Psychiatric Treatment Explained: What It Involves, Who Decides, and What It Cannot Do
Psychiatric Treatment Explained: What It Involves, Who Decides, and What It Cannot Do
People rarely ask me whether treatment works. They ask, in one form or another, what will be done to them.
That is a reasonable thing to want to know, and it is startlingly hard to find out. Most of what is written about psychiatric treatment in this country is either a list of frightening words or a page trying to sell something. Very little of it simply describes the thing.
So this page describes the thing. Not a particular treatment — the shape of the whole process, from the first appointment to the day someone stops. The detailed pages sit underneath it.
The short answer
Psychiatric treatment is three moves repeated: work out what is going on, agree a plan, review whether it is working. That is genuinely the whole architecture.
The plan is built from four things. Conversation-based treatment. Medication. A small group of physical treatments, of which ECT is the one people have heard of. And, occasionally, admission to hospital.
Most people need one or two of those. Many need them for a defined period and then stop. Almost nobody needs all four.
The shape of it
A first consultation is a long conversation — history, questions, sometimes a brief physical check, sometimes blood tests to rule other things out. It usually ends with a working understanding rather than a firm label, because psychiatry has no confirmatory test and an early diagnosis stated too confidently can follow a person for decades.
Then a plan, discussed rather than announced. Then a follow-up sooner than most people expect — often two or three weeks — because early on the question is how you are tolerating treatment, not yet whether it is working.
After that the appointments space out. And at some point, for most conditions, there is a conversation about stopping, which is a stage of treatment in itself and not simply the absence of one.
— More on the beginning: what happens at the first visit.
The four things treatment is made of
Talking therapy
A structured course of conversations with a trained person, aimed at a specific problem, usually counted in weeks rather than years. It is not advice and it is not friendship for a fee. For milder depression and most anxiety problems it stands up well against medication; for obsessive-compulsive disorder a particular form of it is a core part of treatment rather than an optional extra.
Medication
Works on the biological floor of an illness — sleep, appetite, energy, the physical weight of the thing. Most psychiatric medicines take weeks rather than hours, most are not habit-forming though one group genuinely can be, and side effects are real and usually adjustable. The commonest reason treatment fails is not that the medicine was wrong. It is that someone stopped it alone, in week two, without telling anybody.
ECT
The treatment carrying the heaviest load of myth, most of it inherited from films made before modern practice existed. It is given under anaesthesia, it is used in a narrow set of situations — severe illness, refusal to eat or drink, high risk, when other treatments have not worked — and it is not a punishment or a last resort in the way people imagine.
Admission
Uncommon, and far less dramatic than the picture in most people’s heads. It is considered when someone cannot be kept safe or cannot be treated at home, and in India it is governed by law that is written to protect the person being admitted. Admission is not decided in a corridor and it is not decided by a family alone.
Who actually decides
You do, in almost every case, and this is not a courtesy.
The Mental Healthcare Act, 2017 gives a person the right to information about the treatment being proposed and its likely effects, the right to confidentiality, and the right to refuse. Those rights do not switch off because someone is unwell. They narrow only in specific, defined situations, with safeguards written around them.
In practice this means you can ask why. You can ask what else there is. You can say you want to think about it. You can ask for a second opinion, and a doctor who is offended by that request has told you something useful.
— The law in plain words, and what the safeguards actually are — see Your Rights and the Law.
How long does treatment take
It depends on what is being treated, and I would rather give you the range than a comfortable number.
A single episode of depression or anxiety is usually treated for a defined period that continues past the point where you feel well — and that continuation is the part people abandon, because feeling better feels like the finish line. It is not. For recurrent illness, or for conditions like bipolar disorder or schizophrenia, treatment is often longer term, and that is a real decision with real costs, reviewed periodically rather than imposed once and forgotten.
If you have been on the same treatment for years and nobody has re-examined whether it is still needed, that is a legitimate thing to raise. Not a confrontation. A review.
What good treatment looks like
A rough test. None of these are dramatic and all of them are checkable.
— You were told what is thought to be happening — or told honestly that it is not certain yet.
— You know what each medicine is for, and roughly when it should start working.
— You were told the common side effects before you experienced them, not after.
— You have a follow-up date, not “come when necessary”.
— Nobody promised you a cure, a percentage, or a timeline that sounded too clean.
— You were not told to stop medicines prescribed by your physician for something else.
— Your questions were answered without irritation.
If several of those are missing, that is worth raising. Ask directly. It is your treatment and the information belongs to you.
What treatment cannot do
This part gets left out, and leaving it out is how people end up disappointed in something that was actually working.
Treatment does not fix an unhappy marriage, a job that is grinding a person down, a debt, or a house where somebody drinks. It can make a person able to face those things. It cannot remove them.
Grief is not an illness and does not need treating, although it sometimes turns into one and then it does. Personality does not change. And treatment does not make life pleasant — it aims at getting a person back to their own baseline, whatever that was, which for some people was never especially cheerful.
I say this to patients early, because expectations set too high are the second commonest reason people stop.
One arc, from the outside
A man in his fifties came in unable to sleep, having lost eleven kilos, convinced he had ruined his family financially. He had not. The accounts were fine. No argument about the accounts made the slightest difference to him, which is itself the point.
Treatment took the shape this page describes and nothing more inventive than that. Assessment. A plan he agreed to, after asking a great many questions and going home to think about it for a week. Review at three weeks, when he was no better and quite discouraged, which is the ordinary experience at three weeks. Review again, at which his wife said he had started reading the newspaper again.
Months later he told me the newspaper had been the moment he believed it. Not the day he felt well. The day he did something small without thinking about it first.
This account is fictional and composite. It is built from patterns seen in practice and does not describe any individual patient.
What to do next
— If you have not started yet, read what happens at the first visit. It removes more hesitation than anything else here.
— If you have been prescribed something and are uneasy about it, read the page on medicines before you stop it.
— If you are deciding between therapy and medication, read the therapy page. The choice is usually not the one people think it is.
— If ECT has been raised for someone in your family, read that page rather than searching the phrase. What you find elsewhere will mostly be forty years out of date.
— Write your questions down before the appointment. Everybody forgets them in the room.
Sources
Mental Healthcare Act, 2017 (India) — rights to information, confidentiality, and to refuse treatment.
Indian Psychiatric Society — Clinical Practice Guidelines, on assessment, treatment planning and duration.
World Health Organization — mhGAP Intervention Guide, on treatment planning and follow-up.
This page is educational and general. It cannot diagnose anyone, it is not treatment advice for your situation, and it does not replace a consultation with a qualified doctor.
If you or someone near you is in crisis right now, call Tele-MANAS on 14416 or 1800-891-4416. Free, any hour, available in Marathi.
About the author
Dr. Muktesh Daund is a Consultant Psychiatrist and De-addiction Specialist practising in Nashik since 2016. MBBS, Dr. Vaishampayan Memorial Government Medical College, Solapur. DNB Psychiatry, LGBRIMH Tezpur, an autonomous institute under the Ministry of Health and Family Welfare, Government of India. Maharashtra Medical Council registration 2009/02/0243. Life Fellow, Indian Psychiatric Society. Life Member, IMA Nashik.