At a first psychiatric appointment, every question has a job. Your provider isn’t filling in a form. They’re looking for patterns: when things started, what makes them better or worse, and what else could explain them. Knowing why a question is asked makes it easier to answer it honestly, and honest answers lead to a better plan.
Our first visit takes 60 minutes. That’s a lot of talking, and some questions can feel personal or oddly specific. So here is what we ask, what we’re really listening for, and why it matters to your care.
What we ask, and what we listen for
The American Psychiatric Association has guidelines for how a first evaluation of an adult should go. American Family Physician’s summary lists what they cover, from mood and sleep to trauma, safety, and your own goals for treatment. Here’s how those topics sound from your chair.
“What brought you in, and why now?”
This is usually the first question, and the “why now” part matters most. Maybe you’ve felt low for years and a new job made it harder to hide. Maybe something changed a month ago. The timeline tells us whether we’re looking at a long pattern or a recent shift. We also want to hear what you want from the visit. Better sleep? Fewer panic attacks? Being able to focus at work? Your goal shapes the plan as much as any symptom does.
How have you been sleeping?
People are often surprised by how much we ask about sleep. It’s because sleep is both a symptom and a clue. The National Institute of Mental Health lists trouble falling asleep, waking too early, or oversleeping as signs of depression. It also notes that symptoms need to last most of the day, nearly every day, for at least two weeks. So we’ll ask how long, not just how bad.
Have you ever felt the opposite of down?
This one can seem strange if you came in feeling sad. We ask whether you’ve had stretches of unusual energy, racing thoughts, or feeling fine on very little sleep. NIMH explains that people with one type of bipolar disorder may seek help only for their low periods, so the high ones go unnoticed. Missing that changes what a good plan looks like. That’s why we ask everyone, even when the answer is almost always “no.”
Questions about your body
We’ll ask about health conditions, recent illness, and every medication and supplement you take. According to NIMH, certain medications and medical conditions, such as thyroid disorders, can cause the same symptoms as depression. If your body is part of the story, treating only your mood would miss it. Sometimes that means we suggest lab work.
Your family’s story
“Did anyone in your family struggle with their mental health?” isn’t small talk. NIMH notes that people with a parent or sibling with bipolar disorder are more likely to develop it, though not everyone with a family history does. Family history doesn’t decide anything. It’s one more piece that helps us weigh what’s most likely. “I’m not sure” is a perfectly good answer.
The safety question
Every patient is asked about thoughts of suicide or of hurting someone else. Some people worry the question itself could cause harm. The research says it doesn’t. A 2014 review of the research found no study where asking raised suicidal thoughts. A 2018 meta-analysis of 18 studies found that being asked was linked to small drops in those thoughts. So we ask plainly, and we listen without judgment.
The hard parts of your past
The guidelines include trauma history, so we may ask about hard experiences, now or in childhood. What we’re listening for is how the past still shows up today, in sleep, trust, or feeling on edge. You decide how much to share. “I’d rather not go into it yet” is allowed, and we can come back to it later. Our page on trauma explains more.
What does a good day look like?
Near the end, we often ask about your daily life. Work or school, the people you lean on, what you enjoy. The guidelines call for looking at how you’re functioning and your quality of life, not just your symptoms. A good day gives us something to aim for, and a way to tell later on if the plan is working.
What we notice while you talk
Alongside your answers, your provider pays attention to how you seem. That means your mood, how you speak, and how clearly your thoughts flow. It’s called a mental status examination, and it happens quietly during the conversation. Our post on what a psychiatric evaluation is, and what it isn’t explains it in more detail. For what to bring and how the hour runs from start to finish, read what to expect at your first psychiatric evaluation.
Questions you can ask us
The visit goes both ways. NIMH encourages patients to speak up about their concerns and ask about other options. A few worth writing down:
- What do you think is going on, and how sure are you?
- What are my options, including ones without medication?
- How will we know if the plan is working?
- What should I do if I feel worse before the next visit?
- When is my next appointment, and is it in person or by video?
Who you’ll see, and where
Your first visit is with Irine Achuamang, MSN, PMHNP-BC, a board-certified psychiatric nurse practitioner who is accepting new patients. She sees children, teens, adults, and older adults. You can read more about how we run a psychiatric evaluation on our services page.
In person, we’re at 3646 Long Beach Blvd # 205 in Bixby Knolls, north Long Beach. Patients come from nearby cities like Lynwood, Wilmington, San Pedro, and Hawthorne. See every area we serve.
By telehealth, we do first evaluations and follow-up medication management by secure video for anyone in California, as long as you’re in the state during the visit. The questions are the same. Our guide to telehealth psychiatry in California covers how it works.
We’re in network with many major plans, and we check your benefits before the first visit. We don’t accept Medi-Cal at this time. Without insurance, the 60-minute evaluation is $250. Sliding-scale options are available, so please ask.
Ready when you are
If you’re thinking about hurting yourself, don’t wait for an appointment. Call or text 988 to reach the 988 Suicide and Crisis Lifeline, free and open 24 hours a day. If someone is in immediate danger, call 911.
When you’re ready, request an appointment and choose in person or video. Or contact our team if you’d like to ask something first.
This article is for general education and is not medical advice or a substitute for a clinical evaluation. If you are in crisis, call or text 988 for the Suicide & Crisis Lifeline. It’s free and available 24/7.