The diagnosis may have come at the end of a short appointment, or in a letter that arrived weeks later. It may well be right. It has also followed you into every appointment since, shaping what each new clinician expects to see. Some people want it confirmed so they can stop wondering; others have felt from the start that it never quite fitted.
Either way, the question is the same. Does this label explain what is actually happening to me, and is the plan built on it the right one? A mental health second opinion is a structured way of asking that, with your records on the table and enough time to read them.
If you are at immediate risk of harming yourself or someone else, call 999 or go to A&E. For urgent mental health help, call NHS 111 and choose the mental health option, or call Samaritans free on 116 123, any hour.
What do I look at when reviewing a mental health diagnosis?
I try to hear your history before I read anyone else's conclusion. A label read first colours everything heard after it, so I start with your account: when things began, what life looked like at the time, how the difficulties have changed over the years, and what the hardest stretches were like.
Then the records, read carefully. The original assessment and what it rested on. Who saw you, for how long, and what they asked. What was ruled out, and what was never mentioned. Discharge summaries, therapy letters and any later reviews. I am looking for the reasoning as much as the result, because a diagnosis with its reasoning written down is far easier to review than one recorded as a single word.
The timeline often matters more than any single letter. Did the symptoms start after a bereavement, a birth, a head injury, a period of heavy drinking, or a new treatment for something else? Were there physical problems that can imitate mental illness, such as thyroid disease, anaemia, or poor sleep from a breathing problem at night? These are quiet checks, and they are easy to skip once a diagnosis seems settled.
In the room I also notice how things are said: how you describe your own mind, whether mood and expression match the story, how attention holds over half an hour, and whether what you tell me now fits what was written years ago. Where the two differ, the difference is worth understanding rather than smoothing over.
Some overlaps come up again and again in second opinions:
- anxiety and ADHD, which can look alike from the outside and often sit together
- recurrent low mood and a bipolar pattern, where spells of high energy and little sleep were never asked about
- autism in adults, particularly women, recorded earlier as anxiety or social difficulty
- responses to trauma that have been described as personality traits
- grief that has been treated as depression, or depression that has hidden inside grief
None of these is a criticism of whoever made the first diagnosis. Mental illness changes shape over time, and a second look benefits from years of history the first assessor did not have. If anxiety is the diagnosis in question, my piece on private anxiety treatment covers how it is assessed here.
How treatment has gone is information too. When something has helped a little, that tells me one thing. When nothing has helped at all, across several honest attempts, that sometimes says more about the diagnosis than about the treatment. I also ask what the label means for you in practice: at work, in how you understand yourself, and in what support it opens or closes.
The outcome is not decided in advance. Sometimes the original diagnosis stands, and I can explain why it fits, which is a useful result in itself. Sometimes it needs refining. Sometimes my honest answer is that I do not know yet, and I set out what would help to find out. I will not offer a different diagnosis because one was hoped for.
Part of the review is choosing the right route. A GP review suits questions about whether the label and the plan make sense, whether physical causes were checked, and what the records actually say. Where the question is a formal diagnosis of ADHD, autism or a bipolar pattern, or where the picture is complex, an assessment led by a consultant psychiatrist is usually the right step, and I say so.
Will a mental health second opinion affect my NHS care?
Asking for a second opinion is a normal part of making sense of a diagnosis, and it does not mean turning your back on your NHS team. This is private care alongside the NHS, never a replacement for it. With your consent, a summary goes to your NHS GP so that everyone is working from the same picture.
Please do not stop or change any treatment while you wait for a second opinion. If something about it worries you, speak first to the doctor who started it. Stopping suddenly can cause problems of its own.
What should you bring, and when should you get help sooner?
Bring whatever you can find: assessment letters, discharge summaries, therapy summaries, any questionnaires you completed, and a list of treatments tried with rough dates and what happened. You can ask your NHS GP practice for copies of your records. For questions about ADHD, autism or a bipolar pattern, someone who knew you in childhood, or who sees you through good and bad stretches, can add a great deal, with your agreement.
Do not wait for an appointment, and use the crisis lines above or contact your mental health team, if:
- you have thoughts of harming yourself or ending your life
- you are sleeping very little but feel unusually energetic, driven or full of ideas
- you are hearing or seeing things other people do not, or feel that others are against you
- a change in treatment has left you feeling much worse or very unsettled
How do we approach a second opinion at Clinique Alpa?
A GP review starts as a 30 minute consultation at our Palmers Green clinic, for £100. Records sent in advance let that time go on you rather than on reading. If a referral is needed afterwards, the referral letter is included in the consultation fee and is written where clinically appropriate after assessment.
If the right route is a consultant psychiatrist, that work is arranged individually and the fee is confirmed before anything is booked. Our psychiatry services page sets out what it involves. Either way, you will know which route fits, and why, before you commit to it.
Written by Dr Mitesh Parmar, MBBS MRCGP, Principal GP and Clinical Director at Clinique Alpa, 466 Green Lanes, Palmers Green, London N13 5PA. This article is general information, not personal medical advice. In an emergency call 999. For NHS advice call 111 or visit nhs.uk.