Psychiatric care that respects the work you have already done.
When a client may benefit from medical assessment or medication, Dr. McDade adds psychiatric expertise alongside your therapy. Your observations are considered, roles stay clear, and with the client's consent, useful information comes back to you. She handles the psychiatric diagnosis and medication, so your work with the client continues.
Opens the referral page. Send records by email, and the practice confirms fit before scheduling the first evaluation.
- Ages 12 to 70
- Texas and California
- Secure video visits
The answer
Refer when a client is doing the work in therapy but not improving at the rate you would expect. Refer too when symptoms get in the way of using therapy, or grow more severe, such as passive suicidal ideation, self-harm, or hallucinations. With your client's signed release, your summary shapes Dr. McDade's evaluation, and the shared picture comes back afterward. You hear from her when there are significant changes in symptoms, safety concerns, or changes to the treatment plan. Psychiatric care builds on your work, and your work continues.
When is a client ready for a psychiatric referral?
A referral fits when psychiatric care can add something the therapy needs. Dr. McDade names four good times to refer, and three needs that sit outside her practice today.
Good times to refer
- Your client is doing the work in therapy but not improving at the rate you would expect.
- Psychiatric symptoms are getting in the way of using therapeutic interventions.
- Symptoms are more severe, such as passive suicidal ideation, self-harm, or hallucinations.
- The diagnosis is one where medication often comes first, such as ADHD.
Outside the practice today
- TMS or ketamine. Dr. McDade can evaluate whether your client is a good candidate and refer to a provider who does.
- Family therapy and relationship counseling, which stay with your client's other clinicians.
- Emergency care. This practice does not provide emergency services.
The referral adds to the therapy.
If you need help now
If you are in crisis or thinking about suicide, call or text 988 or chat at 988lifeline.org to reach the 988 Suicide and Crisis Lifeline. If you are Deaf or hard of hearing, use your preferred relay service or dial 711, then 988. In an emergency, call 911 or go to the nearest emergency room. This practice does not provide emergency services.
Why does ADHD often start with medication?
In Dr. McDade's practice, ADHD treatment often starts with medication, because therapy alone is unlikely to produce a robust response. Therapy then builds organizational and social skills.
Therapy alone is unlikely to produce a robust response.
The ADHD itself is treated before the skill work.
For adults, NICE guideline NG87 (2018, updated 2019) recommends offering medication when ADHD symptoms still cause significant impairment after changes to the person's environment have been made and reviewed.
Medication first, then therapy builds the skills.
How are your observations used?
Your observations travel with the referral and shape the first evaluation. The path runs from your client's release to a shared picture of your client.
- 01
Client consent
Your client signs a release
Before anything is shared, your client signs a release of information.
- 02
By email
You send a summary
It covers treatment history, diagnosis, and any recommendations.
- 03
The practice
The practice confirms fit
A brief screening confirms fit before the first evaluation.
- 04
60 to 90 minutes
The evaluation
Dr. McDade completes the first evaluation by secure video.
- 05
You and Dr. McDade
You and Dr. McDade align
You agree on your client's current symptoms and how severe they are.
Why the picture can differ
Different clinicians take different histories, so the concerns that come up in therapy often differ from what comes up in a psychiatric evaluation. If something significant has happened, share it, so you and Dr. McDade are working with the same picture.
What matters is the same picture of the patient.
What comes back after the first evaluation?
With your client's signed release, Dr. McDade sends you the shared picture after the first evaluation. It is her working view of your client, written for the clinician already doing the work.
The shared picture
-
Working diagnosis
Her working diagnosis, and what she ruled out.
-
What comes first
What she plans to treat first, and why.
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Medication
Whether she recommends medication, and the plan if she does.
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Roles
What she handles, and what stays with you.
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What to watch for
What your client may notice as treatment starts, so you can watch for it in session.
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Your input
What she would like to hear back from you.
The contents follow the American College of Physicians' guidance on consultation responses, which asks the consultant to answer the referral question and guide the next step in care (Beyond the Referral, 2022).
Your next session starts from the same picture.
Your client keeps their therapist and gains a psychiatrist who reads your summary.
Refer With ConfidenceWhen else will you hear from Dr. McDade?
After the shared picture, Dr. McDade reaches out when something significant changes. Updates come by fax or phone, with your client's release in place.
You will hear from Dr. McDade when
- There are significant changes in symptoms.
- There are safety concerns.
- The treatment plan changes.
- A medication starts or changes, with what your client may notice.
To share something with her
Email Admin@
You hear from her when it matters.
What do referring therapists notice?
Therapists who refer to Dr. McDade have shared what working with her is like.
What referring therapists have shared
- She is thorough.
- She takes her time with patients.
- She builds trust and confidence from the first appointment.
- She looks at all possible contributors, including medical causes and psychosocial stressors.
- She refers patients with an inadequately treated medical condition to community physicians, and talks with those physicians directly.
Shared by licensed therapists who refer clients to Dr. McDade.
In her words
What matters is that the therapist and I are aligned on the patient's current symptoms and how severe they are.
Dr. Allison J. McDade, MDWhich clients can Dr. McDade see, and how?
Dr. McDade sees clients ages 12 to 70 by secure video in Texas and California. The telepsychiatry page explains how video visits work.
- 12 to 70Ages seen
- Texas and CaliforniaBy secure video
- 60 to 90 minutesThe first evaluation, depending on age
Practice facts from Health & Harmony Psychiatry.
Questions therapists ask
When should I refer a client in therapy for a psychiatric evaluation?
When the client is doing the work but not improving at the rate you would expect, when symptoms get in the way of using therapy, or when symptoms become more severe, such as passive suicidal ideation, self-harm, or hallucinations.
Is this an emergency service?
No. Health & Harmony Psychiatry does not provide emergency care. If you are in crisis or thinking about harming yourself, call or text 988, or call 911.
Will psychiatric care replace my therapy with the client?
No. Dr. McDade handles the psychiatric diagnosis and medication, so your work with the client continues.
What do you need from me with a referral?
A summary of treatment history, diagnosis, and any recommendations, sent after your client signs a release of information. Please email it to Admin@
Does a referral share records automatically?
No. The patient signs a release of information first, and then the referring clinician can send a summary.
Why might the psychiatric evaluation surface different concerns than therapy did?
Different clinicians take different histories, and patients are not being evasive. What matters is that you and Dr. McDade are aligned on current symptoms and how severe they are, and that anything significant, such as a recent suicide attempt, is shared.
What comes back to me after the first evaluation?
With your client's signed release, Dr. McDade sends you the shared picture. It covers her working diagnosis, what she plans to treat first, any medication plan, who handles what, and what your client may notice as treatment starts.
When else will I hear from Dr. McDade?
When there are significant changes in symptoms, safety concerns, or changes to the treatment plan.
Does Dr. McDade provide TMS or ketamine?
Not currently. She can evaluate whether your client would be a good candidate for either and refer to a provider who does.
What ages and states does Dr. McDade see?
Patients ages 12 to 70. Health & Harmony Psychiatry provides care by secure video to patients physically located in Texas or California at the time of their appointment.
If you need help now
If you are in crisis or thinking about suicide, call or text 988 or chat at 988lifeline.org to reach the 988 Suicide and Crisis Lifeline. If you are Deaf or hard of hearing, use your preferred relay service or dial 711, then 988. In an emergency, call 911 or go to the nearest emergency room. This practice does not provide emergency services.
Care Through Connection
Your client gains psychiatric care, and the work you started continues.
The referral page shows how to send the referral. Once your client signs a release, email your summary to the practice admin address, and the practice confirms fit before scheduling the first evaluation. Afterward, the shared picture comes back to you.
Health & Harmony Psychiatry does not provide emergency care. If you are in crisis or thinking about harming yourself, call or text 988, or call 911. Ages 12 to 70. Health & Harmony Psychiatry provides care by secure video to patients physically located in Texas or California at the time of their appointment.