Mental Health Navigator

10. Working the Waiting List

Some treatment providers you can approach on your own. Others need a referral. In this chapter, we’ll look at referrals from your family doctor to a psychiatrist or mental health clinic. This is the most common connection between mental health providers and usually the most problematic.

As a patient navigator, you can manage connections between care providers, so that each has what they need to do their job. You can ensure appointments are booked and reports are sent, and try to minimize delays. You can even help bring new providers onto the care team.

There can be long delays before you’re seen. If you must wait, there are a few tricks to help decrease the waiting time. These do not include pretending you’re a politician, NHL star, or other celebrity. Some people think they are special and try to jump the queue to receive care faster than others. We’re not endorsing this or any other form of lying to get ahead.

What we really want is to ensure you’re in the right place in the right line. That happens less often than you might think. Human errors or omissions occur frequently. Your involvement in the process can make a difference.

We’ll first explain what really happens when your family doctor refers you. Armed with a better understanding of that process, you’ll learn strategies to improve the odds of getting seen sooner.

The Consultation Process

What does it mean when your family doctor says they will send you to see a psychiatrist? You’ve probably got a lot of questions about who you’ll see, when you’ll see them, for how long, etc. When your family doctor sends you to see a psychiatrist (or any specialist), this is what typically happens:

  1. Your family doctor picks a psychiatrist to send you to.

  2. They send a letter to the psychiatrist.

  3. You (eventually) get an appointment to see the psychiatrist.

  4. You go to your appointment with the psychiatrist.

  5. The psychiatrist sends a letter back to your family doctor.

This is known as being referred for a consultation. Your family doctor is asking the specialist for advice about how best to help you.

Choosing the Psychiatrist

Your family doctor will have to decide who exactly to send you to. This may be, as you’d expect, an individual psychiatrist. More on that in a moment.

Services and Clinics

You may also be referred to an outpatient psychiatric service that deals with a specific type of mental health problem. It may be part of a hospital or a larger psychiatric clinic. Generally, several psychiatrists work in such a service, and you will see whichever one they decide.1 There may be other staff who provide extra assistance and treatment. If there is a local service for your particular problem, referring you there may make the most sense.

You may also be sent to a general mental health clinic. They will normally have a psychiatrist available, but most of the staff are mental health workers such as counsellors, nurses, and social workers. You first see one of them for an intake interview about your mental health history and current needs. Based on that, you may or may not end up seeing a psychiatrist.

The Buddy System

Who your family doctor refers you to is commonly based on (in decreasing order of preference): who they have referred to before, who else they know, who other people they know recommend, and what they might find either via Google or on the website for the local medical licensing body.

In some ways, it’s not a bad system. After a family doctor has sent a few patients to a psychiatrist, they can appreciate the quality of help given to their patients. They also learn a lot by asking their patients about the psychiatrist. If a past referral has worked well, they’re more likely to refer again. Other family doctors, whether colleagues in the same office or those they know from elsewhere, will similarly recommend psychiatrists who they’ve had good experiences with. Family doctors learn over time which psychiatrists are best for different patient needs.

Your Suggestions

Your doctor may have ideas about who to send you to, but nothing is stopping you from bringing your own suggestions to them. You might find someone who can see you sooner or is a better fit. Where do you look?

You might think that the internet is a starting point. After all, every professional now has a website—except for most doctors. With few doctors and a huge demand for treatment, most don’t need marketing to find patients. Some do have websites, but it’s an exception.

While the doctor may be silent online, it doesn’t mean their patients are. As with restaurants, teachers, or hotels, there are several online rating sites for doctors.2 As with any anonymous review website, read user reviews with a healthy bit of skepticism. A few very good or very bad reviews probably don’t mean a lot. But if enough people have commented, a pattern may emerge. Remember that your needs aren’t the same as everyone else’s. What other people complain about may be exactly what you’re looking for.

The other way of finding a psychiatrist is by word of mouth. Fewer people will mention their fantastic psychiatrist than will talk about the beach resort where they spent their last holiday. Still, though it’s one person’s experience, it’s better than an anonymous internet comment.

You may find a psychiatrist who looks like a good fit that your family doctor doesn’t know. Don’t hesitate to suggest them. Most family doctors are always looking to expand their network of reliable specialists.

Bottom line: don’t hesitate to talk to your family doctor about who they’re referring you to. Ask them why they made that choice and be willing to provide feedback based on things you’ve learned.

The Referral Letter

Your family doctor usually sends the psychiatrist a letter or fills out a form asking them to see you for a consultation. Besides your name, phone number, insurance coverage, etc., the request will ideally also include several pertinent pieces of information such as

  • the problem your family doctor would like help with;

  • the situation leading up to the referral, including the impact the problem is having on your life;

  • specific questions or concerns they want the psychiatrist to address;

  • past mental health problems, treatments, and how well they worked;

  • a summary of any physical health problems;

  • your current medications and doses, as well as any allergies;

  • a bit about your background such as family or employment situation;

  • previous reports or tests that the family doctor feels are relevant; and

  • family mental and physical health history.

In spite of that, some referrals sent by family doctors literally say nothing more than, for example, “PTSD” or “ADHD.” While a one-word referral (or the equally informative “Please see for PTSD”) may not necessarily hurt you, it definitely won’t identify you as someone who needs to be seen quickly.

Ask your family doctor for a copy of your referral letter. If it has errors, is missing or muddles your symptoms, or seems a bit skimpy, talk to them about your concern. They may ask you to give them a concise summary to pass on to the psychiatrist, or they may not change it at all. However, it won’t hurt to ask.

Communication Breakdown

To be seen by a psychiatrist, their office must receive your family doctor’s referral letter. You’d think this was a no-brainer. You’d be wrong.

Referrals are most often sent via error-prone 1970’s-era technology (fax machines). Senders are never entirely sure what the other side has received.

The psychiatrist who received your referral might not be able to accept it. This can happen for all kinds of reasons: their practice is too full, they don’t treat patients with your condition, etc. In that case (if your family doctor receives the rejection fax), it’s back to square one. Another psychiatrist will be picked, and the process begins again.

Ask your family doctor how long it will take before the referral is sent. Add a healthy buffer, then check with your family doctor’s administrative staff if it was sent and if they’ve gotten anything back. If not, call the psychiatrist’s office and ask if the referral was received. Ask if they can tell you how and when you’ll find out about an appointment.

Here are a few of the many things we’ve seen go wrong:

  • family doctor starts working on a referral, puts it in a pile of paperwork to finish later, forgets it, and it never gets sent;

  • family doctor puts a referral together, gives it to office staff, but it gets lost or horribly delayed in their pile of work;

  • referral sits in the psychiatrist’s office inbox for weeks;

  • the referral is faxed, but something happens with one of the fax machines; the family doctor thinks it was sent, but the psychiatrist never gets it;

  • handwritten referral is completely illegible or misinterpreted as something less serious than it is; and

  • fax is sent to the wrong specialist (hint: don’t refer someone to a psychiatrist to help fix their knee ligament damage).

The worst case, which is frighteningly common, looks like this:

  1. Family doctor faxes your referral to the psychiatrist.

  2. Psychiatrist never gets the referral (or rejects it, but the family doctor doesn’t get the rejection fax).

  3. Family doctor assumes you are on a waiting list and will be contacted.

  4. Many months pass.

  5. Family doctor’s office eventually calls psychiatrist’s office to ask about the status of your referral.

  6. Psychiatrist’s office says, “What referral?”

Don’t let this happen to you!

Priorities

A concise but descriptive referral letter can make a big difference. Many psychiatrists prioritize or triage their referrals. They see the sickest people first, often before less acute cases who may have to wait longer. This is similar to what happens in the emergency room.

A good referral letter won’t guarantee you get seen faster. But if your case is more serious, there’s a good chance it will. If your referral just says, for example, “depression,” you can bet it’s getting the lowest priority. Even if they don’t routinely prioritize, certain cases may occasionally still be seen before others. There are other advantages to good referral letters, which you’ll see later.

Be honest about your symptoms and the effect they’re having on your life. Don’t minimize or exaggerate. Give your family doctor the information they need to send an accurate referral and help you. If you have old records, make sure your family doctor has them, too, so they can be passed along.

While waiting to see the psychiatrist, tell your family doctor if your symptoms change or worsen. They may send an update letter or call the psychiatrist, explain the situation has gotten worse, and ask if there’s any way to bump up your appointment.

Appointment Booking

If your family doctor wrote a good referral letter, the psychiatrist received it, and you met the criteria for their practice, you’re most of the way there. Ask your family doctor (or their front office staff) what happens next. Will an appointment (that may be 12 months out) be booked for you shortly? Or, will you be placed on a waiting list? Will you be given an appointment time and told to show up then, or will someone call to find a time that fits your schedule? If you will be given a specific time, who will contact you?

If you can usually be available on short notice, contact the psychiatrist’s office and see if they have a cancellation list. Doctors get last-minute cancellations all the time and are always eager to fill them. This one tip can sometimes reduce your wait from a year to a month!

Make sure the psychiatrist’s office knows the best way to contact you. They may only have your home phone number. So, give them your cell number if that makes sense. This is especially true if you’re on their cancellation list. If you change numbers, tell both them and your family doctor.

If the psychiatrist’s office publishes an email address, ask them if they prefer routine questions by email or by telephone. If you’re on a waiting list, ask if it’s okay to check once in a while where you are on the list. Don’t overdo it. The last person you want to upset is the one booking your appointment.

You may have additional information that wasn’t in your family doctor’s referral letter. If you think it might be helpful to the psychiatrist, ask if it would be okay to send it to them. A one- or two-page summary of your mental health history, symptoms, medications, and past treatment providers may help. A 20-page letter detailing your current suffering will not.

Summary

  • If you’ve been referred to a specialist, get a copy of your family doctor’s referral letter. You may want to provide them with a concise summary of the crucial points to help them write it or to pass along as a supplement.

  • Try to find out about who you’ve been referred to. You may want to keep your eyes open for others who can see you sooner or who might be a better fit.

  • Follow up to ensure that the referral actually was received and approved by the specialist, and how and when they’ll book an appointment for you.

  • If you want to be seen sooner and can be available on short notice, ask if the specialist has a cancellation list. Make sure they know the best way to reach you, especially at the last minute.


  1. Every clinic or service has their own process. Some may randomly assign doctors to patients. Some may pick the next doctor available. Still others may try to match the patient’s needs outlined in the referral information with the doctor who they think would be the best fit.

  2. One of the most popular doctor rating sites in Canada and the USA is RateMDs. Think of it as Yelp! or TripAdvisor for doctors.

    https://www.ratemds.com

Mental Health 201: Real-World Treatment Essentials

Now Available! A MSP-supported live course for BC residents based on the book. [Mar/2023]

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.).

Discover more practical mental health resources:
www.bcpsychiatrist.com
/BCPsychiatrist /BC_Psychiatrist

Mental Health 201: Take Control of Your Mental Health

Now Available! A MSP-supported live course for BC residents based on the book.