When my psychiatrist quit and I found a better one

This is a composite story, drawn from common experiences shared in the schizophrenia community. It does not depict a real individual.

I am 48, a woman, and I live in a small city in Maine. I have schizophrenia. Two years ago, the psychiatrist who had been treating me for eight years sent me a letter. She was leaving private practice to take a hospital administrative position. Her last day in clinic was sixty days away. The letter included a list of resources, a promise to refill prescriptions until I had a new prescriber, and a sentence about how much she had appreciated working with me. I read the letter three times. I cried. I was furious.

I want to write about what happened next, because the loss of a long-term psychiatrist is one of the most destabilizing things that can happen to a person with serious mental illness, and the literature on it is thin. I also want to write about the unexpected ending: my new psychiatrist, the one I found after a stressful three months of searching, is better than the one I lost.

Why the loss was so hard

My old psychiatrist knew my history. She knew which medications I had failed, in what order, with which side effects. She knew the names of my parents. She knew what my voices sounded like when they were active. She had been the steady presence across two job changes, three apartment moves, and a hospitalization. The relationship was not a friendship — she was a careful, somewhat formal clinician — but it was a kind of trust that takes years to build. The thought of starting over with a stranger felt like being asked to relearn a language.

The first thing I did, after I cried, was email her and ask for a transition appointment. She gave me ninety minutes the following week. We made a written summary of my treatment history, my current medications, my known side effect profile, my early warning signs, and my preferences. I left her office with a three-page document. That document became the most important asset of the search.

The search

Step 1: I took my own emotional temperature

My therapist suggested an extra session that week. We talked through the fact that I was, on top of being scared, angry. I had to separate the anger from the search. Walking into a new psychiatrist's office while still grieving the old one would not help me evaluate the new one fairly.

Step 2: I made a list of what I needed

What I needed in a new psychiatrist:

• Experience with schizophrenia specifically, not just general mental health.
• In-network with my insurance.
• Within forty-five minutes of my home.
• Willing to coordinate with my therapist of fifteen years.
• Open to discussing long-acting injections, which my previous psychiatrist had been reluctant to consider.
• Available for refills and basic questions between appointments.

The list became my interview rubric.

Step 3: I sourced names

Three sources:

• My therapist. She had referred clients to four psychiatrists in the area. She told me which two she would send a family member to.
• My insurance company's directory. Useful but partial. Many of the listed psychiatrists were not taking new patients. Many had wait times of four to six months.
• NAMI. The local affiliate maintained an informal list of clinicians their members had had positive experiences with. I called the helpline and asked. They sent me a list of seven names.

I had a starting list of about a dozen names. I cross-checked each against my insurance. Five remained.

Step 4: I made calls

Four of the five offices took my information and put me on a waitlist. The fifth, after I explained that my prescriber was leaving in eight weeks and I needed continuity, offered me an "intake consultation" two weeks later. Some practices have a faster pathway for transferring patients than for new diagnostic intakes. It is worth asking.

Step 5: I prepared

I brought to the first appointment with each candidate:

• The three-page transition summary from my old psychiatrist.
• A list of my current medications with doses and start dates.
• A copy of my insurance card.
• A printed list of my early warning signs and my crisis plan.
• A short list of questions I wanted to ask the candidate.

The questions, in order:

1. How many patients with schizophrenia do you typically see in a week?
2. What is your approach to long-acting injections?
3. How do you handle prescription refills between appointments?
4. Are you willing to coordinate with my therapist?
5. What happens if you go on vacation or leave practice?
6. Are you open to second opinions on medication changes?

I had read the piece on finding a good psychiatrist and used it as my framework.

The two interviews

The first candidate was a younger psychiatrist who had done a fellowship in psychotic disorders. He answered every question carefully. He was open to long-acting injections. He coordinated routinely with therapists. His office had an after-hours number for refill questions. The appointment was forty minutes and I left feeling like I had been listened to.

The second candidate, a few weeks later, was an older psychiatrist with thirty years of experience. He was kind, but his answers were less specific. He saw schizophrenia patients, but not many. He preferred not to do long-acting injections. He took six weeks of vacation a year with no on-call coverage. I left feeling like I had been processed.

The choice was clear.

The first six months with the new psychiatrist

I was anxious for every one of the first three appointments. He was patient with the anxiety. We did not change my medications for the first six months — he wanted to see my baseline before adjusting anything. He did, in month four, suggest a long-acting injection of paliperidone. We talked it through. I switched. I have been on it ever since. My old psychiatrist had been reluctant to discuss this option, partly out of habit. The switch has reduced the cognitive load of daily medication and improved my adherence on bad weeks.

The new psychiatrist also coordinated with my therapist directly, which my old one had not done. They had a fifteen-minute call before our first appointment. The continuity of care was, suddenly, smoother than it had been in years.

What I learned from the transition

• The loss of a long-term psychiatrist is real and worth grieving. Do not minimize it.
• The transition is also a chance — sometimes the only chance — to evaluate whether your previous care was as good as it could have been. Mine was good, but the new fit is better.
• A written summary of your treatment history is the single most valuable asset of the search.
• Ask interview questions. You are interviewing the prescriber as much as they are interviewing you.
• Use NAMI, your therapist, and your insurance directory as parallel sourcing channels. None of them alone is sufficient.
• Tell your prescriber early when you are anxious about transitioning. The good ones will name it and slow down.

What I would say to someone whose prescriber is leaving

• Ask your departing prescriber for a transition appointment and a written summary. Most will say yes.
• Make sure you have at least 90 days of medication on hand or in refills before the last day.
• Start the search immediately. Wait times are longer than you think.
• Use multiple sourcing channels. Your therapist, your insurance, and NAMI together cover more than any one alone.
• Bring documents to the first appointment. The more your new prescriber knows on day one, the faster the relationship becomes useful.
• Allow yourself to grieve. The relationship was real. The new one will become real too, in time.

For more, see finding a good psychiatrist, switching prescribers, and learning to trust a new psychiatrist.

This article is for educational purposes only and is not medical advice, diagnosis, or treatment. Always consult a qualified mental health professional. If you or someone you know is in crisis, call or text 988 in the US, or your local emergency number.