Mental Health
The bread and butter,
done the way it should be.
Depression, anxiety, ADHD, PTSD, mood disorders, addiction. Real psychiatry, telehealth or in person, Oregon and Washington.
Mental health
Pick whatever's closest to what you're dealing with.
Psychiatry is what we actually do, it's the work the practice was built around, and roughly 60% of the people here aren't even on a psych med, because for a lot of them the meds were never the answer.
The honest version
If you've got depression, we'll call it depression. If your ADHD is real, we'll treat it like it's real.
Depression
When the lights are on but no one's home. →
Anxiety
Not the enemy, just a really loud roommate. →
ADHD
The thing you've been Googling for years. →
PTSD
Your nervous system is still doing its job. →
Mood disorders
When the highs and lows both go too far. →
Addiction
Booze or anything else, no lecture. →
In person and telehealth, Washington and Oregon
Don't see your thing on the list?
Talk to a providerA real person replies
Our care team gets back to you within a business day and gets you started.
What this is like
What working with us looks like
Telehealth or in person
Across Oregon and Washington, whichever actually fits the week you're having.
Meds, honestly
We'll tell you what genuinely helps and what's hype, and we'll own our own biases while we're at it.
A real person, not a bot
Our care team reaches out within a business day, sorts the logistics, and matches you with the right clinician.
A real person replies
Enough time to figure out what's going on, instead of a conveyor belt and a quick script.
Why this looks different from the usual psych appointment
The typical psychiatry visit is fifteen minutes, mostly med refills, and the conversation about whether the meds are doing what you wanted them to do never quite happens. That's not because the providers don't care. It's because the model they're working inside basically forces a conveyor belt, and once you're on the belt you stay on it, year after year, with the same prescription, the same five-minute check-in, and no real sense of whether you're better off than you were when you started.
We try to run the visit longer, ask the harder questions, and tell you what the medication can and can't do. If the SSRI you've been on for three years isn't actually helping, we'd rather know that and switch courses than keep pretending. If the ADHD diagnosis you got at twenty-two has been off the rails since you became a parent, we'll re-look at it. The point is not to find the prescription and then stop thinking. The point is to keep checking whether what we're doing matches what's actually happening in your life.
The other thing we do differently is we don't pretend medication is the whole answer. Roughly sixty percent of the people in this practice aren't on a psych med at all, because for them the work is therapy, sleep, alcohol, exercise, structure, the relationships they're in, and the story they tell themselves about who they are. Meds support that work when they're indicated. They don't replace it. We'll say so out loud.
And we'll push back on you when it's the right move. Not in a harsh way, not to be difficult, but because staying stuck is its own form of damage, and a provider who only ever nods along is not actually helping you get unstuck. If you want a yes-man, this is probably not the office for you. If you want someone who will tell you what they actually think and then work with you on what to do about it, we're a fit.
What we do differently
- Longer visitsEnough time to ask the harder questions instead of running a conveyor belt and a quick script.
- We re-lookIf the SSRI you've been on for three years isn't helping, we'd rather know and switch than keep pretending.
- Meds aren't the whole answerThey support the work when they're indicated. They don't replace therapy, sleep, alcohol, exercise and structure.
- We'll push backA provider who only ever nods along isn't actually helping you get unstuck.
Meds don't fix your life, they just give you enough energy back to go and actually fix what is wrong.
The first visit
- Sixty to seventy-five minutesThere's no version of this where we get a real handle on what's going on in fifteen.
- No tidy answer requiredIrritable, tired, not enjoying things, not sure if it's depression or burnout or a bad job? That's a fine place to start.
- A working picture by the endWhat we think is going on, the realistic options, and what we'd recommend trying first.
- Follow-ups that fit youEvery two to four weeks at first, then spread out as things stabilize, on your schedule not the billing system's.
What the first appointment actually looks like
The first visit runs about sixty to seventy-five minutes, mostly because there's no version of this where we get a real handle on what's going on in fifteen. We'll go through what brought you in, what you've already tried, what worked and what didn't, what your family history looks like, what your sleep and alcohol and exercise look like, and what the rest of your life is doing while all this is happening. Some of it will feel like the questions a doctor should have asked you years ago. That's the point.
You don't need to come in with a tidy answer for what's wrong. Most people don't. You might know you've been irritable and tired and not enjoying things and you don't know if that's depression or burnout or a bad job or all three, and that's a fine place to start. The job of the first visit is to sort that out together, not to make you arrive pre-diagnosed.
By the end of the visit you'll have a working picture of what we think is going on, what the realistic options are, and what we'd recommend trying first. If medication is on the table, we'll talk about which one and why, what to expect in the first two weeks, what side effects to watch for, and how we'll know if it's working. If therapy is the bigger lever, we'll say that too, and if you're not already with someone we'll help you find a fit.
Follow-ups start out closer together, usually every two to four weeks, so we can actually see whether what we're doing is working and adjust without dragging it out. Once things stabilize we spread to every couple months, then quarterly. The frequency depends on what you need, not on what the billing system would prefer.
How it goes
How you actually get from a message to a plan
You send a note about what's actually going on, and a real clinician reads it, not a bot and not a front desk screening you out.
We take the time to figure out what's happening instead of pattern-matching you to a script in the first ten minutes.
Medication if that's the move, plus the practical systems that make it stick, and we adjust the whole thing as we go.
Answered honestly
Questions we get a lot
I'm not sure what's wrong with me. Is that a problem?
No, and most people don't walk in with a tidy answer. You might know you've been irritable and tired and not enjoying things without knowing if that's depression or burnout or a bad job, and that's a fine place to start. Sorting it out together is the whole job of the first visit.
Am I just going to get handed a prescription?
Not automatically. Roughly sixty percent of the people in this practice aren't on a psych med at all, because for them the work is therapy, sleep, alcohol, exercise and structure. Meds support that work when they're indicated, they don't replace it, and we'll say so out loud.
Can you really do this over telehealth?
Yes, we see plenty of people entirely over telehealth across Oregon and Washington, and we'll tell you honestly if your situation is one of the few that genuinely needs an in-person piece.
I don't see my exact thing on the list. Now what?
It's probably still on the table. Send a message and we'll level with you on whether it's something we handle or something we'd point you toward someone better suited for.
Where the numbers come from
A couple of the broad claims here, that the field has drifted toward short medication-management visits and away from longer talk-based ones, are backed by the research below. The roughly sixty percent figure is our own practice, not a published statistic.
- Mojtabai R, Olfson M, National trends in psychotherapy by office-based psychiatrists, Arch Gen Psychiatry, 2008, 65(8), 962-970. PMID 18678801
- Cruz M, Roter DL, Cruz RF, et al, Appointment length, psychiatrists' communication behaviors, and medication management appointment adherence, Psychiatr Serv, 2013, 64(9), 886-892. PMID 23771555
Ready to actually talk to someone?
Drop a line. Our care team gets back to you within a business day and gets you set up with the right clinician.
From people who actually came in
What patients are saying.
I'd been to two other psychiatrists in the area before this. The difference here isn't anything fancy, it's just that Ragnar actually reads what's on the chart before he walks in. Sounds dumb that that's notable but here we're.
Chris, 34Was bracing for the standard nine-minute med-check thing because that's what I'd had everywhere else. First visit was a real conversation. Followups are shorter but they still feel like the same person who actually remembers me, not a stranger glancing at notes.
Steven, 28Almost cancelled twice before I went. Stuck it out. The thing that got me through the first appointment was Kelly basically saying okay we're not gonna solve everything today, let's just figure out what's the biggest thing and start there. That felt manageable.
Meghan, 22