Should You See Your Primary Care Provider or a Psychiatric Provider?

What can a primary care provider do for mental health?

Quite a lot. The National Institute of Mental Health describes a primary care provider as a good place to bring a concern when you do not know where to start. In many primary care settings you may be asked whether you feel anxious or depressed, or whether you have had thoughts of suicide. Your provider can do an initial mental health screening and refer you to a mental health professional.

Primary care also has advantages that a specialist visit does not. Your provider may already know your medical history, and they can look for physical causes. That matters, because a change in mood or trouble concentrating is sometimes due to a medical condition.

Many primary care clinicians also prescribe psychiatric medication. Some clinics have behavioral health specialists or a psychiatric clinician consulting with the team, and the American Psychiatric Association describes this kind of integrated care as a way to address common problems such as anxiety and depression together with physical health.

When does specialist psychiatric care make sense?

Specialist care is not a sign that primary care failed. Primary care looks after the whole of a person's health, while a psychiatric provider focuses on mental health. The American Psychiatric Association puts it this way: a primary care clinician can prescribe psychiatric medication, but a psychiatrist or other mental health clinician may be more familiar with these medications.

These situations are common reasons to add a specialist, or to ask your primary care provider whether it is time:

• The diagnosis is unclear, or symptoms do not fit neatly into one condition.
• You have tried more than one medication and the results have not been good enough.
• Side effects have been a recurring problem, or you take several medications and worry about how they interact.
• You or your family have noticed periods of extremely up, elated, irritable or energized behavior, which can raise the question of bipolar disorder.
• You or someone close to you has seen or heard things that others do not, or held false beliefs, such as that others are trying to hurt them. These can be signs of psychosis.
• Symptoms are getting in the way of work, school or relationships, even with treatment.
• Your primary care provider suggests it, or you would simply like a second opinion.

Why do bipolar and psychosis concerns usually call for a specialist?

These are conditions where a careful assessment matters. The National Institute of Mental Health notes that bipolar disorder usually requires lifelong treatment, and that an effective treatment plan can help people manage symptoms and improve quality of life. An evaluation looks at your whole history, including periods when your mood was unusually high and not only the times it was low. Our guide on how bipolar disorder can look like depression explains why that history matters.

With psychosis, timing is especially important. NIMH reports that it is common for people to have symptoms for more than a year before treatment, and that early treatment often means better recovery. If you notice these changes in yourself or someone else, and they intensify or do not go away, contact a health care provider. Your primary care provider can be that first call, and specialized programs for early psychosis also exist. Learn more on our psychosis care page.

How do primary care and psychiatric care compare?

The two are not competing choices. This table shows where each one tends to help most.

How do I bring this up at a primary care visit?

Do not wait to be asked. NIMH advises starting the conversation yourself, and appointments are limited, so it helps to prepare. Say near the start of the visit that you want to talk about your mental health, then be specific about when symptoms began, how severe they are and how often they happen.

1. 1Write down what you want to discussA short list of symptoms and questions keeps the visit on track. Include any major stressors or recent life changes.
2. 2List everything you takeInclude over-the-counter medicines, herbal remedies, vitamins and supplements, and note anything you tried before and how it went.
3. 3Review your family historyCertain mental illnesses tend to run in families. Knowing this can help your provider look for early warning signs.
4. 4Ask a direct question about next stepsFor example, you might ask whether this is something they would treat, or whether a specialist would be useful. You can also ask for a referral if you want one.

What happens to my primary care provider if I see a specialist?

You keep them. Mental health is part of overall health, and people with mental disorders can be at risk for other medical conditions, such as heart disease or diabetes. Primary care stays involved, and it usually goes better when each provider knows what the other is doing.

If you become a patient here, we can coordinate with your primary care provider with your permission. Sharing a medication list between the two offices is a simple step that helps prevent mix-ups. Please talk with your prescriber before you start, stop or change any medication, including during a switch from one provider to another.

What does psychiatric care look like at DanShalom Behavioral Clinic?

Our provider is Victor Onodjacha, MSN, PMHNP-BC, a board-certified psychiatric-mental health nurse practitioner and not a physician. A first visit is a psychiatric evaluation of about 60 minutes, at the Sugar Land office or by secure video if you are physically in Texas, Idaho, Arizona or Maryland at the time of the visit. Follow-up visits are about 30 minutes.

Medication decisions are made after an evaluation. Not every medication can be prescribed at every kind of visit, some may require an in-person visit, and we explain what applies to you. You can read how follow-up works on our medication management page.

You can send a short appointment request or call. We check coverage before the first visit, and details are on our insurance page. If you are weighing other kinds of help too, our guide to therapists and psychiatric providers may help. DanShalom Behavioral Clinic is not an emergency service: in a crisis, call or text 988, or call 911 if there is immediate danger.