Finding a good psychiatrist is essential, both for the initial evaluation and diagnosis process, and for long-term care and treatment. A thorough initial evaluation will increase the likelihood of a correct diagnosis and effective early treatment; however, the relationship with a psychiatrist does not stop there. Schizophrenia and other major psychiatric disorders are almost always lifelong illnesses, and maintaining an ongoing relationship with a psychiatrist you trust is essential. A good psychiatrist will help you identify a treatment plan that works for your individual case, will listen to your concerns and help you adjust your long-term plans if necessary, and provide information and support for your life with your diagnosis.

There is no guarantee that you will find a psychiatrist that you work well with on the first try - many people have to go through a few different doctors before they find one they are happy with. Maintaining a good doctor-patient relationship is so essential to preventing relapse, improving treatment compliance, and promoting recovery (as research studies have shown), that this is definitely a process to put some thought into. For example, a UCLA research team identified 10 key factors to recovering from schizophrenia, by examining the cases of 23 schizophrenia subjects who met the criteria for recovery (remission of symptoms, return to independent living, successful function at work and school, maintenance of social relationships). 78% of the subjects reported that accessible and supportive psychiatrists/therapists contributed to their recovery, and 91% of the subjects were involved in ongoing psychotherapy. Similarly, a study carried out in 8 hospital locations in the U.K. with acute-admission schizophrenia patients found that a good patient-physician relationship influenced positive attitudes towards treatment.

Below are some suggestions and resources for finding and identifying a doctor that will be right for you. If you have further techniques or experiences that might be beneficial to others on this topic, please email us at [email protected]

Where to look for a good psychiatrist:

• Ask for recommendations from family/friends who have experience with mental health care providers in the community, or from acquaintances who are familiar with the local hospital network. Ask your own primary care physician who they would send their own family member to.
• Contact a local mental illness support group (in the United States, NAMI is an excellent place to start), and ask members for their experiences with local providers
• Post a request for good providers on the discussion boards of major non-profit mental illness internet sites - you can start at the discussion boards right here at schizophrenia.com and our sister site, moodswing.org, but other sites (for example, the Child and Adolescent Bipolar Foundation) also have discussion boards where patients and family members request information about doctors.
• Run your own quality-check at http://www.citizens.org, a public citizens health research group that keeps a list of doctors who have been written up for disciplinary action by their state medical boards
• If it is possible and/or convenient, consider looking for an evaluation from a major teaching hospital or clinic that specializes in research on your particular disorder. (see a list of major universities - some with hospitals affiliated - that are involved in pioneering schizophrenia research)

Considerations when looking for a psychiatrist

• Be aware that referrals from the American Psychiatric Association (or other professional associations) are not necessarily the best - APA will add providers to their referral list upon request, without quality-checking.
• Check if your insurance provider restricts your choice of doctors - managed care insurance plans will often have a list of approved, "network" providers that are covered at the full co-pay rate. If you choose to see someone "out-of-network", you may be charged significantly more.
• Some general characteristics of a good doctor (paraphrase from "Surviving Manic Depression" by Dr. E Fuller Torrey, p. 205; and "The Bipolar Child" by Dr. Demitri Papolos, p. 57))
  • is knowledgeable about your diagnosis, and keeps up-to-date with current research and new treatments
  • is willing to say "I don't know"
  • will include patient, and patient's family members, as integral members of the treatment team. Welcomes input from family.
  • is flexible, willing to listen to patient/family needs and make changes when possible and appropriate
  • is supportive for both the patient and the family, particularly during traumatic times such as hospitalization
  • is willing to negotiate for necessary treatment with insurance/managed care companies; is willing to provide documentation of diagnosis, evaluations, and recommendations for schools, employers, etc.
  • has a hopeful, positive outlook

Other questions to ask a prospective psychiatrist:

• How do you handle weekend and after-hours emergencies or phone calls?
• If I have an after-hours emergency, will I be seen by my primary psychiatrist, or by on-call staff?
• What hospital facility do you use (if any) for clients with after-hours emergencies, or who need hospitalization?
• What sort of insurance is accepted? Is there a sliding-scale option for low-income clients?

More articles on how to find a psychiatrist or other mental health care provider:

• How to Choose a Mental Health Therapist (information adapted from SAMHSA)
• Mental Health Professionals: Who They Are and How To Find One (information from NAMI)

Working with a Psychiatrist:

You can help yourself or your family member get the best care possible by making sure the psychiatrist has all the information he/or she needs to make a good diagnosis and treatment. A great way to do this is to keep a symptom and/or medication journal.

A symptom journal is something that is helpful during the initial evaluation sessions. It is a place to write down all the odd/troubling experiences, behaviors, feelings, actions, conversations, or any other symptoms that you think the psychiatrist should know about. Keeping them all in one place, with the days and times of occurrence, will provide the psychiatrist with an ongoing picture of how the illness is manifesting in the person's life. It will also ensure that you don't forget an essential piece of information accidentally during the appointment.

• The Importance of Keeping a Journal - an article written by a schizophrenia.com family member

A family medical history is another thing to bring with you, especially to initial appointments . This should be a comprehensive list of all past medical conditions (psychiatric or otherwise) that have been diagnosed in you, your immediate family, and your extended relations. You should also include conditions such as substance abuse. The Department of Health and Human Services has recently released a free, web-based software called "My Family Health Portrait" to assist consumers in gathering and organizing their family medical information. Schizophrenia and other major psychiatric disorders have a strong genetic component to them; a family medical history is an essential tool to help a psychiatrist come to a diagnosis.

A medications journal is an ongoing documentation of the medications your psychiatrist prescribes, and how they affect you. Keeping a record and bring it with you to appointments will make future treatment adjustments much easier. A good technique might be to make a page or section for each medication, including information such as: name of medication, dosage prescribed, any potential interactions or side effects, symptoms it is supposed to treat, etc. In the same page or section, write down exactly how the medication effects you from the day you start taking it - what symptoms it helps, what (if anything) it makes worse, what side effects you experience, and anything else you want your psychiatrist to know.