“Do I Need a Psychiatrist?”
A Thoughtful Guide for Parents, Therapists, and Patients
By Brandon Gimbel, M.D.
It was a Friday afternoon, and my schedule was clear — a rare chance to catch up on charting and return phone calls. I was typing quietly in my office when I heard a knock. Not at the front desk — at my door.
I opened it to find a woman I’d never met before.
She asked if I was Dr. Gimbel. I said yes. She introduced herself and explained that her physician had recommended she come see me — so she came right over. But she wasn’t sure why she was there.
I told her gently that we don’t do walk-ins. That I couldn’t see her right then. But I asked her what was going on, and she paused.
She said she wasn’t quite sure.
A little down. A little anxious.
And then, as if it were an afterthought, she added: “I’m not sleeping.”
That caught my attention. Insomnia can be brutal — I’ve experienced it myself. So I stepped back into my office, picked up my clipboard, and said: “Actually… I can see you now.”
An hour later, she walked out with a prescription for something to help her sleep.
And it did.
It’s Not Always Obvious When to Ask for Psychiatric Input
Many parents, patients, and even therapists or referring physicians aren’t always sure when psychiatry should be part of the picture. Psychiatrists fill a wide — and sometimes ambiguous — space in the healthcare system. We’re trained to hold uncertainty, to work in the in-between, and to think diagnostically, relationally, and medically all at once. But from the outside, it’s not always clear where we fit.
A big reason people hesitate to call is uncertainty itself. I’ve had many patients tell me they held onto my card for years before ever reaching out. The reasons vary:
Fear of stigma.
Fear of being over-medicated.
Fear that they’ll lose something essential about themselves.
Or that this step — seeing a psychiatrist — somehow makes things “official.”
At North Star, we’ve thought carefully about this. It’s why we structure all initial appointments — and for children and adolescents, the first two — as consultations.
A consultation isn’t a commitment.
It’s a conversation.
Common Signs That a Consultation Might Be Helpful
There are many reasons why a psychiatric consultation might make sense.
Sometimes, therapy has hit a ceiling — helpful in the past, but no longer moving things forward.
Sometimes, physical symptoms become harder to ignore: low energy, appetite changes, irritability, insomnia, or unintentional weight loss.
Sometimes, it’s a more urgent concern — worsening depression, self-harm, or thoughts of suicide.
School or work avoidance might show up, without a clear explanation.
So might persistent physical symptoms: headaches, GI issues, chronic stomachaches — all explored medically but still unresolved.
Emotional dysregulation can cause repeated conflict in relationships — especially with people they care about.
None of these signs automatically mean that medication is the next step.
But psychiatrists often bring a different vantage point — one that blends emotional, relational, and medical thinking.
Sometimes a consultation leads to a revised treatment plan.
Sometimes it leads to a new insight.
Sometimes, simply reassurance.
What a Consultation Actually Looks Like
A consultation at North Star usually lasts about an hour.
For children and adolescents, the structure is slightly different: we meet with the parent or guardian for about an hour, and then separately with the child or teen for another hour.
We treat these appointments as an opportunity to be curious — to understand what’s happening and what might help. We usually begin with some version of, “What’s going on?” or “What brings you in?”
Or, as a supervisor once suggested: “What hurts?”
These questions reflect our approach. We don’t begin with an agenda.
We begin by listening.
Alongside the patient’s story, we explore other parts of their background: medical history, family history, previous experiences with therapy or medication. This helps us form a fuller, three-dimensional picture — not just of symptoms, but of context and meaning.
We also offer to communicate with other providers involved in care — therapists, pediatricians, primary care doctors — and, when appropriate, family members. These additional perspectives often deepen our understanding.
And we’re able to do all of this — to ask, to listen, to think — because we have time.
Time allows us to be curious.
Time allows us to collaborate.
Time allows us to be thorough.
What It’s Not
I often say that curiosity is the antidote to judgment.
At North Star, we don’t stand across from you and evaluate. We stand beside you — and get curious together.
That means we’re not rushing to a diagnosis. We’re not racing toward a treatment plan.
We’re listening, wondering, asking.
A psychiatric consultation with us is just that: a conversation. A chance to think things through.
It is not a sign of failure.
And neither is treatment.
We are not a medication vending machine.
We don’t hand out labels.
And if we do recommend treatment, it doesn’t mean it’s permanent. You will always have a choice — and support in making it.
An Open Invitation
You don’t need to be sure you need a psychiatrist in order to meet with one.
Sometimes, a single conversation can bring clarity — about what’s needed, or what’s not.
If you’re unsure whether a psychiatric consultation might help, we’re always happy to think it through with you.