Psychiatry: mental health conditions, assessment, medicines and how referral works in the UK

Psychiatry deals with the diagnosis, treatment and prevention of mental illness. A psychiatrist is a doctor who has completed medical training and then several years of specialist training in mental health. Because they are doctors, psychiatrists can consider physical causes of symptoms, order medical tests, prescribe medicines and arrange admission to hospital when someone is unwell enough to need it. The Royal College of Psychiatrists is the professional body, describes its purpose as improving the lives of people with mental illness and publishes patient information.

Psychiatrists rarely work alone. In the NHS they lead or contribute to community mental health teams, crisis teams, early intervention services, inpatient wards and liaison teams in general hospitals. They work with mental health nurses, psychologists, occupational therapists, social workers and support workers, and they may be involved at different points of a person's care rather than seeing them regularly.

The distinction with psychology is often confusing. Psychologists mainly provide assessment and psychological therapy and do not prescribe, while psychiatrists are medically qualified. Many people are helped by both, and a good service coordinates the two.

Most common mental health problems such as mild to moderate anxiety and depression are managed in primary care or NHS talking therapies. Psychiatrists usually become involved when problems are severe, complex, persistent or diagnostically unclear.

• Depression, which the NHS describes as more than feeling unhappy for a few days and as persistent sadness over weeks or months. Severe depression, or depression that has not responded to first-line treatment, may be referred for specialist input.

• Bipolar disorder, a condition of extreme mood changes between high moods (mania or hypomania) and low moods. The NHS says it cannot be cured but treatments can help manage it, and diagnosis may take time because symptoms resemble other conditions.

• Schizophrenia and other psychotic illnesses, where hallucinations, delusions or disordered thinking are present.

• Anxiety disorders, obsessive compulsive disorder and post-traumatic stress disorder, particularly when severe or not helped by therapy.

• Eating disorders, personality disorders and complex trauma, usually in specialist teams.

• ADHD and autism assessment in adults, which in many areas involves psychiatrists, with waiting times and pathways that vary.

• Mental health problems linked to physical illness, pregnancy and the postnatal period, dementia and substance use.

A first appointment is mostly a conversation. The psychiatrist asks about current symptoms, how long they have lasted, what makes them better or worse, past episodes, sleep, appetite and mood, alcohol and drug use, physical health, medicines, family history and personal circumstances. They may ask about safety and about thoughts of harm, and may ask permission to speak to family or others who know you well. Some assessments are followed by blood tests or other checks to exclude physical causes.

Treatment is based on diagnosis, severity and preference. It can include medicines such as antidepressants, mood stabilisers or antipsychotics, psychological therapies such as cognitive behavioural therapy, practical and social support, and help with sleep, activity and substance use. The NHS says treatment for bipolar disorder includes medicines to stabilise moods and talking therapy such as CBT. For depression, it says mild cases may be managed by watchful waiting, exercise and guided self-help, with talking therapy and antidepressants for moderate to severe depression and specialist team care for severe cases.

Other treatments exist for specific situations, including electroconvulsive therapy for severe depression that has not responded to other measures, and transcranial magnetic stimulation. Hospital admission is for people who cannot be kept safe or treated in the community, and some people are treated under the Mental Health Act when they lack capacity or are at significant risk.

In the NHS, most people see a GP first. The NHS says a GP who suspects psychosis should refer to a mental health specialist for assessment, and that you should see a GP immediately if you have symptoms of psychosis. For anxiety and depression, the NHS says you can refer yourself to NHS talking therapies in England without seeing a GP and without a formal diagnosis, if you are 18 or over, or in some areas 16 or 17. Some conditions such as bipolar disorder, personality disorders and psychosis need a GP referral for CBT, according to the NHS.

Private psychiatry usually allows a direct appointment, sometimes with a GP letter, and often shorter waits. Ask whether the psychiatrist is on the GMC specialist register in psychiatry, whether they will liaise with your GP, how medicines will be monitored and who to contact between appointments. Shared-care arrangements, where a GP prescribes after specialist initiation, differ by area and by drug, so ask about them early.

• Ask what the working diagnosis is, how confident the psychiatrist is about it, and what might change it.

• Ask about each medicine: what it is for, how long it takes to work, common side effects, how long you are likely to need it and what happens if you want to stop.

• Ask what talking therapies, support groups or practical help are available alongside medicines.

• Bring a list of medicines and supplements, a note of symptoms or a mood diary if you keep one, and consider asking someone you trust to attend.

• Ask what to do if symptoms worsen and who to contact outside appointments.

• If you or someone else is at immediate risk, call 999 or go to A&E. The NHS says that for someone with severe psychosis you can take them to A&E, call their GP or out-of-hours GP, or call 999.