condition
- Current medication is not working
- You have complex medication needs (multiple medications)
- You have severe symptoms
- You have treatment-resistant condition
- You have comorbid medical conditions affecting mental health
- Your therapist recommends medication evaluation
- You need disability evaluation
Conditions Often Requiring Medication
- Severe depression
- Bipolar disorder
- Schizophrenia and psychotic disorders
- Severe anxiety or panic disorder
- OCD
- ADHD
- Some cases of PTSD
Psychiatrist vs. Other Prescribers
Primary Care Doctor
Can prescribe: Common antidepressants, anti-anxiety medications
Good for: Straightforward depression or anxiety, first-line medications, ongoing medication management once stabilized
Limitations: Less expertise in complex cases, may not be comfortable with certain medications
Psychiatric Nurse Practitioner (PMHNP)
Training: Nursing degree plus psychiatric mental health specialization
Can prescribe: All psychiatric medications (in most states)
Good for: Medication management, often more available than psychiatrists, usually less expensive
Limitations: Less medical training than psychiatrist (though often very competent)
Physician Assistant (PA)
Training: PA degree, works under supervising psychiatrist
Can prescribe: Psychiatric medications
Good for: Medication management when psychiatrist not available
When You Need Full Psychiatrist
- Multiple failed medication trials
- Complex diagnostic picture
- Multiple medications with interactions
- Comorbid medical conditions
- Severe or unusual symptoms
- Need for ECT, TMS, or other procedures
For straightforward medication management, PMHNP is often excellent choice.
How to Find a Psychiatrist
Referrals
- Ask your therapist for recommendation
- Ask your primary care doctor
- Ask friends or family
- Ask local NAMI chapter
Online Directories
- Psychology Today: Filter by psychiatrist, insurance, specialty
- Zocdoc: Shows availability, insurance, patient reviews
- Vitals, Healthgrades: Doctor review sites
- Insurance website: In-network psychiatrists
Psychiatric Clinics
- Group practices often have more availability
- May see different psychiatrist each visit
- Usually easier to get appointment
Community Mental Health Centers
- Have staff psychiatrists
- Sliding scale
- Serve uninsured and low-income
Telepsychiatry
- Online psychiatry platforms (Teladoc, MDLive, Talkiatry, Brightside)
- Often faster appointments
- Convenient
- Some accept insurance
- Good option if shortage in your area
What to Expect
Initial Evaluation (Intake)
Duration: 60-90 minutes typically
What happens:
- Detailed psychiatric history
- Current symptoms
- Past treatments and medications
- Medical history
- Family history
- Substance use history
- Mental status examination
- Diagnosis
- Treatment recommendations
- Prescription if appropriate
Cost: Often 300-500, sometimes more
Follow-Up Appointments
Duration: 15-30 minutes (medication management) or 45-60 minutes (therapy + medication)
What happens:
- Review symptoms and functioning
- Assess medication effectiveness
- Monitor side effects
- Adjust medications as needed
- Brief supportive therapy sometimes
- Refill prescriptions
Frequency:
- Starting medication: Every 2-4 weeks initially
- Stabilized: Every 1-3 months
- Complex cases: More frequent
Cost: 200-400 per session typically
Questions to Ask Psychiatrist
About Them
- What is your training and experience?
- Do you have experience with my condition?
- What is your treatment philosophy?
- How long are appointments?
- How often will we meet?
About Medication
- What medication do you recommend and why?
- What are the expected benefits?
- How long until it works?
- What are the side effects?
- What if it does not work?
- How long will I need to take it?
- Can I stop if I want to?
- What about withdrawal?
- Will it interact with other medications?
About Therapy
- Do you provide therapy or just medication?
- Do you recommend I also see a therapist?
- Will you communicate with my therapist?
About Logistics
- What is your cancellation policy?
- What if I have questions between appointments?
- What happens in a crisis?
- Who covers when you are unavailable?
Combining Therapy and Medication
The Best Outcomes
Research shows therapy plus medication is most effective for many conditions.
- Medication addresses biological symptoms
- Therapy teaches skills and addresses underlying issues
- Together they are more effective than either alone
Coordinating Care
Ideally:
- Therapist and psychiatrist communicate
- Share treatment plan
- Update each other on progress
- Coordinate if crisis arises
You may need to facilitate this:
- Sign releases for them to communicate
- Keep both updated on what other is doing
- Share medication changes with therapist
- Tell psychiatrist what you are working on in therapy
Challenges Finding Psychiatrist
Shortage of Psychiatrists
- Severe shortage in most areas
- Long wait times (often months)
- Many do not take insurance
- Expensive
Solutions
- Consider PMHNP instead
- Try telepsychiatry
- Ask primary care doctor to prescribe while you wait
- Community mental health centers have psychiatrists
- Get on multiple waitlists
- Call regularly to check for cancellations
Making the Most of Short Appointments
Psychiatry appointments are often brief. Maximize them:
- Write down symptoms and questions before appointment
- Track medication effects between appointments
- Be honest about side effects and whether taking medication
- Prioritize most important issues
- Ask for email or portal access to ask questions between visits
When to Consider Changing Psychiatrists
- Does not listen to your concerns
- Dismisses side effects
- Keeps prescribing medication that is not working
- Will not try different approaches
- Rushes appointments
- Makes you feel judged
- Does not explain decisions
Good psychiatrists collaborate with you, explain their reasoning, and adjust treatment when needed.