Conditions we can help with by video

When more than one thing is going on at once

Lists of conditions suggest that people arrive with one. Most do not. Low mood and anxiety travel together; ADHD often sits underneath years of treated depression; alcohol used to get to sleep worsens both mood and concentration. A single hour cannot untangle it all, so an assessment works in a deliberate order.

• Timeline first. What came first, and what has been present since childhood rather than arriving in the last two years, does most of the work.
• Physical and substance causes ruled in or out. Thyroid problems, anaemia, sleep disorders, pain, prescribed medication and alcohol all imitate psychiatric symptoms.
• The most treatable problem addressed first. If severe depression or heavy drinking dominates the picture, an ADHD or autism assessment made on top of it is unreliable; treat the acute problem, then reassess.
• Sequencing, not refusal. Being told that an assessment should wait until another problem settles is a judgement about accuracy, and the reasoning should be written down for you.

This is why an honest answer is sometimes two appointments rather than one, and why the process allows a second review.

Why a diagnosis is only part of the answer

A diagnosis is shorthand that lets clinicians share information and treatment guidelines apply to you. What it does not do is explain you. Two people with identical diagnoses can need different plans.

The part that explains is the formulation: a short account of how your difficulties arose and what keeps them going. It pulls together your early years, your physical health, how you cope, what work and relationships demand of you, and what has helped or backfired before. A diagnosis says what to call it. A formulation says why it is happening to you now, which determines whether the first move is medication, a particular therapy, a change to sleep or alcohol, or watchful monitoring.

If you leave an assessment with a label and no explanation, you have had half of it. Ask the psychiatrist to talk you through their formulation and to put it in the summary.

When the answer is therapy rather than medication

For some presentations, particularly post-traumatic symptoms, OCD, phobias, health anxiety and much of mild to moderate depression, the strongest recommendation is a talking therapy rather than a drug. Happy Clinic does not provide psychological therapy, so the outcome is a clear recommendation about which therapy, at what intensity, plus a written summary to take to the right service.

In England you do not need to wait for a referral for the most common of these. You can refer yourself to NHS Talking Therapies if you live in England and are 18 or over, which covers persistent low mood, generalised anxiety, panic, phobias, OCD, PTSD and body dysmorphic disorder. You normally need to be registered with a GP, and some areas accept 16 and 17 year olds. NHS guidance notes that some conditions still need a GP referral, including eating disorders, bipolar disorder and psychosis. In Scotland, Wales and Northern Ireland the equivalent services are reached through your GP.

Medication and therapy are not rivals. A common plan is both, in a sensible order, and a psychiatrist can advise on therapy pathways while managing prescribing. See fees for what an appointment covers.

What is outside the scope of this service

Being clear about the gaps is more useful than a longer list. Appointments promoted on this site are provided by Happy Clinic, which does not cover the following.

• Anyone under 18. Assessment and treatment are for adults only; younger people are seen through a GP referral to NHS child and adolescent mental health services.
• Dementia and other cognitive decline. Assessment needs examination, brain imaging and collateral information gathered in person, so it belongs with a GP referral to a local memory service.
• Crisis and emergency care. There is no out-of-hours or urgent response. If a life is at risk, call 999 or go to A&E. For urgent mental health help call NHS 111 and, in England, choose the mental health option. Samaritans are free on 116 123, day or night.
• Medico-legal, court and benefits reports. These need a different type of instruction and assessment; a clinical summary written for your care is not a substitute.
• Psychological therapy itself, though advice on the right pathway is part of the assessment.

If you are unsure which side of those lines you fall on, the suitability checklist is the quickest way to find out before paying.