Second Psychiatric Opinions: When Getting Another Expert View Helps
Receiving medical advice from multiple sources has been practiced for centuries, with wealthy ancient Romans frequently seeking counsel from several physicians.[1] And yet, seeking a second medical opinion today is sometimes perceived as patient dissatisfaction or even an accusation of negligence, and this can make people reluctant to ask for one. It can be especially difficult if you have a strong emotional bond with your psychiatrist, and don’t want to offend them or harm that relationship.[1]
Not only is obtaining a second opinion your right, but it can also help you access more beneficial treatment options. To help give you the confidence to make the right decision, this article will cover:
- When to get a second opinion on mental health.
- Unclear diagnosis for mental illness in adults.
- The benefits of second opinion psychiatry for different mental health conditions.
- How to navigate a psychiatric evaluation for a second opinion.
- What to expect from a mental health expert consultation.
When Does a Second Opinion Help Most?
Psychiatric care review options exist because second opinions are a recognized and valuable part of quality mental health care. People tend to ask for a second opinion if they don’t agree with a diagnosis or prescribed treatment and want a different doctor to review it. You might hope for:[2]
- A different diagnosis.
- Alternative treatment options.
- Treatment that is less invasive.
People often do their own research about a mental health condition and come across treatments that their psychiatrist hasn’t suggested. You might have one in mind that you’d like to be prescribed, or feel that your symptoms meet the criteria for a different diagnosis.[2]
Between 10% and 62% of second opinions lead to major changes in:[3]
- Prognosis.
- Diagnosis.
- Treatments.
However, second opinions in psychiatry are more common in certain situations than others. In some of these, an alternative medical opinion can be very beneficial.
Below are some of the circumstances that may benefit from a second psychiatric point of view.
If Your Diagnosis Is Unclear or Complex
An unclear diagnosis for mental illness in adults is a common reason to seek a second opinion. Typically, diagnoses are complicated if someone has experienced several adverse experiences in life, culminating in overlapping symptoms.
Doctors may be unclear about your diagnosis if:[2]
- They’re wondering if your symptoms will change over time to reveal a different condition.
- Your condition is possibly caused by a physical illness or the side effects of medication.
- You have downplayed the severity of your symptoms.
- You are under the influence of drugs or alcohol.
Alternatively, you might seek a second opinion when your condition is deemed “complex.” Complex mental health difficulties are not the same as severe conditions, such as schizophrenia or bipolar disorder. Complex refers to the symptoms being:[4]
- Recurring.
- Frequently unpredictable.
- Long-term.
There are often multiple factors combining to complicate the diagnosis.[4]
Anxiety, depression, personality disorders, and various other conditions can be termed complex. Diagnoses may be more complex if someone has trauma in their past, a history of substance use, or neurodevelopmental issues.[4]
Having a second opinion for more complex presentations means that symptoms can potentially be looked at more accurately. This is important because overlapping symptoms can make it harder to give a clear diagnosis.
Receiving a complex diagnosis for mental health through a second opinion can bring a fresh perspective where symptoms don’t fit neatly into a single category.
Someone with a complex mental health diagnosis may be more likely to:[4]
- Use crisis services.
- Have poor treatment outcomes.
- Act in self-harming or suicidal ways.
A second opinion can help avoid these dangerous consequences.
If You Haven’t Responded to Treatment
Research finds that when psychiatric hospitals provide second opinions for complex or treatment-resistant mental health conditions, people with affective disorders tend to improve more.[3] This group includes people with depression and bipolar disorder.
How your condition is categorized as treatment-resistant depends on the condition. For example, someone may be deemed to have treatment-resistant depression if they’ve tried two courses of antidepressants and not seen an improvement.[5] Other conditions may require a certain period of non-responsiveness to treatment, such as 90 days.
A second opinion for depression treatment is particularly valuable for treatment-resistant conditions. In these situations, a fresh perspective may identify treatment options that haven’t yet been considered.
If You Have a Rare Condition
If your condition is rarer, you may wish to see a specialist instead of a general psychiatrist. For example, rarer sleep disorders, variations of psychosis, psychosexual disorders, and culture-bound disorders tend to be less researched than more commonly occurring conditions.[6]
Expert psychiatric consultation for adults with rare conditions can connect you with clinicians who have specialized knowledge of what treatment you need.
If You Have Been Recommended a High-Risk Treatment
You may seek a second opinion if a doctor has suggested a high-risk treatment. However, what you deem “high-risk” can be a personal judgment. For example, you may feel reluctant to begin a course of antipsychotic medication due to the side effects. Other treatments that may feel invasive include:
- Electroconvulsive therapy (ECT).
- Benzodiazepines.
- Ketamine therapy.
- Inpatient stays.
While these approaches can be effective, it’s important that you feel safe and comfortable with the treatment you’re receiving. This kind of mental health treatment uncertainty is a legitimate reason to seek another perspective before proceeding. It can help reassure you about the treatment, so you can make a well-informed decision.
Benefits of a Second Opinion in Psychiatry
The benefits of a second opinion in psychiatry can be felt in a range of different situations and different mental health conditions.
Alternative Diagnoses
When there has been a misdiagnosis of mental illness conditions, a second opinion can be truly life-changing. You may receive a new diagnosis that better explains your symptoms and opens up access to more effective treatments.
For example, someone with complex PTSD may have been misdiagnosed with a personality disorder. Correcting this could open the doors to more trauma-informed therapy, helping to improve symptoms of post-traumatic stress.[7]
Medication change
Changing psychiatrists’ advice as a result of a second opinion could lead to a new medication being prescribed. For example, a 2009 study found that:[3]
- About 5% of ADHD prescriptions exceeded safety thresholds.
- Over 50% of second opinions led to prescription adjustments.
Medication changes can be instrumental in reducing symptoms effectively and addressing more extreme side effects.
Specialized psychotherapy
If you have received a complex diagnosis for mental health, help from a second psychiatrist may lead to a referral to specialized counseling or psychotherapy.
For example, someone with a PTSD diagnosis may be referred to Eye Movement Desensitization and Reprocessing (EMDR) therapy, which can help reprocess traumatic memories.
Less commonly prescribed treatments
A second psychiatrist may refer you for treatment that is offered less commonly, especially if your condition has been resistant to treatment so far. For instance, people with treatment-resistant depression may be offered ketamine therapy or transcranial magnetic stimulation.[5]
How to Get a Second Psychiatric Opinion
Getting a second opinion requires you to be transparent, brave, organized, and prepared for anything. Understanding how to navigate a psychiatric evaluation for a second opinion can make it feel less daunting. Here are our top tips for approaching this situation:
1. Be Transparent About Your Intentions
Understandably, seeking a secondary mental health expert consultation may feel awkward. If you have a good relationship with your psychiatrist, you might worry about hurting their feelings if you express your wishes to get additional advice.[1]
You might also feel reluctant to engage with yet another mental health professional if you’ve experienced stigmatization because of your condition. Understandably, some people expect to experience embarrassment and suffering in healthcare settings.[3]
But getting another therapist’s opinion doesn’t have to damage your existing therapeutic relationship. Most clinicians recognize the value of collaborative care, and different physicians have different opinions. This keeps the field alive with innovation and creativity, and competent healthcare practitioners will support your decision to get as much help as possible.[1]
During the initial conversation, be transparent. You don’t have to give a complete explanation, and can simply say that it’s for your peace of mind. You can thank them for their efforts so far and state that you just don’t want to leave any stone unturned.[1] They may even offer to refer you to a colleague in a different area of expertise.
2. Collect Your Medical Records and Share Your Concerns
A second psychiatrist will need to have all the facts. Ensure they have your complete medical records, lab results, and any imaging that has been obtained by previous psychiatric assessments.[1]
When you meet the new physician, make sure you explain your journey so far. They will be best able to support you if they know about your concerns and wishes.[1]
3. Be Prepared for Anything
While you may very well receive a different diagnosis or more effective treatment, there is a chance that you won’t. The second opinion may be the same as the first or even a prognosis that is harder to take.[1]
There is often a fine balance between hoping for good news and mentally preparing for the unexpected. Changing psychiatrists isn’t always necessary, and sometimes a second opinion that confirms what you already knew can be reassuring.
Mission Connection is here to help you or your loved one take the next steps towards an improved mental well-being.
Get an Expert Second Opinion With Mission Connection
Getting the most accurate diagnosis and most helpful treatment for your mental health condition can be a difficult journey to navigate. However, once you find it, you’re more likely to find long-lasting symptom relief.
At Mission Connection, personalized mental health care is our priority. That means that we welcome your treatment preferences and desire to receive medical advice from multiple practitioners.
We offer flexible outpatient treatment programs in several formats, including in-person, by virtual telehealth, and a hybrid approach that combines in-person and virtual care.
Reach out to us online or call 866-833-1822 to learn more about how we can support your well-being.
