11. Mental Health Interviews

Your first visit to a psychiatrist, therapist, or mental health clinic often involves a detailed interview. A passive patient might go and assume the interviewer will cover everything. A patient who is ready to advocate for themselves and play an active role in their health care doesn’t assume. You know that time pressures and information overload lead to things being missed. Preparing for the interview ensures you make the most of this opportunity.

These comprehensive interviews play a critical role. They can determine the assistance the treatment provider or clinic will offer you. They can lead to recommendations to your family doctor that may guide your ongoing treatment. Ideally, you want the suggestions to be helpful. The consultation reports that stem from these interviews also tend to follow you around. If you are referred to someone else, they’ll likely get a hold of your previous reports. It helps when they’re accurate.

A mental health interview is very different than speaking with most other medical specialists, such as neurologists or surgeons. In your first session, other specialists normally have a brief discussion with you about your symptoms and history. They then perform a physical exam of some sort, order a bunch of lab tests or scans and send you on your way.

Their discussion with you is important, but not very taxing. It’s not something you’d likely need to prepare for. As for the rest, well, it’s not like you can study for a blood test! In mental health, the discussion itself and your answers to questions play a much larger role than in other areas of medicine. You may have spent a considerable amount of time waiting to be seen. Don’t let that time be wasted.

In this chapter, we’ll describe what you can expect from a mental health interview, including the types of questions you will likely be asked. Jot down some notes ahead of time if you have a poor memory or anxiety. You may also want to ask family members about particular topics. Be proactive. Taking this extra initiative can result in significant benefits.

If you have an extensive mental health history (seen by many professionals, tried many medications) or a long list of physical illnesses, write it all down. A point-form list, no more than a page or two, will be helpful for the interviewer, too. Make them a copy and bring it with you.

What to Expect

As often happens when you first visit a clinic, you may be asked to complete some paperwork. They may just want your contact information or ask questions about your physical and mental health history. They may ask you to complete some of the self-rating scales we discussed earlier.

You then meet with the psychiatrist, psychologist, social worker, nurse, or other provider conducting your interview. Don’t be surprised if they get right down to business. Some will spend a few minutes to help you feel comfortable and explain what will happen during your appointment. Others introduce themselves (hopefully) and start asking questions.

Mental health interviews consist of a lot of questions, often deeply personal. Usually, the interviewer steers the conversation to keep your answers short. That way they have time for all their other questions. Being on the receiving end of this questioning can be intense, especially if you’re not expecting it. Some people describe it as facing a verbal machine gun.

If you don’t think well on your feet, this may feel overwhelming. As well, many people are understandably anxious during these appointments. Let the interviewer know about your anxiety or any other difficulty you’re having. They may be able to adjust their interviewing style to help you. They might also bring you back for a second appointment to complete the initial interview; but, for many reasons, this isn’t often possible.

These interviews pack a lot into a short time. You may have other information to share, to provide a fuller answer or add what you feel is the necessary background. Sometimes you may feel like you’re getting cut off, as the interviewer tries to manage the time. Help them by pointing out your biggest concerns, saying, for example, “This has been a huge problem,” and, “Let’s return to it later” if they pressure you to move on. Feeling frustrated is common. After all, you’re faced with a barrage of highly personal questions, posed by a person you just met. Try not to get your back up.

Keep in mind that the interview is for your benefit, and not for the person interviewing you. Doing some preparation beforehand can be a big help. The diagnosis and treatment advice the interviewer will eventually give are only as good as your answers. The rest of this chapter will show you the types of questions likely to be asked.

Typical Questions

Mental health interviews tend to follow a regular pattern, though usually adapted to your situation. They might focus more on some areas and omit or skim through others. There is no completely standard interview, and interviewers have their own quirks. Still, conducting a comprehensive but efficient interview is part of mental health training.

You may not be asked some important and highly relevant questions. Often, the interviewer already has the answers from other sources such as an excellent referral letter or material your family doctor sent along with it. Other sources include previous consultations, labs, or medication lists pulled from an electronic medical record. The interviewer may quickly verify the information with you, but given the time pressure, usually not.

Basics

The interviewer’s job is to get a picture of who you are. This starts with information such as your age and gender (which may encompass biological gender, gender identity, gender expression, sexual orientation, and much more). They may also ask things such as:

• Are you currently single, married, living common-law, or divorced? Do you have a regular romantic partner? Has anything changed recently?

• Do you have children?

• Where do you live, and who else lives there with you?

• What do you (or did you) do for work, school, or other important areas of your life?

• What is your current source of income?

Current Illness

You’ve sought help and are now in this interview for a reason. So, the interviewer will want to know more about your symptoms and may ask:

• How would you describe your current difficulties?

• How long have you been experiencing these difficulties?

• Are they getting worse? How have they progressed over time?

• How is your illness impacting your life?

• Were there any events that you think triggered the problems?

• What would being better look like?

If someone is going to help you, they need to know what exactly they’re helping you with! They may also ask what you hope to get out of this interview, to ensure that your expectations line up with theirs.

Mental Health History

The interviewer will ask about your past mental health history. Your past experiences are invaluable in assessing your current situation. Knowing what treatments have or haven’t worked in the past also helps narrow down further treatment options. Your formal mental health history covers any periods of time when you saw a mental health professional. For each, consider the following:

• What caused you to seek help?

• Who did you see?

• How long/often did you see them?

• What diagnosis (or diagnoses) were you given, if any?

• What treatments were tried (e.g., psychotherapy, medications)?

• What helped? What didn’t help?

• If you tried medications, why were they stopped?

Your history includes the times you were admitted to hospital for mental health reasons. It includes visits to the ER for mental health symptoms, voluntarily or not. It also includes any previous suicide attempts, self-harm (e.g., hair pulling, cutting), or harming anyone else (e.g., legal history). The interviewer may request your records from previous treatment providers to fill in gaps. Some records may have been sent with the referral.

Your mental health history also encompasses mental health struggles when you weren’t seen by a professional. Many people battle for months, years, or decades before seeking help. Providers want to know what problems you had and how they affected you. They also want to know how you coped, including unhealthy coping such as self-harm or self-medicating with alcohol or drugs.

Physical Health

Your mental health is intricately tied to your physical health. Your mental health providers need to understand your physical health history and current issues. Even if you are seeing a counsellor or psychologist, who won’t have had the medical training of a doctor or nurse, they need to know about this.

Your physical health impacts your mental health in so many ways. Some physical illnesses directly cause mental health symptoms. Many medications for physical illnesses do the same thing. Struggling psychologically with a physical illness can also lead to mental health problems. Your physical health may also affect what mental health treatments are safe to use. Even things that might sound innocuous to you may not be. Let your provider know everything and let them sort out what is relevant. Include both current and past physical health problems.

Medications and More

The interviewer will ask about the medications you’re currently on. That includes mental health medications but also others. So many medications interact with one another that it pays to be safe. They also want to look out for medications that can trigger mental health symptoms. You should include over-the-counter, and herbal or natural products too. Many of these can also interact with prescribed medications or can affect mental health. Report any allergies or sensitivities, especially to medications.

You will also likely be asked about substance use, both perfectly legal and illegal, and how much you use. Such substances include

• caffeine (e.g., coffee, tea, cola, energy drinks, some exercise supplements), which often increases anxiety;

• nicotine (smoking, chewing, vaping);

• alcohol;

• cannabis (including strain and/or CBD:THC ratio); and

• other street drugs.

We’ll talk about how different substances can affect mental health later in the book.

Family History

There is a strong genetic component to some mental illnesses. Having a relative with a mental illness may increase your risk of developing that illness or a related illness. It can help to know about past or current mental illness in biological family members, including

• anxiety or depression;

• schizophrenia;

• bipolar disorders;

• addictions issues;

• personality disorders;

• suicides (or attempts);

• hospitalizations (a marker of the severity of their illness); and

• treatments (medications, therapy, etc.) they used and how well they helped because something that helped a relative has a greater chance of helping you.

Not all families are equally open about mental illness. It’s common that even when there is a history of mental illness, nobody in the family talks about it or seeks treatment for it. Often, you’re pretty sure that a family member has an undiagnosed mental illness. If your family doesn’t talk about it, it’s better to tell the interviewer that you suspect something rather than deny your relative has had a mental illness. If you are adopted, mention that, and whether you know details about your biological family.

Learning about your family mental and physical health history can help you now and in the future. If you haven’t had the conversation, it’s worth having. If your family doesn’t know or says they don’t want to talk about it, don’t worry. They may be more open later. Attitudes can and do change, often after the death of a strong family matriarch or patriarch.

Social History

Your social history includes where you were born, where you lived, your time with your family during childhood, schooling, relationships, etc. Yes, this includes the cliché, “so tell me about your mother.” This can help the interviewer to understand your overall story and even identify past events affecting you now.

Certain behaviours and ways of coping with stressors are developed very early in life and affect your behaviour. Experiencing traumatic events can also have long-term consequences. It’s not uncommon to see PTSD misdiagnosed as another form of anxiety.

Typical Day

You may be asked to describe a typical day. This is another way for the interviewer to learn how your illness may be impacting you. Sometimes you may not even consciously realize how it affects you. You might think that most people think or act the same way you do. Describing your day can reveal things that asking about your symptoms won’t, and so the interviewer may ask

• how much you sleep, if you wake up often, have nightmares, don’t feel rested, or sleep during the day;

• how much energy you have;

• what activities you participate in or how much you stay at home;

• if you eat in a healthy and nutritious manner, and exercise;

• what stressors may be impacting your life; and

• your key relationships.

Symptom Screen

The interviewer will ask you about other symptoms that haven’t come up earlier in your discussion. We discussed this in the Describing Your Symptoms chapter, but typical examples include

• depressive symptoms (e.g., low mood, lack of interest or motivation);

• hypomania or mania (i.e., an abnormally elevated mood lasting at least several days, often with severe irritability, grandiosity, lack of sleep, faster speech, racing thoughts, excess energy or activity, and poor judgment; hypomania is a milder form of mania);

• psychotic symptoms (e.g., hearing voices);

• different types of anxiety (e.g., future-oriented worry, obsessive-compulsive rituals, social anxiety);

• sleep disturbances;

• eating disorders (e.g., binge, purge);

• gambling or other addictive behaviours;

• concentration, memory, attention, learning disability; and

• suicidal or homicidal thoughts, intent or plans.

Some of these may have been covered by self-report scales that you completed earlier. Time restrictions sometimes result in screening questions that are too brief. We’ve heard of some providers screening for hypomania or mania by asking only, “Do you ever spend too much money?” That’s cutting a few too many corners. Obviously, if you have major concerns that weren’t directly asked about, make sure to bring them up.

Follow-Up

At the end of the interview, make sure you know what the next steps are. Will you be meeting with the interviewer again? If so, when? Do you need to set up an appointment?

Will a report be sent back to your referring doctor? If so, how long should that take? Plan to make an appointment with the doctor who referred you shortly thereafter.