Mental Helath
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When you are struggling psychologically, the healthcare system can sometimes seem like another problem to solve. You may hear terms like GP, psychiatrist, clinical psychologist, therapist, assessment, or diagnosis, without anyone clearly explaining how these pieces fit together.
The important thing to remember is that mental healthcare is rarely the responsibility of one person. Different professionals look at different parts of the picture, and you can ask questions, express concerns and take part in decisions about your care.
Your GP: often the first point of contact
In England, your GP is often a useful starting point when emotional or psychological difficulties begin affecting everyday life.
A GP can:
- discuss your symptoms and how they are affecting you;
- consider whether physical health problems or medication might be contributing;
- arrange blood tests or other investigations when appropriate;
- diagnose and treat some common mental-health conditions;
- discuss treatment choices;
- prescribe medication when clinically appropriate;
- refer you to psychological therapies or specialist mental-health services.
Some NHS psychological therapy services can also be accessed through self-referral without first seeing a GP.
A GP does not necessarily provide the final answer to every psychological question. Part of their role is recognising when a more specialist assessment would be useful and helping you access it.
What does a psychiatrist do?
A psychiatrist is a medically qualified doctor who has undertaken specialist training in mental health.
Psychiatrists are trained to assess mental state, consider psychological, biological and social factors, diagnose mental illness and use medication as well as other forms of treatment.
A psychiatric assessment can be particularly valuable when:
- symptoms are complex or severe;
- the diagnosis is uncertain;
- several conditions may overlap;
- medication needs specialist consideration;
- previous treatments have not worked as expected;
- there are significant changes in mood, perception, thinking or behaviour;
- a more detailed medical psychiatric opinion is needed.
However, a psychiatrist is not the only healthcare professional who can ever make a mental-health diagnosis. For example, GPs routinely assess and diagnose conditions such as depression, and appropriately qualified psychologists work within assessment and diagnostic processes according to their professional scope.
The psychiatrist’s particular strength is that they combine specialist mental-health expertise with medical training and prescribing knowledge.
What does a clinical psychologist do?
A clinical psychologist approaches difficulties primarily through psychological science.
Rather than concentrating mainly on medication, a clinical psychologist may explore patterns involving thoughts, emotions, behaviour, relationships, development, life experiences, cognition and coping.
Clinical psychologists are trained in detailed psychological assessment and formulation. UK professional standards specifically recognise assessment, diagnostic and therapeutic processes as part of practitioner psychology, while requiring psychologists to work within their individual competence and professional scope.
A psychological formulation is slightly different from a diagnosis.
A diagnosis asks:
“What recognised condition might explain these symptoms?”
A formulation asks something broader:
“What may have contributed to these difficulties, what keeps them going, and what might help them change?”
Both perspectives can be useful.
Can I ask for a comprehensive psychological assessment?
Yes. If you feel that the current explanation does not fully describe what you are experiencing, you can ask your GP, psychiatrist or mental-health team whether a more detailed psychological or psychiatric assessment would be appropriate.
The NHS describes mental-health assessment as a process intended to understand what support someone needs. A GP or nurse may refer someone for a specialist assessment, and specialist mental-health services often undertake detailed assessments.
A comprehensive psychological assessment is not one single universal test. Depending on the question being investigated, it might include:
- a detailed clinical interview;
- personal, developmental and family history;
- review of previous treatment;
- questionnaires or validated psychological measures;
- assessment of mood, anxiety, attention or other symptoms;
- cognitive or neuropsychological testing where appropriate;
- assessment of personality or longstanding behavioural patterns where clinically relevant;
- consideration of physical-health and medication factors;
- a psychological formulation;
- recommendations for further treatment or investigation.
Not everybody needs every type of assessment.
You can therefore ask:
“Would a more comprehensive psychological assessment help clarify what is happening?”
You can also ask exactly what kind of assessment is being proposed and what clinical question it is intended to answer.
Access through the NHS will depend upon clinical need and the pathway available locally. A private assessment by an appropriately registered clinical psychologist or psychiatrist may also be an option.
A diagnosis is part of the map, not the whole person
A diagnosis can be useful. It can help professionals communicate, guide treatment and sometimes make particular services available.
But a diagnosis does not describe everything about a person.
Two people with the same diagnosis may have very different histories, personalities, strengths, difficulties and treatment needs. Good mental healthcare therefore looks beyond the label and considers the individual person.
What is the role of a therapist or hypnotherapist?
Therapists can work alongside medical and psychological healthcare rather than competing with it.
Depending upon their training and professional scope, they may help with areas such as emotional regulation, anxiety management, habits, confidence, coping strategies, relaxation, behavioural change and exploration of psychological patterns.
A therapist or hypnotherapist who is not separately qualified as an appropriate healthcare professional does not prescribe medication and should not substitute a therapeutic impression for a medical assessment.
They can, however, recognise when something deserves further investigation and encourage a client to speak with their GP, psychiatrist or another appropriate professional.
Sometimes the most effective care is collaborative: medical treatment addresses one part of the problem while psychological therapy works with another.
If an antidepressant is suggested, you are allowed to have questions
Being offered medication does not mean that you have lost your voice in your treatment.
NICE recommends that when antidepressant medication is offered, the healthcare professional and patient discuss matters including:
- why medication is being suggested;
- which medication is being considered;
- expected benefits;
- possible side-effects;
- possible withdrawal effects;
- the dose and possible adjustments;
- the person’s individual concerns and preferences.
Treatment decisions should be made collaboratively, taking account of both clinical needs and the person’s preferences.
So if something worries you, say so.
You might ask:
“What are we hoping this medication will improve?”
“Why have you selected this particular medicine?”
“What side effects should I watch for?”
“What should I do if I feel worse after starting it?”
“How long should we try it before reviewing whether it is helping?”
“Are there alternatives?”
“How would we eventually stop it safely?”
These are reasonable healthcare questions.
How does an SSRI work? A simple explanation
SSRIs — selective serotonin reuptake inhibitors — are a commonly used group of antidepressants. Examples include sertraline, citalopram, escitalopram, fluoxetine and paroxetine. They are used not only for depression but also for several anxiety-related conditions.
Imagine two nerve cells communicating across a tiny space.
One nerve cell releases a chemical messenger called serotonin. Normally, the original nerve cell takes back some serotonin— like recycling it.
An SSRI slows this recycling process.
That means serotonin remains available between nerve cells for longer, changing serotonin signalling in the brain.
The full therapeutic effect is more complicated than simply “adding serotonin”. Antidepressants influence brain signalling and, over time, downstream processes involved in mood and emotional processing. This is also why taking a tablet does not normally produce an immediate emotional change.
Antidepressants may begin to have an effect within the first couple of weeks, but the fuller benefit can take several weeks.
A useful simple image is:
The medication does not manufacture happiness. It changes part of the biological environment in which the brain processes emotion, giving healthier patterns a better opportunity to develop.
Psychological therapy can work alongside that process by addressing thoughts, reactions, behaviour, relationships and learned emotional patterns.
What if I experience side effects or feel uncomfortable taking it?
Talk to the person who prescribed it.
You do not have to silently tolerate something that is troubling you.
The prescriber may decide to:
- monitor the symptom;
- adjust the dose;
- change when the medication is taken;
- choose another medication;
- investigate whether something else is causing the problem;
- discuss a different treatment approach.
NICE specifically recommends monitoring benefits, side effects, and harms after treatment begins.
Antidepressants are not considered addictive in the same way as substances that produce craving and compulsive use, but withdrawal symptoms can occur, particularly if medication is stopped suddenly. For this reason, discuss changes or discontinuation with the prescriber and, when appropriate, carry them out gradually.
If your mental state deteriorates significantly after starting medication, particularly if thoughts of self-harm or suicide appear or become stronger, seek medical help promptly. In an immediate emergency, call 999; NHS 111 can provide urgent advice when the situation is not immediately life-threatening.
You can ask for another opinion
If something still does not make sense, asking for further assessment is not a failure of treatment.
The NHS recognises that people may wish to seek an independent specialist opinion. Your psychiatrist may help arrange this, or your GP may be able to request another specialist opinion, although NHS funding and local arrangements can affect how this is provided.
You might simply say:
“I understand the current explanation, but I would like the diagnosis and treatment options reviewed.”
Or:
“Before making a longer-term treatment decision, I would like to know whether a psychiatric or comprehensive psychological assessment would be appropriate.”
Good healthcare should be a conversation
You do not need to become a doctor, psychologist or pharmacologist to participate meaningfully in your own care.
Your responsibility is not to know every answer.
It is to describe your experience as accurately as you can, ask when something is unclear, report concerns or side effects, and remain involved in decisions that affect you.
Different professionals may each hold one part of the picture. Good care emerges when those pieces are brought together: physical health, psychological understanding, medication when appropriate, therapy, personal circumstances and, importantly, your own experience of what is happening.
Healthcare works best not when you are simply treated, but when you are meaningfully involved in your treatment.
This article provides general educational information and does not replace individual medical, psychiatric or psychological assessment.