Experiences with mental health practitioners: Psychiatrists, counsellors and others

On the whole, people spoke about positive experiences with mental health practitioners, particularly in the private sector. However, a few described negative experiences. Many people had suggestions about how mental health professionals could improve their services, for example through continuity of care, a person-centred approach, and the use of clear language (see Advice to others: Health, mental health and allied health professionals).

Although most people had experienced several psychiatrists looking after them at different times in their lives, many had also stayed with a particular psychiatrist for years (five years or longer) and highly valued their input. Others were seeing a mental health professional on a regular basis, although the satisfaction with this experience varied. Brendan explained how he sees a psychiatrist ‘who is really busy’ once every six to eight weeks because ‘that’s how often you can get an appointment’.

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The relationship
Treatment decisions

Evan said his psychiatrist has many good qualities, and ‘doesn’t create boundaries’.

While people’s experiences of mental health practitioners were often positive, they could vary depending on a number of things, such as the sorts of questions asked, how the practitioner related to them, and whether their ‘input’ was taken into account. Being able to establish a good relationship with mental health practitioners was what stood out most when people talked about positive experiences. In contrast, negative experiences were associated with feeling as though they had not been treated as an equal.

Although Anna currently has a ‘fantastic’ psychiatrist, in the past she found psychiatrists to be ‘egocentric’.

People met mental health practitioners in hospital (see Hospitalisation: Being admitted and leaving and Hospitalisation: Daily life and treatment), through mental health clinics, or through private consultations. Quite a few people spoke about the benefits of being able to choose their psychiatrist through the private medical system. Chris changed psychiatrists after experiencing a bad reaction to a medication. He said having a new psychiatrist ‘opened [his] eyes’ to the fact he could access other doctors, which ‘felt great’. However, a few people spoke about ‘exorbitant fees’ that inhibited their access to psychiatrists. Jenny described how she had to stop seeing her psychiatrist who was helping her ‘a lot’ because she was doing unpaid voluntary work and couldn’t afford the fees. Quite a few people mentioned only being able to see someone who ‘bulk-billed‘. Bulk-billing providers do not charge patients more than the amount they bill Medicare, Australia’s publicly funded universal health care scheme.

The relationship

Having a good relationship with mental health practitioners was seen as important for everyone we spoke to (see also Experiences with GPs). For several people, having a good relationship with their psychiatrist meant being able to trust them. Allen felt that he had ‘a trust relationship’ with his psychiatrist. Others felt that it was important to have someone they were able to open up to. Paddy said his psychiatrist was a ‘good shrink’, ‘professional’, asked ‘the right questions’ (such as “Are you sleeping, are you taking medication?”), and someone with whom he felt he could ‘really have a conversation’. Michelle described the psychiatrist who diagnosed her as ‘very insightful’ and said he asked ‘very probing questions’. For many people, feeling listened to was critical. Anna said her psychiatrist was ‘eager’ for her input, which really gave her her ‘dignity back’.

Helen described a very frank conversation with her psychiatrist who admitted he could not ‘completely’ understand what depression was, but said he would ‘try’.

When Ann realised she needed help with the voices she was hearing, she wrote a letter to her psychiatrist because she didn’t want to answer any questions.

Some people described how a mental health professional had gone out of their way to help them. When Helen noticed she was ‘going down’ her psychiatrist offered to put a note on her file to contact her or her family to see how she was going in one month’s time. This offer of follow-up was very important for Helen because, as she explained, ‘if I don’t come for a long time, that means that I’m not on my meds’.

Paddy’s psychiatrist came to his school to talk to the teachers so that Paddy would pass Year 11.

Even where mental health professionals didn’t agree with them, a few people found that a relationship of trust meant they were willing to accept the professional’s decision.

Although Jenny said she didn’t like it when her psychiatrist was ‘dictating’ to her, she trusted her expertise.

In contrast, some people recalled seeing mental health professionals whom they felt unable to speak to. Simon and Jenny talked about their experience with psychiatrists who had used ‘Freudian therapy’ in their sessions. Simon said his psychiatrist ‘just sat there and stared at me … waiting for me to talk’. Jenny said, ‘the whole thing seemed a bit silly to me’ (see also Talking therapies). Bernadette said her psychiatrist was ‘hopeless’ and breached her confidentiality by speaking to her family without legal permission to do so.

Alice and Charlie spoke about their awareness of the power imbalance between themselves and the medical professionals who treated them. As Charlie said, ‘they have the power, not me’. Susana said that talking to mental health professionals was ‘kind of intimidating sometimes’. David found the ‘high-handed’ approach of his psychiatrist ‘threatening’ and felt he should have been involved and given some ‘choice’: ‘it’s my body, I want to feel in control of my body’.

Despite feeling ‘more in tune’ with herself, Alice found it difficult to speak to her doctor.

Treatment decisions

A few people we spoke to felt they were able to convey their ideas about treatment decisions to their mental health practitioner. Ann described a good relationship with her psychiatrist. She felt she would be able to ‘advocate strongly for’ herself if she wanted to stop her medication when she decides to have children. Lisa was able to talk to her doctors about stopping her medication because she felt it wasn’t helping and was worried that the side effects of weight gain might aggravate her eating disorder. She said her psychiatrist was ‘supportive of that decision’ (see also Support in treatment decisions). Others took the decision to alter their medication without their doctor’s consent and told us that they found their psychiatrist was supportive when they told them.

Allen said he doesn’t always discuss with his doctor in advance when he changes his medication, but his doctor supports him when he does.

In contrast, a few people described having negative experiences in relation to discussing treatment decisions with their mental health practitioners. Some described this as a struggle between themselves and the mental health professionals caring for them. Several people felt that if you weren’t compliant with medication or treatment decisions, mental health professionals would withdraw care. Anna said ‘There is no support. There is just judgement’ (see Community Treatment Orders, and Medication – Choice and non-compliance).

For others, the decisions made and care provided weren’t quite enough or were felt to be wrong. Simon, who is transgender, saw a social worker at a clinic when he had postnatal depression. Simon said that the social worker ‘flatly refused’ to let him see a doctor to get antidepressants.

Anna said she’d had many bad experiences with psychiatrists. She felt that psychiatrists ‘often misdiagnose’ and aren’t ready to change the treatment when it ‘doesn’t work’.

Alice described mental health practitioners as ‘risk averse’ and said this made her feel like there wasn’t ‘a lot of hope’.