By Jonathan Tamaiev, MD

Most people do not come to a psychiatrist casually.

They come because something has become too painful, too confusing, too frightening, or too disruptive to keep managing on their own. They come when they feel like they no longer have a choice. Their anxiety is no longer manageable. Their child is struggling. Their marriage is under strain. They are not sleeping. Work is becoming impossible. Their thoughts feel out of control. Or they simply do not feel like themselves anymore.

In that way, going to a psychiatrist is a little like going to the dentist. Most people do not make the appointment when everything feels fine. They make it when the pain has become hard to ignore.

But there is another part of that analogy that I think about often. If you go to the wrong dentist, you can leave in more pain than when you came in. The same is true in psychiatry.

A bad psychiatric experience can be deeply discouraging. It can make someone feel dismissed, misunderstood, overmedicated, undertreated, judged, rushed, or reduced to a diagnosis. It can make a person who already waited too long to ask for help feel like maybe asking for help was a mistake.

That should not happen. But unfortunately, it happens all the time.

Psychiatry is impossibly difficult to access. In New York City, where there are supposedly endless options for everything, finding excellent psychiatric care can still feel strangely impossible. You are either waiting too long, paying too much, or finally getting in to see someone and leaving with the feeling that the person did not really understand you.

Sometimes the doctor is rushed. Sometimes the system is too big and impersonal. Sometimes the appointment feels like a checklist. Sometimes you are not even seeing a doctor at all. You may be seen by someone with far less training, far less experience, and far less ability to manage a complicated psychiatric picture.

And when someone is in crisis, that matters.

People deserve better than that.

They deserve to be seen and heard by a competent physician. They deserve someone who is thoughtful, intelligent, respectful, and relatable. They deserve someone who can sit with complexity without panicking, oversimplifying, or pretending every problem has an obvious answer. They deserve to be able to reach their doctor when something urgent is happening. They deserve not to be billed every time they need a basic refill. They deserve a psychiatrist who takes the work seriously.

That is why I started Highline Psychiatry.

I started this practice because I love psychiatry. I love helping people. And I hate seeing patients mistreated.

During residency, people would call me and ask if I could help them find a “great psychiatrist.” Friends, family members, colleagues, acquaintances. They were not asking for anything extravagant. They just wanted someone good. Someone smart. Someone normal. Someone who would actually listen and know what they were doing.

It always seemed like it should have been an easy request. I was in the field. I knew many psychiatrists. I trained with and worked alongside some truly excellent doctors.

But the honest answer was often frustrating.

Many of the best psychiatrists I knew were working in locked inpatient units, emergency rooms, hospitals, or large clinics buried under layers of red tape. They were excellent, but not easily accessible. You could not simply call and request them. You could enter a big system and maybe get lucky, but you could also wait months, get bounced around, or end up with someone who was not the right fit at all.

What bothered me was that even people inside the field could not reliably connect someone they cared about to excellent outpatient psychiatric care.

That felt wrong.

Highline Psychiatry was built to solve that problem.

I wanted to build a practice where, when someone is referred, they can feel confident they are being sent to a place that takes psychiatric care seriously. A place with excellent doctors. A place where patients are not treated like a diagnosis, a medication list, or a time slot. A place where the standard is not “good enough,” but genuinely thoughtful care.

Good psychiatry requires time, judgment, and clinical seriousness.

It requires knowing when to medicate and when not to. It requires knowing when to move quickly and when to slow down. It requires understanding that symptoms do not happen in isolation. Anxiety, depression, irritability, obsessional thoughts, insomnia, impulsivity, school refusal, marital conflict, trauma, ADHD, bipolar disorder, substance use, family dynamics, and personality all overlap in real life.

Psychiatry is messy. People are messy. The work is not always clean or obvious.

That is part of why I love it.

At Highline, we do not rush to medicate, and we do not delay treatment when medication is clearly needed. We are not interested in being reflexively “pro-medication” or “anti-medication.” Both positions are too simplistic. Medication can be life-changing when used well, and harmful or useless when used carelessly. The real work is in understanding the person well enough to know what makes sense.

We also do not see psychiatry as separate from the rest of a person’s life. Sometimes the most important intervention is medication. Sometimes it is therapy. Sometimes it is helping a patient understand what is happening in their marriage, their family, their school, their work, or their own patterns of thinking and feeling. Sometimes it is coordinating with a therapist, speaking with parents, clarifying a diagnosis, or helping someone stop blaming themselves for something that actually has a name and a treatment path.

We help patients connect with quality therapists when therapy is needed. We communicate with therapists because collaboration matters. We try to be reachable because crises do not always happen conveniently between scheduled appointments. We stay current on emerging treatments, but we do not chase gimmicks. If something has real evidence behind it, we want to understand it. If it is mostly marketing, we are not interested.

We take on complicated cases because that is what psychiatry actually is.

A lot of patients do not come in with one clean issue. They come in with years of symptoms, prior medications, unclear diagnoses, family conflict, school problems, work stress, trauma, religious or cultural complexity, medical issues, or a long history of feeling misunderstood by treatment. Those cases require more thought, not less.

That is the kind of psychiatry we want to practice.

Highline Psychiatry is a New York City practice, but the idea behind it is simple and universal: people deserve excellent psychiatric care from doctors who are serious about the work and humane with the person in front of them.

My hope is that Highline becomes a place where patients know they are being referred to a practice they can trust. A place where families, therapists, physicians, and other professionals can send someone and feel confident that the patient will be treated well. A place where excellent psychiatrists can practice psychiatry the way it is supposed to be practiced, with time, thoughtfulness, independence, and pride in the craft.

People usually come to psychiatry when they are already in pain.

The least we can do is make sure they are met by someone who knows how to help.

Most people do not come to a psychiatrist casually.

They come because something has become too painful, too confusing, too frightening, or too disruptive to keep managing on their own. They come when they feel like they no longer have a choice. Their anxiety is no longer manageable. Their child is struggling. Their marriage is under strain. They are not sleeping. Work is becoming impossible. Their thoughts feel out of control. Or they simply do not feel like themselves anymore.

In that way, going to a psychiatrist is a little like going to the dentist. Most people do not make the appointment when everything feels fine. They make it when the pain has become hard to ignore.

But there is another part of that analogy that I think about often. If you go to the wrong dentist, you can leave in more pain than when you came in. The same is true in psychiatry.

A bad psychiatric experience can be deeply discouraging. It can make someone feel dismissed, misunderstood, overmedicated, undertreated, judged, rushed, or reduced to a diagnosis. It can make a person who already waited too long to ask for help feel like maybe asking for help was a mistake.

That should not happen. But unfortunately, it happens all the time.

Psychiatry is impossibly difficult to access. In New York City, where there are supposedly endless options for everything, finding excellent psychiatric care can still feel strangely impossible. You are either waiting too long, paying too much, or finally getting in to see someone and leaving with the feeling that the person did not really understand you.

Sometimes the doctor is rushed. Sometimes the system is too big and impersonal. Sometimes the appointment feels like a checklist. Sometimes you are not even seeing a doctor at all. You may be seen by someone with far less training, far less experience, and far less ability to manage a complicated psychiatric picture.

And when someone is in crisis, that matters.

People deserve better than that.

They deserve to be seen and heard by a competent physician. They deserve someone who is thoughtful, intelligent, respectful, and relatable. They deserve someone who can sit with complexity without panicking, oversimplifying, or pretending every problem has an obvious answer. They deserve to be able to reach their doctor when something urgent is happening. They deserve not to be billed every time they need a basic refill. They deserve a psychiatrist who takes the work seriously.

That is why I started Highline Psychiatry.

I started this practice because I love psychiatry. I love helping people. And I hate seeing patients mistreated.

During residency, people would call me and ask if I could help them find a “great psychiatrist.” Friends, family members, colleagues, acquaintances. They were not asking for anything extravagant. They just wanted someone good. Someone smart. Someone normal. Someone who would actually listen and know what they were doing.

It always seemed like it should have been an easy request. I was in the field. I knew many psychiatrists. I trained with and worked alongside some truly excellent doctors.

But the honest answer was often frustrating.

Many of the best psychiatrists I knew were working in locked inpatient units, emergency rooms, hospitals, or large clinics buried under layers of red tape. They were excellent, but not easily accessible. You could not simply call and request them. You could enter a big system and maybe get lucky, but you could also wait months, get bounced around, or end up with someone who was not the right fit at all.

What bothered me was that even people inside the field could not reliably connect someone they cared about to excellent outpatient psychiatric care.

That felt wrong.

Highline Psychiatry was built to solve that problem.

I wanted to build a practice where, when someone is referred, they can feel confident they are being sent to a place that takes psychiatric care seriously. A place with excellent doctors. A place where patients are not treated like a diagnosis, a medication list, or a time slot. A place where the standard is not “good enough,” but genuinely thoughtful care.

Good psychiatry requires time, judgment, and clinical seriousness.

It requires knowing when to medicate and when not to. It requires knowing when to move quickly and when to slow down. It requires understanding that symptoms do not happen in isolation. Anxiety, depression, irritability, obsessional thoughts, insomnia, impulsivity, school refusal, marital conflict, trauma, ADHD, bipolar disorder, substance use, family dynamics, and personality all overlap in real life.

Psychiatry is messy. People are messy. The work is not always clean or obvious.

That is part of why I love it.

At Highline, we do not rush to medicate, and we do not delay treatment when medication is clearly needed. We are not interested in being reflexively “pro-medication” or “anti-medication.” Both positions are too simplistic. Medication can be life-changing when used well, and harmful or useless when used carelessly. The real work is in understanding the person well enough to know what makes sense.

We also do not see psychiatry as separate from the rest of a person’s life. Sometimes the most important intervention is medication. Sometimes it is therapy. Sometimes it is helping a patient understand what is happening in their marriage, their family, their school, their work, or their own patterns of thinking and feeling. Sometimes it is coordinating with a therapist, speaking with parents, clarifying a diagnosis, or helping someone stop blaming themselves for something that actually has a name and a treatment path.

We help patients connect with quality therapists when therapy is needed. We communicate with therapists because collaboration matters. We try to be reachable because crises do not always happen conveniently between scheduled appointments. We stay current on emerging treatments, but we do not chase gimmicks. If something has real evidence behind it, we want to understand it. If it is mostly marketing, we are not interested.

We take on complicated cases because that is what psychiatry actually is.

A lot of patients do not come in with one clean issue. They come in with years of symptoms, prior medications, unclear diagnoses, family conflict, school problems, work stress, trauma, religious or cultural complexity, medical issues, or a long history of feeling misunderstood by treatment. Those cases require more thought, not less.

That is the kind of psychiatry we want to practice.

Highline Psychiatry is a New York City practice, but the idea behind it is simple and universal: people deserve excellent psychiatric care from doctors who are serious about the work and humane with the person in front of them.

My hope is that Highline becomes a place where patients know they are being referred to a practice they can trust. A place where families, therapists, physicians, and other professionals can send someone and feel confident that the patient will be treated well. A place where excellent psychiatrists can practice psychiatry the way it is supposed to be practiced, with time, thoughtfulness, independence, and pride in the craft.

People usually come to psychiatry when they are already in pain.

The least we can do is make sure they are met by someone who knows how to help.

Most people do not come to a psychiatrist casually.

They come because something has become too painful, too confusing, too frightening, or too disruptive to keep managing on their own. They come when they feel like they no longer have a choice. Their anxiety is no longer manageable. Their child is struggling. Their marriage is under strain. They are not sleeping. Work is becoming impossible. Their thoughts feel out of control. Or they simply do not feel like themselves anymore.

In that way, going to a psychiatrist is a little like going to the dentist. Most people do not make the appointment when everything feels fine. They make it when the pain has become hard to ignore.

But there is another part of that analogy that I think about often. If you go to the wrong dentist, you can leave in more pain than when you came in. The same is true in psychiatry.

A bad psychiatric experience can be deeply discouraging. It can make someone feel dismissed, misunderstood, overmedicated, undertreated, judged, rushed, or reduced to a diagnosis. It can make a person who already waited too long to ask for help feel like maybe asking for help was a mistake.

That should not happen. But unfortunately, it happens all the time.

Psychiatry is impossibly difficult to access. In New York City, where there are supposedly endless options for everything, finding excellent psychiatric care can still feel strangely impossible. You are either waiting too long, paying too much, or finally getting in to see someone and leaving with the feeling that the person did not really understand you.

Sometimes the doctor is rushed. Sometimes the system is too big and impersonal. Sometimes the appointment feels like a checklist. Sometimes you are not even seeing a doctor at all. You may be seen by someone with far less training, far less experience, and far less ability to manage a complicated psychiatric picture.

And when someone is in crisis, that matters.

People deserve better than that.

They deserve to be seen and heard by a competent physician. They deserve someone who is thoughtful, intelligent, respectful, and relatable. They deserve someone who can sit with complexity without panicking, oversimplifying, or pretending every problem has an obvious answer. They deserve to be able to reach their doctor when something urgent is happening. They deserve not to be billed every time they need a basic refill. They deserve a psychiatrist who takes the work seriously.

That is why I started Highline Psychiatry.

I started this practice because I love psychiatry. I love helping people. And I hate seeing patients mistreated.

During residency, people would call me and ask if I could help them find a “great psychiatrist.” Friends, family members, colleagues, acquaintances. They were not asking for anything extravagant. They just wanted someone good. Someone smart. Someone normal. Someone who would actually listen and know what they were doing.

It always seemed like it should have been an easy request. I was in the field. I knew many psychiatrists. I trained with and worked alongside some truly excellent doctors.

But the honest answer was often frustrating.

Many of the best psychiatrists I knew were working in locked inpatient units, emergency rooms, hospitals, or large clinics buried under layers of red tape. They were excellent, but not easily accessible. You could not simply call and request them. You could enter a big system and maybe get lucky, but you could also wait months, get bounced around, or end up with someone who was not the right fit at all.

What bothered me was that even people inside the field could not reliably connect someone they cared about to excellent outpatient psychiatric care.

That felt wrong.

Highline Psychiatry was built to solve that problem.

I wanted to build a practice where, when someone is referred, they can feel confident they are being sent to a place that takes psychiatric care seriously. A place with excellent doctors. A place where patients are not treated like a diagnosis, a medication list, or a time slot. A place where the standard is not “good enough,” but genuinely thoughtful care.

Good psychiatry requires time, judgment, and clinical seriousness.

It requires knowing when to medicate and when not to. It requires knowing when to move quickly and when to slow down. It requires understanding that symptoms do not happen in isolation. Anxiety, depression, irritability, obsessional thoughts, insomnia, impulsivity, school refusal, marital conflict, trauma, ADHD, bipolar disorder, substance use, family dynamics, and personality all overlap in real life.

Psychiatry is messy. People are messy. The work is not always clean or obvious.

That is part of why I love it.

At Highline, we do not rush to medicate, and we do not delay treatment when medication is clearly needed. We are not interested in being reflexively “pro-medication” or “anti-medication.” Both positions are too simplistic. Medication can be life-changing when used well, and harmful or useless when used carelessly. The real work is in understanding the person well enough to know what makes sense.

We also do not see psychiatry as separate from the rest of a person’s life. Sometimes the most important intervention is medication. Sometimes it is therapy. Sometimes it is helping a patient understand what is happening in their marriage, their family, their school, their work, or their own patterns of thinking and feeling. Sometimes it is coordinating with a therapist, speaking with parents, clarifying a diagnosis, or helping someone stop blaming themselves for something that actually has a name and a treatment path.

We help patients connect with quality therapists when therapy is needed. We communicate with therapists because collaboration matters. We try to be reachable because crises do not always happen conveniently between scheduled appointments. We stay current on emerging treatments, but we do not chase gimmicks. If something has real evidence behind it, we want to understand it. If it is mostly marketing, we are not interested.

We take on complicated cases because that is what psychiatry actually is.

A lot of patients do not come in with one clean issue. They come in with years of symptoms, prior medications, unclear diagnoses, family conflict, school problems, work stress, trauma, religious or cultural complexity, medical issues, or a long history of feeling misunderstood by treatment. Those cases require more thought, not less.

That is the kind of psychiatry we want to practice.

Highline Psychiatry is a New York City practice, but the idea behind it is simple and universal: people deserve excellent psychiatric care from doctors who are serious about the work and humane with the person in front of them.

My hope is that Highline becomes a place where patients know they are being referred to a practice they can trust. A place where families, therapists, physicians, and other professionals can send someone and feel confident that the patient will be treated well. A place where excellent psychiatrists can practice psychiatry the way it is supposed to be practiced, with time, thoughtfulness, independence, and pride in the craft.

People usually come to psychiatry when they are already in pain.

The least we can do is make sure they are met by someone who knows how to help.