“I should have come years ago.”
That’s the most common sentence I hear in a first session. Almost never is it because the person’s condition had become that severe. It’s because the mental picture they’d built of what a psychiatrist actually does was wrong - and they’d been navigating that wrong picture for years, sometimes decades, before finally coming in.
I want to walk through what a real first session actually involves, because the gap between the picture in most people’s heads and the reality is genuinely costing lives.
Why the wrong picture exists
India has approximately 9,000 practising psychiatrists for a population of over 1.4 billion. That’s a density of roughly 0.75 psychiatrists per 100,000 people. The World Health Organization’s recommended minimum is at least 3 per 100,000. India would need roughly four times its current number of psychiatrists just to reach that minimum baseline.
The practical consequence of that shortage: most people’s only exposure to psychiatry has been a rushed 10-minute encounter, followed by a prescription. That experience becomes their entire model of what psychiatric care is.
Then, when they need help themselves, that model is what they’re anticipating. And most people would rather delay seeking help than repeat what they assume the experience will be.
What a real first session actually involves
A proper first psychiatric evaluation typically runs 45 to 60 minutes. It systematically covers three domains - a framework called the biopsychosocial model, which has been foundational to psychiatric assessment for decades:
Biological. Medical history, physical health, family psychiatric and medical history, current medications, sleep, appetite, energy. Sometimes ordering blood work or other tests to rule out physical causes that can produce psychiatric-looking symptoms - thyroid dysfunction, B12 or vitamin D deficiency, certain neurological conditions, and others.
Psychological. Thought patterns, coping style, personal history, symptoms and their onset, past therapy or treatment, personal understanding of what’s happening.
Social. Work, relationships, finances, current stressors, living situation, cultural and family context - because none of the above happens in a vacuum.
Only after that full picture is a treatment plan discussed. Medication is one option in a much larger toolkit - not the default starting point.
What’s in the actual toolkit
Modern psychiatric practice includes:
- Structured psychotherapies (CBT, DBT, ACT, IPT, and others), often delivered in coordination with a clinical psychologist.
- Medication when the biological assessment genuinely indicates it.
- Lifestyle and behavioural intervention (sleep, exercise, nutrition, structured routines).
- For treatment-resistant conditions, neuromodulation techniques such as rTMS (repetitive Transcranial Magnetic Stimulation) and TBS (Theta Burst Stimulation) - non-invasive brain stimulation techniques increasingly used for depression, OCD, and other conditions that haven’t responded to first-line treatment.
That is a substantially larger toolkit than the “10-minute prescription counter” stereotype allows for.
For HR and corporate wellness leads
If you’re building a mental health referral system inside a company, the mental picture your team has of psychiatry is one of the largest determinants of whether they’ll actually go when you refer them. The “10-minute prescription” expectation is a genuine access barrier.
Framing expectations correctly upfront - that a first session is a full clinical evaluation, that medication is one option among several, that neuromodulation exists for cases that haven’t responded to other things - measurably increases uptake in employee mental health programs.
The takeaway
Psychiatry is a full clinical discipline. Not a prescription counter. Not a therapy substitute. A structured medical specialty with its own diagnostic frameworks, its own toolkit, its own body of research.
“I should have come earlier” is preventable, with the right expectations set upfront. If this shifts that picture for even one person reading it - or one HR lead building a referral system - the article did its job.
References
- Engel, G. L. (1977). The need for a new medical model: A challenge for biomedicine. Science, 196(4286), 129-136.
- World Health Organization. (2021). Mental Health Atlas 2020. Geneva: WHO.
- Indian Journal of Psychiatry (2023). Number of psychiatrists in India: Baby steps forward, but a long way to go.
About the author: Dr. Sidharth Sood is a super-specialist in Addiction Psychiatry, trained at the All India Institute of Medical Sciences (AIIMS), New Delhi — one of a handful of DM-level Addiction Psychiatry consultants in India. He practises at Umang Mind and Brain Clinic and consults across Delhi NCR. His clinical work focuses on ADHD, addictions, and disorders of impulse, reward, and control — including complex cases involving neuromodulation (rTMS/TBS).
Decoding impulse, addiction, and the brain.
For consulting, corporate wellness programs, media requests, and speaking engagements: connect on LinkedIn or write to contact@drsidharthsood.com.