Most people wouldn’t think twice about getting a second opinion for a physical health concern. But when it comes to mental health, it can feel like a more difficult decision. You might worry about offending your therapist or feel like questioning a diagnosis means you’re being a difficult patient.Â
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But a fresh pair of eyes looking at your treatment approach is perfectly acceptable and, in many cases, encouraged. Understanding when to get a second opinion on mental health can be the difference between years of ineffective treatment and finally finding the right path forward. To help explain why, this page will cover:
Mental health diagnoses work differently from most physical examinations and diagnoses. For example, there is no blood test for depression or a scan that confirms anxiety.Â
Diagnoses are based on a number of factors, including interviews and observed behavior, which means they rely heavily on the judgment of the person making the assessment.
Trials that tested two clinicians’ diagnoses on the same person, placed major depressive disorder at a reliability score of just 0.28.[1] To put that in context, that falls in what researchers classify as the “questionable” range. Generalized anxiety diagnoses also showed lower rates of reliability in the same trials.[1]
This doesn’t suggest that you should automatically question any diagnosis you receive. Just remember that psychiatric assessment involves a level of subjectivity that other areas of medicine don’t, and this alone makes a second opinion worth considering.Â
Mental health uncertainty around diagnosis is common, and seeking another therapist’s opinion is a reasonable response.
Not every difficulty you experience in mental health treatment calls for a full psychiatric care review, but there are specific situations where fresh eyes could genuinely change the direction of your care. Below, we look more closely at some of these situations.
You’ve followed the plan, you’ve taken the medication, you’ve engaged with the therapy, you’ve shown up to every session, and done the homework. Yet, it feels like nothing has meaningfully changed.Â
At some point, the question has to change from one of your own commitment to whether the treatment is focused on the right thing.
A review of second opinions in psychiatry found that patients with complex or treatment-resistant conditions are among the groups most likely to seek reassessment.[2] If you are in one of these groups, a second opinion could help you find a treatment approach that is more effective.
You may not be an expert in the field, but that doesn’t mean that your opinion and gut feelings are wrong. If you’ve been given a diagnosis, read about the condition, and symptoms or aspects of it don’t match your experience, that is a valid concern.Â
Your experience of your own symptoms is data, and a clinician seeing it from a different angle may interpret that data differently. While it is always worth discussing this with your own treatment team first, someone looking at your symptoms with fresh eyes may notice something your team has missed.
Complex presentations, or diagnoses with multiple overlapping conditions, are where second opinions may be especially valuable. If you’ve received a diagnosis from providers that suggests that more than one condition is present, seeking another perspective can help provide clarity.
When depression, anxiety, trauma, and attention difficulties all coexist, single-visit assessments can miss components. For example, research has found that as many as 80% of adults with attention-deficit hyperactivity disorder (ADHD) have at least one other psychiatric condition alongside it.[3]Â
Understanding the full scope of your mental health challenges can then help develop a treatment plan to address all simultaneously.
If your diagnosis was made during a crisis or very early into your treatment, it may not reflect what things look like now.
For example, if you were diagnosed with depression at 22, things may have changed when you get to 32. There is now a lot more history to draw from, meaning a new diagnosis could be in order. Research backs this up, with one study finding that roughly 40% of first diagnoses for psychosis change within the first decade.[4]Â
If the assumption is being made that your needs are still the same as they were five or ten years ago, your treatment plan may no longer be sufficient.
During a psychiatric evaluation for a second opinion, you can expect a clinician to review your full history. This will include your current symptoms, along with the areas of treatment that have and haven’t worked in the past.
Specialist clinics may go deeper and ask for family input, along with neuropsychiatric testing.[5]
The new clinician won’t be starting from scratch, as they have the same information your current provider has, but they may come to different conclusions.Â
In some cases, they may confirm what you’ve already been told, which can actually be reassuring in itself. However, they may also identify something that was missed by your current provider.
The benefits of a second opinion in psychiatry go beyond diagnosis to treatment planning and direction. Studies have found that:[6]Â
This shows a clear benefit of a second opinion, as even if the diagnosis stays the same, the way it’s treated may change for the better.
AMFM is here to help you or your loved one take the next steps towards an improved mental well-being.
Certain mental health conditions are missed far more frequently than others, but understanding where the biggest gaps are can help you assess the need for a second opinion.
This is the most well-documented misdiagnosis pairing in psychiatry. A survey of 600 people with bipolar disorder found that 69% were initially misdiagnosed, with unipolar depression being the most common incorrect label.[7]Â
Those who were misdiagnosed consulted an average of four physicians before receiving the correct diagnosis, and more than a third waited ten years or longer.[7]
It’s worth noting that this data comes from a patient survey rather than a controlled study, so the exact figure carries some limitations. But the direction has been confirmed across clinical samples, with misdiagnosis rates ranging from 40% to 75% depending on the study.[8]
Getting a second opinion on depression treatment is especially important here, as bipolar and unipolar depression require very different medications to treat. For example, prescribing antidepressants without a mood stabilizer to someone with bipolar disorder could cause manic episodes.[9]Â
A misdiagnosis of mental illness makes a second opinion not just helpful but essential in these cases.
Adult ADHD is one of the most underrecognized conditions in psychiatry, especially in women. A review found that ADHD research samples were 81% male and that women usually present with inattentive rather than hyperactive symptoms.[10] This means that women are typically diagnosed later in life than men.
ADHD symptoms in adults, such as difficulty concentrating and low motivation, overlap heavily with conditions like depression. Adults with undiagnosed ADHD may be treated for mood or anxiety disorders without the ADHD ever being identified.Â
Research has shown that untreated ADHD is associated with higher rates of antidepressant treatment resistance.[11] This could suggest that the ‘treatment-resistant depression’ label is sometimes really untreated ADHD.
Complex trauma can sometimes be misread as personality disorders or depression. This can potentially affect treatment planning and the therapy approach taken.
One review concluded that complex post-traumatic stress disorder (PTSD), now formally separated from borderline personality disorder (BPD) in the ICD-11 (International Classification of Diseases, 11th Revision), could not be understood as a subtype of either PTSD or BPD.[12]
If you carry a personality disorder diagnosis but have a documented history of developmental trauma, that could be a case where a second opinion could meaningfully change the therapeutic direction.
You might have read through this page and found that some of it resonates with you, but that other parts don’t. If you were already not sure whether a second opinion is right for you, this may have left you even more confused.
But this uncertainty is common, and everyone’s situation is different, with many individual variables to take into consideration. You don’t need to be 100% sure you need a second opinion. Many people who seek one don’t know for certain that it’s necessary.
In some cases, they may just feel instinctively that their current treatment isn’t quite hitting the mark. It could be the pace of progress or a feeling that their current diagnosis doesn’t capture the full complexities of what they’re experiencing.
And crucially, a second opinion isn’t solely to catch diagnostic mistakes. Sometimes, the most useful outcome is a mental health diagnosis confirmation, where someone looks at your needs and verifies that the current direction is the right one.
This confirmation can be just as important as change, because it removes any doubt that may have been undermining your ability to commit fully to the treatment.
If you’ve been feeling uncertain about your diagnosis, even if you’re not quite sure why you feel this way, it’s still something worth acting on.
Even with all of the information covered, it can still feel scary to ask for a second opinion. If it’s not the worry about offending your therapist, it’s also the confusion about how to begin the process.
Below, we take a look at the different ways you can go about getting a second opinion in psychiatry.
Telling your therapist that you’d like another perspective is a big step, and a good clinician will support it.Â
The American Medical Association’s (AMA) code of ethics lists the right to obtain a second opinion as an explicit patient right.[13] Most providers welcome the additional input because it gives them more information to work with.
Specialist expertise is important if you’re looking for a second opinion. For example, if you suspect ADHD might be part of the picture, you will want to see someone who specializes in ADHD rather than a general therapist whose focus is somewhere else.Â
This follows the same logic as physical health, where you should get a mole on your arm checked by a dermatologist rather than a dentist. Both are experts in their own field, but it’s always best to consult an expert.Â
Research supports this, with the highest diagnostic yield coming from consultations at focused services rather than general practice.[14]
A full psychiatric evaluation takes time, and you should expect a thorough interview rather than a brief chat. The clinician will review your history and conduct more testing if needed.Â
At the end of the process, you’ll likely have some of the following:Â
Any of these outcomes is valuable, so don’t be disheartened if the results are not what you expected.
If anything on this page has raised questions about your treatment so far, getting a second opinion could be the right next step for your mental health. Remaining uncertain about which direction your treatment is heading can cost you the time that could be spent on getting the answers you need.
AMFM (A Mission For Michael) Mental Health Treatment provides mental health care for adults managing a range of conditions. Our mental health consultation services are built around evidence-based approaches, and our clinical team is experienced in providing accurate second opinions.
We offer residential treatment programs at our locations across the U.S., which are designed for those who need the structure of a full-time therapeutic environment to work on their mental health. We also offer flexible outpatient treatment options for those who need support that fits in around their daily life.
AMFM Mental Health Treatment accepts insurance and is in-network with most major insurance providers. To check your insurance coverage for mental health care, simply complete our confidential online verification form or call us at 866-478-4383.
If you’re looking for a full diagnostic reassessment or just a new perspective on a treatment plan that’s hit a roadblock, our team can help you work out what the next steps look like.
Contact us today, and a compassionate member of our team will be more than happy to talk about the options available to you.
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At AMFM, we strive to provide the most up-to-date and accurate medical information based on current best practices, evolving information, and our team’s approach to care. Our aim is that our readers can make informed decisions about their healthcare.
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