Taking the first step: What to expect

So, you've decided to approach a healthcare provider about getting help for your mental illness. This is the biggest and best step you can take, so if you are at this point, congratulations!
This step is scary, and often it's a fear of the unknown. Are they going to lock me in an asylum and throw away the key? Will they judge me?
Here's what to expect from that first appointment.

1) Preparation
Before you go, you may want to write everything down that you might forget or feel embarrassed saying out loud. This can include any symptoms you've experienced, anything that triggers you or anything you think your doctor should know. Don't be afraid to write everything down. Your doctor may not have time to read it through with you if you have limited appointment time, but the more information they have at their disposal, the better for you.

2) Coming out with it
For me, this was the hardest part. How do you say "I'm depressed"? Written down, it's so easy, but to say it to a stranger like that? Not so much.

Credit to Hyperbole and a Half

If this part is really scary for you, write it down. You could even just write down your symptoms and let the doctor work it out from that.Otherwise, the basics work just fine. 

"I have been feeling very down lately"

"I've been having panic attacks and feeling very anxious quite a lot"

"I think I am depressed, can you help?"

My tip here is that the doctors have heard it all before, a LOT of times. 1 in 4 people has a mental illness, they have seen thousands of people who have said something similar, there is nothing to be embarrassed about.

3) The questioning

Your doctor is obligated to ask you some questions at this point which may seem completely irrelevant to you. Your doctor has to ask these questions, so just answer honestly.

Do you drink, smoke or take any illegal drugs? 

This is important because excessive alcohol intake can effect the brain, it is a depressant after all. Illegal drugs can also lead to mental issues and it is important to rule them out, or take them into account as a factor, straight away.

Have you had any thoughts of injuring yourself, or others?

It's quite obvious why they ask this question. Your safety is first and foremost. Saying yes to this question does not mean you will be sectioned. There are plenty of other factors that come into being put into a mental institution and this question alone will not do it. I have personally answered yes to this question before. Being honest just allows them to treat you well.

Do you have any history, or family history, of mental illness? 

This question is especially common if you are suffering from symptoms of schizophrenia or other mental illness that is shown to run in families. You will not implicate your family if you answer yes to this question.

Do you take medication for, or suffer from, any other illnesses? 

Your doctor may not need to ask this if they have your full medical history, but they may check anyway. They mean any illness. They're checking to make sure you don't have a history of, say, thyroid problems, that could cause depression, or are on any medication that can cause mental problems. 

4) The further questioning: Paper edition

At this point, especially if you have mentioned depression or anxiety, your doctor is probably going to produce a GAD-7 (PDF), PHQ-9 (PDF) and possibly a HAM-D (PDF). They may ask you to fill in a CDRS-R (PDF) if you are under a certain age (usually under 12). 

An example of GAD-7 questions

These are short questionnaires that are widely used as diagnostic tools in mental health. Answer these questionnaires honestly, and do not second guess yourself. Often your initial reaction to the question is the most accurate one. The doctor is not judging you on your answers, you do not need to artificially inflate your score to get help, nor deflate it to make yourself seem less 'sick'.

5) Treatment: The options

Before this part, your doctor may schedule you for blood tests. This may seem stupid, since after all you have mental problems, not physical ones, but they are for a good reason. Some illnesses, such as thyroid insufficiency or vitamin deficiency, can cause symptoms that mimic mental illness. It is important your doctor checks for these. However, if you have not said you sleep excessively, or too little, or have trouble eating, they may not feel this necessary. 

By now, your doctor may have mentioned what diagnosis they would suggest for you. They may not. Don't worry too much either way, after all it is just a label and the treatment is most important. Here are some options for what they may suggest:

Medication 

Celexa (Citalopram), Prozac (Fluoxetine) or Lustra (Sertraline) are the most common, in my experience, but any SSRI (Selective Serotonin Reuptake Inhibitor) may be prescribed to you. If you have any queries about the medication, now is the time to ask, or let your doctor know. SSRIs do have side-effects, but mostly I would suggest they are better than the depression and/or anxiety that you may already be suffering. Your doctor may start you on 10mg or 20mg of these drugs daily, or may go straight for a higher dose of 40mg or upwards. 

Prozac effect on CDRS-R score Vs. Placebo (non-medication). Lower is better!

Therapy

In England especially, this is a rarer option. This is a shame because it is very successful, but funding is lacking. You may be offered CBT (Cognitive Behavioural Therapy), counselling, or psychotherapy. Certain types of therapy won't work for some people, and it is important you stick with it, and try other things, if you do find the type of therapy you are receiving isn't working for you.

Research suggests that a combination of both medication and therapy will be most successful in treating depression and anxiety, and research differs for other mental disorders. Personally, I found a combination of Citalopram and CBT worked for me, whilst Fluoxetine and Counselling did not. 

6) Follow-up

Keep in touch with your healthcare provider! I cannot emphasise this enough. If you are in England, try to stay with the same GP and keep them updated on your progress. If you are on medication you will likely be asked to go back for check-ups anyway, but if you aren't, go anyway.

Always stick to what they have provided you as treatment. Do not come off your medication without the help of your doctor, and especially do not do it cold-turkey. SSRI Discontinuation Syndrome is real and quite unpleasant. If you decide you would like to come off, allow your doctor to wean you off slowly. 

If you find that your therapist, or type of therapy, aren't a good fit for you, tell your doctor. Again, try not to just stop going. It is important to stick to a routine with these things.

If you feel your doctor isn't helping you enough, or just isn't for you, try to find a way to change. In England, this is as easy as seeing a different GP at the same surgery, or swapping surgeries. 

Personally, I saw a GP who was quite rude and abrasive, and later saw a different GP at the same surgery who ultimately helped me get the best treatment I have every received. Try not to get disheartened. 

Do you have experience of healthcare providers and mental health? Was it positive or negative? Did anything happen in your first appointment that I haven't mentioned? Let me know!