Coming to see a psychiatrist or mental health practitioner can be daunting and you or your child may feel nervous. We won't ask you to lie on a couch, won't be in a white coat and aim to put you at ease.
In an initial assessment meeting, we will gather information by asking general questions to get a broad look at the situation and background. Quite often more than one meeting is needed for complex situations.
We will listen to what you bring and how you describe the issues, wanting to find out more and engage you so that you feel comfortable and understood. We are interested in your/your child's goals, rather than assuming what they might be.
Assessment can be therapeutic when it is done this way and we hope you will experience it as helpful, even if there is a long way to go.
Common presenting symptoms are anxiety and panic, unhappiness, irritability, obsessions, anger and withdrawal. Together we will be making sense of the situation, which may be complex, working out where to intervene to make things better.
A medical model diagnosis is sometimes made (as well as a formulation of the situation) and can sign-post to the right treatment and interventions. It can help obtain funding from medical insurance companies or from education services. However, a label is not always necessary or helpful; we are all different and the current classification system is often inadequate to explain and communicate about a young persons' distress and difficulties. When receiving a diagnosis, some young people may feel ashamed or that they are inadequate or flawed, whilst others may experience great relief at understanding why they are different or struggle.
Most importantly, we aim to understand your distress, how it arose, what is maintaining it and find ways of making changes that you want.
Initial assessment meetings are done by any of the team, depending on the issues and our availability. Occasionally we will suggest they are done jointly with a psychiatrist and our mental health practitioner, Jo. Jo may be involved right from the beginning, especially if we have already identified that she is likely to have the skills and availability for ongoing intervention needed.
Sometimes the question you come with may be around a specific disorder. For example, does she/he/I have ADHD or am I/they autistic?
These assessments will start with an initial general assessment meeting. They usually involve gathering information and observations from school and other settings, completing standardized questionnaires and asking more specific questions.
An ADHD assessment is likely to take around a minimum of 3 hours of our time, so likely to cost around £900. We don't have fixed costs for this at the moment.
If we diagnose ADHD and medication is recommended then we can prescribe this.
If the initial meeting indicates that further assessment for Autistic Spectrum Disorder (ASD) is indicated, I can refer you to colleagues who are neuro-developmental diagnostic specialists. They offer the ADR-I and ADOS, as recommended in the NICE guidelines as part of ASD diagnosis, and I am involved as part of ta team in the diagnosis decision-making. This is a very detailed and time-consuming process so the fees are in the range of £2500.
We would always take an affirmative, strengths-based approach, exploring and identifying neurodiversity alongside mental health difficulties that so often co-occur. We also recognise the cultural stereotypes are often not helpful or accurate and understanding of the spectrum is rapidly growing. We also see the need for medical diagnosis in order to access resources, despite the medical model being 'deficit' based, and try our best to navigate these issues sensitively.
We cannot diagnose or treat dyslexia or other specific learning difficulties as we are not experts in this.
Health insurance companies sometimes find assessments, though rarely fund ongoing treatment for neurodiversity, such as ADHD medication.