Mental Health Navigator

12. Difficult Encounters

This is one of those chapters we’d rather not write or only include as a brief paragraph. But given how many people have had negative experiences with mental health care, we can’t ignore this topic.

The people who treat you are skilled professionals. Most are caring and genuinely want to help. They want to see you healthy again. Ideally, they are friendly, empathetic, respectful, reassuring, and even delightful.

Unfortunately, this isn’t always the case. Some people don’t have a good experience with a mental health provider. Others find the experience unhelpful. A few find it so horrific that it leaves them traumatized years after.

Sometimes this is due to unrealistic expectations. You hope you’ve finally found the person who can help get your life back on track. Instead, they’re doing their best to get through their sixth interview of the day and not confuse your story with that of someone else. At other times, patients don’t know what to expect at all. That won’t be the case for you after reading the previous chapter. The person interviewing you may be cold, rude, or belligerent. In an ideal world, you could walk out the door and immediately see someone else. Unfortunately, it doesn’t work that way.

Taking charge of your mental health means knowing the system, warts and all, and making the most of each opportunity. Preparing for what could be an uncomfortable (or worse) interview is part of taking charge. It can keep a bad situation from getting worse or salvage a futile interview. We hope this isn’t something you need to use. Still, forewarned is forearmed.

In what follows, we’ll introduce you to a motley crew of unsavoury characters you may have the misfortune to meet. These are all based on actual events that patients have shared with us. Afterwards, we’ll offer some general advice for dealing with these and other situations.

The Nasty Sourpuss

Everyone knows this character. From the start, they’re gruff, frustrated, or rude. You’re sure they woke up on the wrong side of the bed and found that someone peed in their corn flakes. Not the welcome you’d expect from someone whose job is to help people who often feel vulnerable and scared.

They might always be a grumpy jerk, or, most likely, they’re having a bad day. They may be ill or have a sick kid. They might have had an argument with their spouse or had a colleague yell at them. It’s your bad luck that their crappy day coincides with the one day you see them.

It’s not easy being the target of someone else’s bad day. Rest assured it’s most likely caused by something else. Healthcare is a stressful environment. People become jaded. Sometimes they take it out on you. All you can do is remind yourself that it’s them, not you, and deal with it the best you can.

The Slow Starter

You waited months or years for this appointment, worried about it for days. You hope it will turn your life around. You’re seeing the expert now. They enter, quickly glance at the consult letter, apparently for the first time. They ask, “So, what are you here for?” Your heart drops.

This may be a once-in-a-lifetime visit for you, but it’s just another day in the office for them. They’re constantly seeing new patients. Some specialists prefer to start with your perspective and integrate what your referring doctor had to say afterwards. Others know that, because of the long wait time, your situation has likely changed from what your family doctor told them.

Everything won’t be resolved in the first ten seconds. This is a marathon, not a sprint. But, if things are still off-track after ten minutes, clearly tell them what you expected from this visit. Try to get on the same page.

The Sprinter

We talked earlier about mental health interviews being akin to machine-gun questioning. Some providers are undeniably more set than others on getting through everything in the time they have with you. They may get irritated if you don’t answer fast enough or say too much.

You are discussing some intensely personal experiences. You may have never shared them before and are now telling them to a complete stranger. It’s a bit presumptuous to expect you can rattle off answers as if you’re reading a grocery list. And more than a little bit rude. Do your best, try to keep calm, and do not get your back up. Many times, the interview is the start of a longer process. You’ll have other opportunities to tell more of your story.

The One-Track Mind

Any doctor can have their particular hang-ups, things they emphasize just a bit too much. Your family doctor might focus on smoking, exercise, and diet. It’s not that these aren’t important, but continually harping on them wears thin after a while. If they really ignore everything else and only focus on their hot buttons, it affects the quality of your care.

Mental health professionals aren’t immune to this. Some might obsess over caffeine intake. Yes, cutting back on caffeine if you’re anxious is a good start, but only part of the problem. Others insist that certain medications (e.g., benzodiazepines) should never be used and focus on that. Some will refuse to deal with anything else until alcohol or drug problems are resolved. (Incidentally, most guidelines recommend concurrent treatment of addiction and other mental health problems.)

The Very Specialized Specialist

You wouldn’t expect a psychiatrist to say, “Depression? I don’t treat depression!” It can happen though. Many have general practices, seeing a bit of everything, e.g., anxiety, depression. Some sub-specialize and focus on one area of mental health. It does sound odd for a psychiatrist to say, “I’ll treat your ADHD, but you’ll have to see someone else for your depression.” But in some areas, such as eating disorders, there are so few psychiatrists relative to the demand, it does happen. This is another reason why you and your family doctor should check out who you’re being sent to ahead of time. Their practice may not be appropriate for your needs.

The Really Alternative Practitioner

Some people take specialization to a whole different dimension. There are a few psychiatrists, fully trained and licensed, who have a less-than-mainstream focus in their practice. This isn’t about only treating ADHD or eating disorders. They treat people exclusively using the incredible wisdom found in a particular book. Eckhart Tolle and Deepak Chopra tend to be popular, as are the Bible or other religious texts. Or perhaps they see everything through a very narrow-focus lens. A psychiatrist who attributes all mental health problems to trauma related to abortion is an example.

These people may be trained, qualified, and licensed as psychiatrists, but they’re not in any way practicing as psychiatrists. Run.

The Not Really a Psychiatrist

We had one patient who saw the same psychiatrist on three occasions. Their reports gave a different diagnosis each time. Two of the three diagnoses were not actually from the DSM-5 or previous editions. The assessments also didn’t appear to meet the standard of practice for psychiatrists. They missed essential elements like whether the patient was suicidal.

We did some digging and found that this doctor completed psychiatric training in another country. However, they had not yet met the national standards of practice qualifying them as a specialist in psychiatry in Canada.1 But they had a medical license and could practice psychiatry here. They were always called “the psychiatrist.” Nobody knew differently.

The Diagnostic Nerd

Some specialists are obsessed with the diagnosis. Clarifying a diagnosis is often one of the main reasons that family doctors refer to psychiatrists. Diagnosis is important, but for some psychiatrists, it’s really important. Their one mission is making sure the diagnosis is exact, precise, with every specifier correctly quantified.2 If they can diagnose a rare or obscure illness, they may need a cold shower before seeing their next patient.

Both you and your family doctor are probably interested in the psychiatrist’s opinion of your diagnosis. But what you truly want to know is how to get better. Keep in mind that getting the right diagnosis is itself a valuable step toward finding the right treatment.

The Psychic

Some providers have you pegged the moment you walk into the office. At the outside, it takes five minutes of talking with you. A full interview is a pointless waste of their time.

It’s sheer arrogance to think anyone could learn everything relevant about you in a single visit. Most people don’t completely open up the first time they meet someone. Giving someone a superficial diagnosis after a few minutes in an unfamiliar environment is unprofessional and demeaning. The full story is often needed to appreciate the situation. Many illnesses have significant areas of overlap that take time to distinguish. A token interview does you and the doctor who referred you a disservice.

People with distressing mental health conditions often have more than one thing going on. Proper treatment takes this into account. Treating what’s merely on the surface is a guarantee you’ll be seeking care again in the not-too-distant future. Welcome to mental health’s revolving door.

The Expert Know-It-All

Everybody experiences mental illness differently. So, what to make of the expert who thinks they know what’s going on in your head based only on your diagnosis? Or, who definitively says that you aren’t experiencing what you describe? They may have treated 500 patients with a bipolar illness. Then you come along with some symptoms that are slightly different. It doesn’t mean you’re not experiencing them. When their mental model doesn’t fit a new piece of data (i.e., you), you’re not necessarily wrong. They may know more than you about psychiatry, but you know more than they do about what you’re actually experiencing.

Sometimes though, it turns out they are right. A symptom you thought was due to medication sensitivity may be anxiety about taking it. Worsening of your symptoms may not be related to your treatment but to a new life stressor. The best psychiatrists don’t tell you they’re right or you’re wrong. Instead, they’ll share how most people react, acknowledging that everyone is different. It’s an opportunity to consider alternatives. Maybe something else is going on. If both of you can keep an open mind moving forward, you may reach a better understanding.

The God Complex

At the extreme, some people feel they are so brilliant that they don’t need to take what you say into account. They’ll listen to you only if it’s a direct answer to one of their questions. Consider yourself lucky that you’ve been permitted to bask in their presence. They look down on patients as people who are beneath them, and certainly not equals. Patients are almost like objects that can be manipulated. These providers are condescending and paternalistic. They’ll tell you the way things really are. Any advice you’ve gotten from anywhere else is wrong. It doesn’t matter if it comes from other specialists or your family doctor who you have known your entire life. This attitude, sadly, can be found in nearly every profession and setting.

The Complete Jerk

And of course, some people treat everyone they see badly. The reasons—arrogance, prejudice, stigma, or whatever—it really doesn’t matter. You’re an imposition, a waste of their time. You’re stupid. You are the cause of all your own problems. You’re completely broken, and there’s nothing that anybody can do to fix it. While it’s bizarre to find people like that in a caring profession, unfortunately, there are some. Hopefully, you won’t ever encounter one of them.

Our Advice to You

The above characters are exceptions. Most mental health workers, though stressed and frazzled, are kind and considerate. But they are human. These extreme examples are a minority. With luck, you’ll never meet them.

Some of the behaviours we described, if not mean or abusive, are at the very least quirky or unusual. We think it’s best that you’re aware these people are out there in case you do encounter them. Being surprised and taken aback could derail the interview. Look at it this way. High expectations are rarely surpassed. Low expectations are often exceeded. Your choice.

We recognize the inherent power imbalance in these situations. You need them, or at least their expertise, a lot more than they need you. That’s no excuse for bad behaviour, and no reason to put up with abuse. You can be polite, respectful, and assertive at the same time. However, there is nothing to gain by antagonizing them. Resist pushing back when emotions run high. Decide which battles to fight and when to grit your teeth and move on.

Having said all that, we offer you the following advice for any interview:

  • Be on time.

  • Be prepared. If there are things you’ve been asked to bring, show up with them. If you have other information, bring a copy to leave. Think about how to answer the questions in the previous chapter.

  • Gently remind them of your goals. Get on track early.

  • Remember that the interview is for your benefit, not the interviewer’s. Be honest, open, and straightforward. Provide the best information you can. You’re more likely to get useful advice in the end.

  • You’re not there to make friends. Some people want everyone to like them. Watch out if you’re one of those people. If the provider is rude, insulting, or arrogant, try your very best not to get your back up.

  • You’re there for an opinion and advice. You should consider it seriously, but you don’t have to agree with it or act on it.

Summary

  • Even though most are not, some people can be real schmucks. That includes people who work in mental health.

  • It’s in your best interest to try to be as helpful as possible, no matter what you think of the interviewer or their behaviour. Even the vilest person may have something useful to offer.


  1. Before someone can practice as a fully-licensed specialist, they need to successfully complete certain training, be observed and evaluated by supervising specialists, and pass exams. When doctors move from other countries, their training is assessed. Often, they need to write the same exams, redo some or all of their residency training, and/or practice under someone’s supervision for a time to demonstrate competency. Only then are they fully qualified to practice independently.

    In this case, the doctor hadn’t completed one or more of those steps. Their license to practice medicine, in Alberta, was classified as “Provisional Register Conditional Non-specialist Defined Practice.” That is for “non-specialist physicians in a specialty discipline, who are in the process of qualifying for the General Register but do not yet meet the full criteria.”

    We recently checked, and that particular doctor had just fully qualified as meeting national standards, and now had a “full” license to practice as a psychiatrist. They’d held the same conditional license for six years. That’s longer than doctors spend in training after medical school to become psychiatrists in the first place.

  2. After all, why say “dysthymia” when you could say “persistent depressive disorder, severe, late-onset, with anxious distress (moderate-severe), without psychotic features, with intermittent major depressive episodes, without current episode, in partial remission?”

While you can read it for free online, there are conditions on sharing it with others (see below).
You can also still purchase copies in paperback or e-book (PDF, Kindle, Kobo, etc.).