How to Prepare for A Mental Health Intake

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This past week I met with a new psychiatrist. My previous psychiatric doctor had moved on which was disappointing because I liked her gentle and collaborative approach. I had some anticipatory anxiety because a psychiatrist is an important part of one’s mental health team and finding a good fit isn’t always easy.

The day of the appointment – just ten minutes before I was about to leave – I received two urgent calls. One was from my dad’s care home and another from Dad saying he was in emergency but was okay. I had missed both calls as my ringer was off, so I wasn’t sure what had happened. I quickly called the care home and they said my dad had not returned from a walk and I quickly filled them in and they sent a staff member to pick him up.

As I said, my nervous system was already a bit anxious about this doctor’s appointment. Then I had a spike of anxiety thinking about my dad being lost in the city for a couple hours and how scary that must have been for him.

When I arrived at my doctor’s appointment, I was first asked if I was okay with a student observing in the room. I figured it would be a shorter appointment, so I was okay with another person in the room. I shouldn’t have assumed what the appointment would be like. I realized having to talk to two strangers about my mental health heightened my anxiety.

It turned out to be an hour full intake with a lot of personal questions. Even though I said I was feeling a bit dysregulated at the start of the appointment, and the doctor assured me the appointment was going to be relaxed, I don’t think he realized that me talking through my whole mental health history might be triggering. For him, as a professional, the questions are standard. He probably has asked these questions hundreds of times. But the difference is – I am assuming – he doesn’t have a mental illness and any trauma related to the questions. For me I relive the very hard parts of my history when answering these questions. If only I had known it would be a full intake. My last two psychiatric doctors had not done full intakes so I wasn’t expecting it.

I felt internal pressure to try to tell my history fully because quick answers don’t reflect my experience. But in doing so, I left myself feeling very vulnerable. There were a couple times I felt a bit judged. I also felt a lot of internalized stigma after the appointment.

I know it will take time to get to know this doctor and see how we work together. I do like that we have the same goal: being on the lowest dose that is most effective for my mental health. I am 45 years old and am concerned about the side effects of some of my medications. One medication I have taken for 25 years is causing a heart issue called QTc interval prolongation which can be very serious. I have been lowering this medication and will likely continue to need to lower it. All my recovery tools will be necessary to help adapt to the changes to my body and the resulting medication withdrawal as I very slowly continue with lowering this medication.

This whole experience of the intake made me think of how to prepare people with lived experience of mental illness for an intake.

I think that my new psychiatrist was being thorough and was not assuming things based on my historical notes of my mental health care. This is a good thing. However, it would have been better if someone had told me what to expect at this first meeting. It takes mental preparation to for me to tell my story plus I would probably prepare some notes to jog my memory as I got first diagnosed thirty years ago. It would also have been helpful for the doctor to realize that questions can trigger traumatic memories and to approach the questioning and his responses with that in mind.

It is probably good to be prepared that a first appointment (with a psychiatrist and/or another mental health professional) might include a thorough intake of your history both with mental health and/or substance use. I suggest making notes before you go in, especially if you have had a longer history.

A psychiatrist or intake worker at a mental health centre may ask you about…

• your mental health history (in specific they want to know how many episodes, hospitalizations you have had and the medications that worked/didn’t worked and any side effects)
• your family history of mental illness
• your childhood and what were you like as a child
• any physical illnesses that you have had or currently have
• prior history of abuse
• what your life looks like now – living situation, relationships situation, whether you have pets, whether you work, where your income comes from
• your hobbies
• your support circle
• whether you have a family doctor, their name and potential spelling of their name
• what you hope from the sessions and what goals you have around your mental health treatment
• about your current medications, any side effects, the pharmacy that you use, and whether you’d like medications in a blister pack or not
• other treatments (holistic or otherwise) that you have tried for your mental health

You can probably see how difficult some of these questions are to answer and how some of them might bring up trauma. Some of the structures of the medical model in the mental health system are not very trauma-informed. It is also an example of how a systemic process (i.e. the intake) can reinforce stigma. When questions are not framed as strengths-based, it can bring up feelings of shame. This happened to me at that appointment. I had to literally walk myself through all the wonderful memories, experiences, support, and gifts in my life the weekend after this intake just to remind myself that my life hasn’t been all about pain or failure. But really, wouldn’t it be great if our mental health services where more trauma-informed? If these questions could be held the way they are with a skilled counsellor? It wasn’t that this doctor wasn’t well-meaning or trying to be kind. There was just a lack of understanding about how to hold space in a way that made me feel safe.

I’d like to share some tips for preparing for these kinds of intakes.

1. Come prepared with detailed notes and questions. Perhaps use my questions above and prepare a document and just keep it for reference when meeting a new mental health professional. You can get a support person to help with this. It is so important in general to keep health notes documenting your mental health history as it can be used as a reference that might help you make treatment decisions.
2. If you have someone that you feel comfortable sharing everything with, bring them. If you can bring in a calming dog, bring your pet. Another alternative is to meet with a support person after your appointment so you can debrief.
3. Always realize that you can say no to having a student in your appointment. You do not have to feel guilty if you’d rather talk to your doctor alone.
4. Realize that you can say if you find a question triggering and ask to move on to another one. You don’t have to answer everything that is asked. You have the right to answer in a way that feels safe for you.
5. Make sure on your intake day to not have anything else stressful (if possible). Best to go in as relaxed as you can which might be a lot since you may be really struggling with your mental health. Perhaps just plan one activity of self-care that day that feels good.
6. Realize that mental illness is not your fault. Mental illness and/or substance use issues are not something you asked for in life. Mental illness is an illness like any other but because it affects the brain and behaviour, there is a lot of stigma associated with it. While we can do many things to help our own recovery, this doesn’t mean you’ve failed if you have had struggles with your mental health. Mental illness is very complex to manage.
7. Learn to love and care for yourself even when your life is not how you want it to be. Just offer yourself acceptance. It is only our society that perpetuates that people’s lives need to be perfect and defines what this perfect looks like. If you were to look in every household around the world, you’d realize people are not perfect (even if it looks like it on the outside), many people have hard times, and many people live in different ways according to their values.
8. Learn what recovery means to you. What are your values? What does a good day look like to you? What gives you joy? Who provides you with compassionate support?
9. Remember that medication and doctors are only one of many interventions for your wellness. If you want an overview of recovery tools that I use, clicking this link and scrolling down Welcome For a 9.99 CAD (a one-time fee) you can access my Mental Health Mapping blog subscription that offers an integrative approach to mental health recovery. There are over 52 posts with personal stories, tools and wisdom about recovery and therapeutic arts activities to help integrate the information.

Finally, if you feel triggered after your intake follow it up with something nourishing, like art making or yoga. Recognize that wherever you are in your recovery and life, you have inherent worth and value.

I think it is important to study yourself and what recovery means to you because likely you’ll find ways to support your mental health that you will not learn from a psychiatrist. Their job primarily (and we are speaking of a traditional psychiatrist in a traditional system) is to help with medication doses, side effects, and to monitor symptoms. That is what the appointments are about. All the other things – nutrition, exercise, social connection, mind/body practices, therapy – all these things are up to you to seek out and try. However you can ask for help from support people, in both your personal and professional life to help find wellness. You are not alone in your mental health recovery. There are so many people in the world working on their recovery. If you feel alone, you can just do an internet search and find so many personal stories about people who are living with a similar experiences to you.

with care and kindness ❤️ Meegan