Sunday, September 20, 2015

How to Find a Psychiatrist

This website is designed to help people find a psychiatrist quickly.  For those who are in no particular hurry, there are many more options.
It seems like a simple enough questions: How do you find a psychiatrist? 

It's not that easy to answer. There are all sorts of psychiatrists who do all sorts of things (therapy, not therapy, specific forms of therapy like psychoanalysis or CBT), and then there's the overriding insurance question. Not to mention location, location, location.

And what about insurance?  You should be aware that if a psychiatrist doesn't take your insurance, you will likely still get reimbursed, but there may be a higher deductible, you may need to mail in the form yourself, and there may be a long wait (and assorted hassles) before the money is sent. Some people are reimbursed very well, others or not. If your insurance is an HMO or has no out-of-network benefits, then you will be responsible for the full fee.

So start here:
--Does it matter if the psychiatrist is in your insurance network?
If it does, and you live in an area where many psychiatrists don't participate with insurance, then call the insurance company and get names and numbers and do hope they aren't all dead or not-accepting patients.

--What kind of psychiatrist do you need? If the patient is under age 16-18, your best best is a child and adolescent psychiatrist. Be aware that many psychiatrists at academic centers run research projects and teach, and don't see many outpatients. That's not to say never---and most have a few patients --but they are often a bit harder to reach, especially when they are presenting at conferences or have grants dues, and may have difficult parking. So child, general adult, or is there some specialty need which may be very restrictive---for example treatment of sexual or eating disorders or psychoanalysis? 

--Finally: does it matter to you if the psychiatrist does psychotherapy or are you fine seeing one person for therapy (if necessary) and another for meds? If it matters, you need to clarify this upfront.

-- There are other concerns: parking and the setting may be a concern (is your ex-lover working in the same practice?),  how difficult is it to get an appointment? How long do appointments last? 

To start:
If you have no insurance and no money, your options are limited. The traditional place for treatment in this case is a local Community Mental Health Center or CMHC and the standard had been to have one per geographic catchment area. These clinics usually offer split care (a psychiatrist for medicines and a therapist for psychotherapy), there may be a wait, and you don't get to choose your doctor. They take Medicare and Medicaid, and they sometimes don't take private insurance. How do you find your CMHC (or OMHC). To find the closest clinic, try Google, and then call any clinic in your area and have a heart-to-heart with the receptionist. He may be able to give you the number of the clinic that serves you.

There are other agencies that over care for the indigent. In Baltimore, HealthCare for the Homeless offers psychiatric treatment, and The Pro Bono Counseling Project will give referrals for free or discounted care from professionals in the community who have agreed to volunteer their time. Again, there's no choice in which psychiatrist you get.

If you have insurance and want to stay in network: Call your insurance company for a list of names.

Aside from financial concerns, here are the best ways to find a good psychiatrist:

  • If you know someone who likes their doc, see that doc!
  • If you know someone who likes their psychiatrist, but you can't see that person, ask your friend to get some names from their psychiatrist, or call yourself.
  • Call your state psychiatric society and ask for a referral. If the office is located near where you live, the staff may well know some of the psychiatrists and you can ask for a nice one.
  • Ask your primary care doctor, they are used to making referrals.
  • Ask a psychiatrist --they  tend to know each if you can get one on the phone, they may give you names even if they can't see you. In our state, we have a listserv, and people frequently post, "Does anyone know a psychiatrist in Timbuktu?" for a patient who is moving, a child of a patient, friend of a friend of a friend. As a rule, psychiatrists don't know what insurance networks other psychiatrists participate in.
  • Ask a doctor, any doctor. They not be able to help you, but they may. My favorite was the friend who asked me for a referral for a breast surgeon in another part of the state. Not something I'd know, but my neighbor the breast radiologist was able to give some names and so I was email-helpful. Between listservs, Facebook, email, etc...people can sometimes find names.
  • If you're a student, try the school's counseling/health center. They may also be able to suggest off-campus referrals.
What to ask on the phone (besides the obvious money issues):
It's fine to tell someone the one-sentence version of what you want help for and to ask if they are taking new patients. It's probably a burden to try to tell them your whole history.
It's fine to ask how long the evaluation is, how long a typical appointment is, and if the psychiatrist sees people for therapy or just meds. 

See also: Why Psychiatrists don't take insurance on KevinMD