Seeking treatment for mental health is a big step to take. Navigating the obstacles between yourself and the care you deserve is challenging enough, and those same mental health struggles can make it even harder to take that step.

Today, we want to do a little to alleviate one of the more common concerns we see: anxiety over what happens during a psychiatric evaluation.

When you've scheduled your first appointment, your provider will start with an initial evaluation, sometimes called an intake session. This can feel very high stakes, but we're here to assure you there are no wrong answers, and no way to "fail" the appointment.

Being open about what happens during these appointments can help you understand the process and how it works, to put your fears at ease. So, read on, and if you have any questions, don't hesitate to reach out! You can contact our office during business hours at 248.528.9000.

DISCLAIMER: This article is for informational and educational purposes only and should not be considered medical or psychological advice. The information presented here is not intended to diagnose, treat, cure, or prevent any mental health condition or replace professional therapeutic care. Every individual's experience with trauma and mental health is unique. Please consult with a qualified mental health professional, therapist, or healthcare provider to determine the most appropriate treatment approach for your specific situation. If you are experiencing a mental health crisis or emergency, please contact your local emergency services or crisis hotline immediately.

Who Will You Meet With?

At our office, your initial evaluation may be with a psychiatrist, a psychiatric nurse practitioner, or one of our therapists.

Psychiatrists and psychiatric nurse practitioners are both licensed to diagnose mental health conditions and prescribe medication. If your evaluation is with one of them, it may include a discussion of whether medication could be part of your treatment.

Our therapists also conduct initial evaluations. They focus on understanding your concerns and building a treatment plan centered on therapy.

There's no wrong place to start. If you begin with a psychiatrist or nurse practitioner and they believe therapy would help, they can refer you to one of our therapists. If you begin with a therapist and medication might be beneficial, they can refer you to a psychiatrist or nurse practitioner for medication management. Either way, you won't be starting from scratch.

Throughout the rest of this article, we'll use "provider" to refer to whoever conducts your evaluation.

What's the Purpose of a Psychiatric Evaluation?

Why spend the first appointment with an evaluation? Why not jump right to therapy or other treatment?

An initial evaluation is an important first step for a lot of reasons.

First, it's a way for your provider to learn about you. Through discussion and testing, your provider can understand where you are in your mental, emotional, and behavioral health. It's not just about how you're feeling today, either. This evaluation discusses your past and future, your struggles, your highs and your lows. The goal is to get a solid picture of your mental health, not just for today, but of the journey you've been on.

Another big reason the evaluation exists is to get on the same page regarding your goals. Some people want any treatment they can get. Others prefer to stay away from certain kinds of treatment; for example, many are hesitant to try medications. Some are curious and want to explore their concerns, while others have a longer history and need to change things up. It's important that you and your provider are on the same page and working towards the same goals.

The evaluation is also an opportunity for certain kinds of testing that might not otherwise find a place in regular meetings. In particular, some testing needs to be done in person, like the QbTest for ADHD; if you're planning to be largely telehealth or virtual appointments, finding time to work in an assessment like that during a routine schedule is much harder.

One often-overlooked aspect of the initial meeting is just being able to meet your provider and get a feel for them and how they'll work with you. Not everyone meshes well with every specialist, and that's okay! It's important to find someone you can trust and feel comfortable working with, so if you don't like how you interact in the initial assessment, you can change providers. The information gathered during the initial assessment is still valid and can carry forward to another provider as need be.

Finally, while the assessment is largely going to be focused on your provider asking you questions, you're also free (and encouraged) to ask questions of your own. The appointment is a great opportunity to ask more about how treatment works, what options are available to you, and what considerations you might want to keep in mind.

Do You Need to Prepare for a Psychiatric Evaluation?

Only a little!

You will generally have a few minor responsibilities before the appointment date. You guessed it; it's paperwork, just like any other medical appointment. You'll fill out the general background information forms, intake forms, medical history, medication lists, and so on.

One thing you might consider doing is talking to your family to gather a family history of mental health. It's helpful for your provider to know what they're working with, and if your family has a history of certain issues, you can be at greater risk of them, even if you don't currently experience them.

It's okay to not know any of your family history, too. There are tons of good reasons why you might not, and it won't hurt your treatment to not know; it's just a potentially helpful bit of information if you have it to share.

We also highly recommend making a list of any questions you want to ask during the appointment. It's easy to think of a bunch of them, and hard to remember them in the moment. If you have them written down, it will be easier to recall them during the appointment.

Of course, you'll need to gather the few things you're asked to bring, but that's typical as well. Photo ID, insurance card, and so on.

Be sure to also bring a list of every medication you currently take. For each one, include the name, the dose, and how you take it (how often and at what time of day). Don't forget over-the-counter medications, vitamins, and supplements, since these can interact with other medications too. If your appointment is in person, it doesn't hurt to bring the actual bottles with you. That way, your provider can see exactly what you're taking and nothing gets missed.

Beyond that, you don't need to pre-study any assessment materials or anything of the sort. Just bring yourself and an open mind!

What Happens During a Psychiatric Evaluation?

Every office and every provider will have a different style, but in general, this is what you can expect.

First, when you arrive at the office, you'll check in. If there are any additional forms to fill out, you'll be asked to do so. You may have a copay to pay, or not, depending on your insurance and how your chosen office functions. You'll likely be asked to sign a consent to treat form. There may be other bits of bureaucracy as well, such as naming a trusted contact and signing a consent to share information form, if you have such an individual.

Then, you wait until your provider is ready for your appointment. Hopefully they aren't running late today! Feel free to enjoy any amenities provided in the waiting room.

When you're called back, you'll be brought to a room, and you'll meet your provider. After introductions, the evaluation begins.

We're going to break this down into parts, but the appointment probably won't be structured rigidly around them. In fact, the typical evaluation is designed to be comfortable and conversational, to help put you at ease.

Discussing Current Concerns

The first portion of the evaluation is a discussion of your current concerns. Your provider will ask you questions such as:

• What brings you to the office, and why are you seeking treatment?
• What are the current symptoms you've been experiencing?
• When did those symptoms begin, how long have they lasted, and do they come and go?
• Are these challenges affecting your life in tangible ways?
• Are you losing sleep, changing how you eat, or experiencing poor energy levels?

This is all about your provider getting a feel for what's going on. There's no wrong answer to these questions; rather, it's about expressing what you're dealing with and how it's affecting your life.

Throughout this process, your provider will be offering words of encouragement, asking clarification questions, and generally probing for more information. This helps them figure out what level of treatment and what kinds of treatment may be most appropriate to start.

Discussing History and Context

Once this portion is complete, the conversation will transition into a discussion of your personal history, family history, background, and other salient details.

This is where things like your past history with mental health struggles, as well as any past treatment you've undergone, will come up. Whether or not past treatment has been effective, and why you stopped (if you stopped) is worth talking about.

Some medical information is relevant here as well. Chronic illnesses, past surgeries, current medications, and other concerns can all influence the course of treatment. This is especially important if medication for mental health is on the table, since some medical conditions or other medications are contraindications for antidepressants, for example. Even if your first evaluation is with a therapist, sharing this information helps if you're later referred to a psychiatrist or nurse practitioner.

If you have a family history of mental health struggles, diagnosed or suspected, it can be relevant to the discussion and is worth talking about too. Genetics can play a role in psychological disorders, risk factors, and even medication allergies and reactions.

It can be difficult to talk about, but your provider will also ask questions about safety. Do you use substances? Have you thought about self-harm, or attempted it? Do you take unnecessary risks? Do you have thoughts of harming others, or have you taken those actions? All of this helps determine whether or not you need more immediate assistance to keep you and those around you safe.

Mental Status Exam

Throughout your appointment, and often as a distinct section of the appointment itself, is the mental status exam. This is a standardized tool that many medical and mental health professionals use to create a baseline assessment of your mental state during the appointment. Your provider will evaluate things like:

• What is your mood like during the appointment?
• How is your speech? Do you slur, stutter, lose your train of thought, or otherwise have broken or disrupted speech patterns?
• What is your general appearance like? Are you well-kept or disheveled?
• Do you demonstrate any abnormalities in thought patterns during discussion?
• Do you experience or demonstrate hallucinations, delusions, or illusions?
• What is your level of cognitive function?
• What is your current level of insight and capacity for abstract thinking?

Some of this is just observations taken by your provider during the course of your evaluation. Other elements of it will be assessed with specific questions.

Your provider will make note of the results, typical or atypical, in your chart. They might make note of things like being overly chatty, being agitated, being distracted, and so on.

It's important that you don't try to "score well" on this assessment. It's an evaluation of who you are in the moment, not a test of your ideal self. You don't pass or fail. An accurate representation is the starting point for treatment.

Optional Testing

Depending on the kind of evaluation you're having, you may have a variety of tests to take. These can be tests like the previously-mentioned QbTest for ADHD, or an autism assessment, or another specific assessment. Common screening tools like the PHQ-9 for depression, the GAD-7 for anxiety, and others might be used as well.

Not all evaluations include these tests. Shorter appointments generally don't, while longer appointments leave room to include them.

Impressions, Diagnosis, and a Path Forward

By the end of the evaluation, your provider will have a pretty good picture of who you are and what you need.

Obviously, this is just a snapshot in time. That's why so much history is included in the evaluation, after all.

Armed with information and a direct discussion with you, your provider can make an initial set of clinical impressions and a diagnosis. They might want to refer you for further, more in-depth testing. Or, they might recommend treatment right away.

All sorts of different treatment options are available. Your provider might recommend any of a number of forms of therapy, like dialectical behavior therapy, eye movement desensitization and reprocessing, group or family therapy and counseling, mindfulness therapy, cognitive behavioral therapy, and much more.

If your evaluation is with a psychiatrist or psychiatric nurse practitioner, they might also recommend medication, if you're open to the idea. If your evaluation is with a therapist and medication seems like it could help, they can refer you to one of our psychiatrists or nurse practitioners to discuss it. Medication management can be an important part of mental health treatment, and combining therapy with medication is often more effective than either one alone.

What's important is not to get it right, right now. It's to get you started on the path to a better state of mind. There will be bumps along the road, bad days and setbacks, even dead ends in treatment. But getting started is the hardest part, and the evaluation is that first step.

If the time has come for you to take that first step, we're pleased to offer our services. The office of Behavioral Medical Center-Troy is located at 1639 E Big Beaver Rd, Suite 201. You can call us to get started scheduling an appointment at 248.528.9000. Or, you can fill out our new patient intake form right here on our website, and we'll be in touch.

Rest assured, your evaluation will not be a scary or high-pressure experience. It's just a conversation that helps you get the care you deserve.