What Questions Does a Psychiatrist Ask at a First Assessment?

By Prof. Ahmed El-Missiry, MD, FRCPsych, FAPA, Consultant Psychiatrist · GMC 6032945 · Medically reviewed October 2026

Most people arrive at a first psychiatric appointment with one quiet worry: what are they going to ask me, and will I get it wrong?

You can’t get it wrong. A psychiatric assessment isn’t a test. It’s a structured conversation that lets a doctor understand what you’re going through well enough to help. The questions can feel personal, sometimes surprisingly so, but each one has a clinical reason behind it.

This guide walks through the questions you’re likely to hear, why a psychiatrist asks them, and how to get the most out of the time. It reflects how first assessments are run when you book a private psychiatrist in London with Prof. El-Missiry, and how most UK consultant psychiatrists work.

How is a psychiatric assessment structured?

UK psychiatrists are trained to follow a standard framework. It covers your history, a mental state examination, a risk assessment and, at the end, a formulation: a short explanation of what’s going on and why.

The order changes with each person. A good psychiatrist follows your lead rather than reading from a script. But these are the areas almost every first assessment covers:

Area	Typical question	Why it’s asked
What brought you here	“What’s been happening that made you want to come in?”	Puts your main concern at the centre
History of the problem	“When did you first notice this? Has it changed?”	Timing and pattern point towards some diagnoses and away from others
Mood and anxiety	“How has your mood been over the past few weeks?”	Severity and duration shape treatment
Sleep, appetite, energy	“How are you sleeping? Has your appetite changed?”	These often change early in depression, anxiety and bipolar disorder
Past mental health	“Have you had help for your mental health before?”	What worked, or didn’t, guides what comes next
Medication	“What do you take now, and what have you tried?”	Avoids repeating failed treatments and unsafe combinations
Physical health	“Any medical conditions? Thyroid, heart, head injury?”	Some physical problems cause psychiatric symptoms
Family history	“Has anyone in your family had mental health problems?”	Some conditions run in families
Life story	“Tell me a little about your childhood, school and work.”	Context explains why problems appear when they do
Alcohol and drugs	“How much do you drink in a typical week?”	Substances can cause, mask or worsen symptoms
Safety	“Have you had thoughts of harming yourself?”	Keeping you safe comes first
Your goals	“What would you like to get from today?”	Makes sure the plan fits what you want

“What’s brought you here today?”

Almost every assessment opens with an open question like this. It’s deliberately broad. The psychiatrist wants to hear the problem in your own words before narrowing anything down.

Follow-up questions then fill in the detail:

• When did it start, and was there a trigger?
• Is it constant, or does it come and go?
• What makes it better or worse?
• How is it affecting work, study, relationships and day-to-day life?

That last question matters more than people expect. Two people can have the same symptoms, but if one is still working and the other hasn’t left the house in a month, the urgency and the plan will be different.

Questions about mood, anxiety and thinking

Next, the psychiatrist explores your symptoms more closely. Depending on what you’ve described, you might be asked:

• “On a scale of 0 to 10, how would you rate your mood most days?”
• “Do you still enjoy things you used to enjoy?”
• “Do you worry a lot? Is it hard to switch off?”
• “Have you had panic attacks, with a racing heart or feeling you can’t breathe?”
• “Have there been times you felt unusually high, needed little sleep or felt full of energy?”
• “Do you have thoughts that keep coming back even though you don’t want them?”
• “Have you ever heard or seen things other people couldn’t?”

Some of these may feel unrelated to why you came. They’re screening questions. Asking about high moods, for example, helps tell depression apart from bipolar disorder, which changes treatment significantly. A “no” is useful information too.

Your past mental health and medication

The psychiatrist will want to know what’s already been tried:

• Have you seen a GP, counsellor, therapist or psychiatrist before?
• Have you been given a diagnosis?
• Which medicines have you taken, at what dose, for how long, and what happened?
• Have you ever been admitted to hospital for your mental health?

If you can’t remember doses or dates, don’t worry. Bringing your current medication boxes or a photo of the labels, plus any old clinic letters, saves a lot of time.

Physical health questions

Psychiatrists are medical doctors first, so expect questions about your body as well as your mind:

• Any long-term conditions, such as thyroid problems, diabetes, epilepsy or heart problems?
• Any head injuries or recent illnesses?
• For women, questions about periods, pregnancy, contraception or menopause, which can all affect mood

This isn’t box-ticking. An underactive thyroid can look like depression. Some heart conditions affect which medicines are safe. Part of a psychiatrist’s job is ruling out physical causes before calling something a mental health condition.

Family history

“Has anyone in your family had depression, anxiety, bipolar disorder, ADHD, addiction or psychosis? Has anyone died by suicide?”

These can be hard questions. They’re asked because several conditions have a genetic component, and knowing what runs in your family helps the psychiatrist weigh up possibilities. It can also influence medication choices: if a relative responded well to a particular medicine, that’s worth knowing.

Your life story

This is often the longest part of the conversation, and the part people expect least. You may be asked about:

• Your birth and early childhood, if you know anything about it
• School: how you got on, friendships, any difficulties
• Work history and what you do now
• Relationships, children and who you live with
• Significant life events, losses or trauma
• Money, housing or legal worries

You’re never obliged to go into detail about traumatic experiences at a first appointment. It’s completely fine to say, “Something difficult happened, but I’m not ready to talk about it today.” A good psychiatrist will respect that. If trauma does seem central, a PTSD assessment may be suggested later, at your pace.

Alcohol, drugs and other habits

“How much do you drink in a typical week? Do you use cannabis or any other drugs? How much caffeine? Do you smoke or vape?”

People sometimes minimise their answers here out of embarrassment. Please don’t. Psychiatrists ask without judgement, and the information is clinically important. Alcohol is a depressant and commonly worsens low mood and sleep. Cannabis can trigger anxiety and, in some people, psychosis. Some substances interact with psychiatric medication. If substance use is part of the picture, Prof. El-Missiry has specialist experience in addiction treatment.

Questions about safety and risk

At some point, every psychiatrist will ask about safety. It usually sounds something like:

• “Sometimes when people feel this low, they have thoughts that life isn’t worth living. Has that happened to you?”
• “Have you had thoughts of harming yourself, or acted on them?”
• “Have you had thoughts of harming anyone else?”

These questions are asked of everyone. They’re not a sign that the psychiatrist thinks you’re at risk. Asking directly about suicidal thoughts does not put the idea in someone’s head; it gives people permission to talk about something they may have been carrying alone.

Answering honestly will not automatically lead to hospital or police involvement. In the vast majority of cases, it simply means your plan includes extra support and a clear idea of what to do if things get worse.

What the psychiatrist notices: the mental state examination

Throughout the conversation, the psychiatrist is also carrying out a mental state examination. This isn’t a separate test. It’s a structured way of noting how you are in the moment:

• Appearance and behaviour
• Speech: its speed and flow
• Mood (how you describe it) and affect (how it comes across)
• Thoughts: their content, and whether they flow logically
• Perceptions, such as hearing voices
• Cognition: attention, memory and orientation
• Insight: how you understand what’s happening

You don’t need to do anything for this part. It’s simply careful observation, the psychiatric equivalent of a physical examination.

Questionnaires you might be given

You may be asked to complete short questionnaires before or during the appointment. With Prof. El-Missiry, a secure pre-assessment questionnaire is sent before your first visit, so the consultation time goes on talking rather than form-filling.

Common UK screening tools include the PHQ-9 for depression and the GAD-7 for anxiety. Questionnaires support the psychiatrist’s judgement; they never replace it. For suspected ADHD, more detailed structured tools are used, which we cover in our guide to preparing for a private ADHD assessment.

“What are you hoping to get from today?”

Toward the end, a good psychiatrist asks what you want. A diagnosis? A medication review? A second opinion? Help to get back to work? Your answer shapes the plan.

This is also your chance to raise anything you haven’t had time to mention.

How to answer: practical tips

1. Be specific. “I’ve been anxious” is a start. “I wake at 4am with my heart racing most nights and I’ve stopped taking the Tube” is far more useful.
2. Bring notes. Write down your main concerns, when they started and your current medication. It’s normal to forget things when you’re nervous.
3. Describe bad days, not just good ones. Many people present their best selves at appointments. The psychiatrist needs the full picture.
4. Don’t edit for embarrassment. Psychiatrists have heard it all before. Nothing you say will shock them.
5. Say if you don’t understand. Asking “What do you mean by that?” is perfectly fine.
6. Bring someone if it helps. A partner, relative or friend can add details you might miss. You can ask to speak alone for part of the appointment.

Questions you can ask your psychiatrist

An assessment works both ways. Before you leave, it’s reasonable to ask:

• What do you think is going on, and how sure are you?
• What are my treatment options, including ones without medication?
• If you recommend medication, what are the common side effects, and how long before it helps?
• When will I see you again, and who do I contact in between?
• Will you write to my GP? Can I see the letter?

What happens at the end of the assessment?

The psychiatrist will share their formulation: a summary of what they think is happening and why. Sometimes that includes a clear diagnosis. Sometimes they need more information first, such as blood tests, a follow-up or a report from someone who knows you well.

You’ll then agree a plan together. It might include medication, a recommendation for therapy, practical changes, further assessment, or reassurance that specialist treatment isn’t needed. With us, you receive a clinic letter summarising the assessment and plan, copied to your GP if you agree.

A first assessment with Prof. El-Missiry lasts 45 minutes and costs £250. For a full breakdown of fees, see what an assessment costs in London.

In person or online?

The questions are the same either way. You can be seen in person at our clinics in Marylebone (Nightingale Consulting Rooms, NW1 6SH), Harley Street (41 Harley Street, W1G 8QH) or Finsbury Park (17 City North Place, N4 3FU), or by secure video from anywhere in the UK. If you’re unsure which suits you, read our comparison of online vs in-person psychiatric assessment.

Frequently asked questions

Do I have to answer every question?

No. You can decline any question or come back to it later. The more the psychiatrist knows, the better they can help, but you stay in control of what you share.

Will my psychiatrist tell my GP or employer what I said?

Your employer will not be told anything without your explicit consent. Psychiatrists usually write to your GP, but only with your agreement. Confidentiality can be broken only in rare situations where someone’s safety is at serious risk.

How long does a first psychiatric assessment take?

Usually 45 to 90 minutes, depending on the clinic and the complexity. A first assessment with Prof. El-Missiry is 45 minutes, supported by a questionnaire you complete beforehand.

Will I get a diagnosis at the first appointment?

Often, but not always. A careful psychiatrist won’t give a diagnosis until they’re confident in it. Sometimes a follow-up or extra information is needed first.

What if I get upset during the appointment?

That’s very common and completely fine. Psychiatrists expect strong feelings to come up. You can take a pause, have some water, or ask to move on to something else.

About the author

Prof. Ahmed El-Missiry is a consultant psychiatrist with 30 years’ experience, trained at Guy’s and St Thomas’ and King’s College London. He is a Fellow of the Royal College of Psychiatrists and the American Psychiatric Association, works as an inpatient consultant at Nightingale Hospital, and sees patients in English and Arabic. Read his verified patient reviews on Doctify.

This article is general information, not a substitute for individual medical advice. If you are in crisis or worried about your safety, call NHS 111 (option 2), Samaritans on 116 123, or 999.