What is a psychiatric second opinion —
and when should you get one?

What a psychiatric second opinion is

A psychiatric second opinion is an independent clinical assessment of your mental health situation by a psychiatrist who has not previously been involved in your care. It may cover:

• Your current diagnosis — whether it is accurate, complete, or whether something has been missed
• Your current treatment plan — whether the medications you are on are appropriate, optimal, or still indicated
• Your psychiatric history — a fresh review of the full picture, often revealing patterns that were not visible to previous clinicians
• Specific questions — for example, whether a particular medication should be continued, whether a different diagnosis better explains your experience, or whether deprescribing is clinically appropriate

A second opinion is not a complaint about your current clinician. It is a standard clinical process — routinely used across all areas of medicine — that ensures no single clinical perspective goes unchallenged when the stakes are significant.

When to seek a psychiatric second opinion

There is no strict criterion for when a second opinion is warranted — it is your right as a patient to seek one at any time. That said, the following situations are particularly common reasons people seek independent psychiatric review:

• Treatment is not working — you have tried multiple antidepressants or other treatments without adequate response, and something feels missing from the clinical picture
• You question your diagnosis — the diagnosis you have been given does not fully fit your experience, or a new possibility has been raised (such as ADHD, bipolar spectrum, or a trauma-related presentation) that has not been properly explored
• Long-term medication without review — you have been on psychiatric medication for years and nobody has properly reassessed whether it is still appropriate
• Significant side effects — your medication is affecting your quality of life and your concerns have not been adequately addressed
• You want to reduce or stop medication — and your current clinician has not engaged seriously with this request
• A major clinical decision is pending — such as a change in medication, an augmentation strategy, or a recommendation for a more intensive intervention
• You simply want reassurance — that the plan you are on is the right one. This is a perfectly valid reason for a second opinion

What happens during a second opinion consultation

A thorough psychiatric second opinion typically involves:

• A review of any previous psychiatric letters, clinic notes or GP summaries you bring (useful but not essential)
• A thorough clinical interview covering your psychiatric history, developmental background, current symptoms, medications and treatment history
• The psychiatrist's independent clinical formulation — their understanding of what is going on and why
• An honest account of whether they agree with the current diagnosis and treatment, and if not, why not
• A written report summarising their findings and recommendations, which you can share with your GP or current treating team if you wish

At our clinic, initial second opinion consultations are 90 minutes. This is the time we believe is necessary to form a meaningful independent clinical view rather than simply rubber-stamping what has come before.

Do I need a GP referral?

No. You can self-refer to a private psychiatrist for a second opinion without a letter from your GP. A GP letter or previous clinic notes are helpful because they provide clinical context, but they are never a requirement for a private second opinion.

If you do have previous psychiatric letters, bringing copies to the consultation allows the psychiatrist to review the clinical reasoning behind previous diagnoses and treatment decisions — which often provides valuable context.

Will my current clinician be told?

Only with your explicit consent. Nothing from a private psychiatric second opinion is shared with any other clinician, including your GP, without your permission. You are completely in control of who knows you have sought an independent view.

Many people choose to share the second opinion report with their GP or NHS psychiatrist — and find it opens up productive conversations that would not otherwise have happened. Others prefer to keep it private. Both are equally valid choices.

What if the second opinion disagrees with my current diagnosis?

If an independent psychiatrist reaches a different clinical view, they should explain their reasoning clearly — what they see differently, what evidence supports their view, and what they would recommend instead. A good second opinion is not about confirming or denying the existing diagnosis as a matter of course. It is about forming an independent view based on a thorough assessment.

Disagreement between clinicians is not unusual in psychiatry — particularly in complex presentations where the boundary between diagnostic categories is genuinely unclear. A second opinion that reaches a different conclusion is not necessarily "right" and the original view "wrong" — it is additional clinical perspective that allows you to make a more informed decision about your care.