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A patient & advocate's guide

Psychiatry has a checklist for good care. A lot of it never reaches you.

We compared de-identified records from millions of U.S. psychiatric patients against the field's own guidelines and found 57 recommended care steps that often get missed. Usually it's because the system around your clinician is stretched too thin to track them. This site shows you the checklist, so you know what to ask for.

Nothing you enter leaves your browser. This is information, not medical advice.

How it works

  1. 1

    Tell us what applies to you

    Check the medicines you take and the situations you're in. It all stays on your device.

  2. 2

    See the care steps you're owed

    We show you the guideline-backed steps that fit your situation, and how often they get missed.

  3. 3

    Bring the questions to your visit

    Each card gives you plain questions you can ask. It never tells you to change your treatment on your own.

Why this exists

Good psychiatric care follows guidelines: clear statements of what should happen and when. Check someone’s blood sugar when they start an antipsychotic. See a patient within a week of leaving the hospital. Give an antidepressant a fair trial before deciding it failed. None of this is controversial. It is the field’s own set of rules.

We took millions of de-identified U.S. psychiatric records and measured, step by step, how often those recommended steps actually happened. A lot of them didn’t. Usually that isn’t because a clinician got it wrong. It is because the people doing this work are carrying impossible caseloads, records are scattered across systems, and often nobody is keeping the checklist at all.

So we wrote the checklist down in plain language and handed it to the person who has the most reason to care about it: you. Everything below is something you can ask about at a visit. None of it tells you to change your treatment. That is always a conversation with your own clinician. It just helps you walk in knowing what to ask for.

Start with the big ones

A few of the most common gaps, and the ones that matter most.

Antipsychotic safety

Baseline tests before a child starts an antipsychotic

Before a child starts an antipsychotic, baseline blood tests and measurements should be taken.

99% missed
Bipolar disorder

Lithium blood-level monitoring

If you take lithium long-term, a blood lithium level should be checked every few months to keep the dose safe.

78% missed 3.7x risk
General

A follow-up within 7 days of leaving hospital

After a psychiatric hospital stay, you should have a follow-up appointment within 7 days.

75% missed
Children & teens

Close follow-up when a teen starts an antidepressant

When a teenager starts an antidepressant, they should be followed up closely (about weekly) in the first weeks.

73% missed
Antipsychotic safety

Blood-sugar checks on antipsychotics

If you take an antipsychotic, your blood sugar (an HbA1c test) should be checked before you start and at least once a year.

69% missed 5.1x risk
Substance use

Medication for opioid use disorder

If you have opioid use disorder, you should be offered medication to treat it (buprenorphine, methadone, or naltrexone).

55% missed
Schizophrenia

Clozapine blood-count monitoring

If you take clozapine, your white-blood-cell count should be monitored on schedule - this is a safety requirement.

51% missed
Antipsychotic safety

Tracking weight on antipsychotics

If you take an antipsychotic, your weight or BMI should be tracked over time, not just measured once.

18% missed 3.0x risk
Substance use

Opioids and benzodiazepines together

An opioid and a benzodiazepine should not be prescribed together unless there is a clear, discussed reason - the combination raises overdose risk.

14% missed 3.7x risk
Substance use

Medication for alcohol use disorder

If you have alcohol use disorder, you should be offered medication that treats it (such as naltrexone or acamprosate).

87% missed
Depression

Giving an antidepressant a fair trial

An antidepressant should be given a fair trial - a full dose for long enough - before it is judged a failure or switched.

53% missed
Depression

Esketamine for hard-to-treat depression

For hard-to-treat depression, esketamine is an approved option that can be discussed.

99% missed
Anxiety & PTSD

Prazosin for PTSD nightmares

For PTSD with nightmares and poor sleep, prazosin can be discussed.

80% missed
Antipsychotic safety

Treating antipsychotic weight gain

If an antipsychotic has caused significant weight gain, newer weight treatments (like GLP-1 medicines) can be discussed.

77% missed