Seeking psychiatric care for the first time takes courage. Many people put it off for months — or years — because they're not sure what to expect, worry they'll be judged, or fear being immediately put on medication they don't want. I've been practicing psychiatric nursing for over a decade, and I've seen the difference it makes when patients come in knowing what the appointment will actually look like. So let's demystify it.
Here is exactly what happens during a comprehensive psychiatric evaluation at Portland Mental Health & Psychiatry.
Before You Arrive
We'll send you intake paperwork to complete before your appointment — typically through a secure online patient portal. This includes standard health history forms, symptom questionnaires (like the PHQ-9 for depression and GAD-7 for anxiety), medication lists, and consent forms. Completing these beforehand lets your provider spend appointment time on conversation rather than paperwork.
What to bring:
- A list of your current medications and dosages (including supplements)
- Names of any prior mental health providers and approximate dates
- Any relevant records or prior diagnoses, if available
- Your insurance card and a photo ID
- A brief sense of what brings you in and what you're hoping to get from treatment
The First 30 Minutes: Your Story
The evaluation starts with your provider asking an open-ended question — something like "Tell me what's been going on" or "What brings you in today?" This is intentional. We want to hear your experience in your own words before we start asking structured questions.
You might talk about your mood, your energy, your sleep, things that have changed, relationships, work, or anything that feels relevant. Your provider will listen, ask follow-up questions, and begin to form a clinical picture of what you're experiencing and how long it's been going on.
This part of the visit is not rushed. You won't be cut off or handed a checklist. The goal is understanding you as a whole person, not just cataloging symptoms.
The Middle Section: Structured Review
After the open narrative, your provider will ask more targeted questions to make sure nothing important is missed. This is the diagnostic portion — a systematic review of mental health symptoms, medical history, and relevant personal history. It covers:
- Current symptoms: Depression, anxiety, mood instability, psychosis, OCD, trauma responses, ADHD, eating, sleep, substance use
- Mental health history: Prior diagnoses, prior treatment, hospitalizations, crises
- Medication history: What you've tried, at what doses, for how long, what helped and what didn't
- Medical history: Relevant medical conditions, thyroid function, neurological history
- Family history: Mental health conditions in first-degree relatives, which can inform diagnosis and medication choices
- Social history: Living situation, relationships, work, trauma history, substance use
- Safety: Your provider will ask directly about thoughts of self-harm or suicide — not to alarm you, but because it's a standard, important part of every psychiatric evaluation
The Last 20–30 Minutes: Diagnosis and Treatment Plan
After gathering your history, your provider will share their clinical impressions and proposed diagnosis with you. This isn't a pronouncement handed down from on high — it's a conversation. You'll discuss whether the diagnosis makes sense to you, ask questions, and together develop a treatment plan.
The treatment plan might include one or more of the following:
- Starting, adjusting, or continuing medication
- Referral to therapy (with a specific modality recommendation)
- Further evaluation — labs, neuropsychological testing, specialist consult
- Referral for interventional treatments (TMS, Spravato) if indicated
- Lifestyle recommendations (sleep hygiene, exercise, alcohol reduction)
- A follow-up schedule
You will leave with a clear next step. That is the standard at our practice — no one leaves unsure of what comes next.
Will I Be Prescribed Medication?
Not necessarily. Some patients leave their first appointment with a new prescription. Others leave with a plan that involves therapy, further evaluation, or monitoring before starting medication. Some leave with a referral for TMS or Spravato evaluation instead of medication.
Medication is never prescribed without your understanding and agreement. We'll explain what the medication is, how it works, what to expect, common side effects, and what to do if you have concerns. You are always a partner in these decisions.
Frequently Asked Questions
Ready to Schedule Your Evaluation?
New patient psychiatric evaluations are conducted in-person at our Portland clinic. We will verify your insurance before your visit.
Request a Psychiatric Evaluation