The Psych Central Report

Mental Health Care Choices Available to You

By John M. Grohol, Psy.D.
November 2005

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Individuals with mental health problems in today's society still suffer an unwarranted stigma and discrimination. What is often left out in the confusion surrounding mental disorders is how many treatment choices are available to the average individual. In this month's column, I will outline some of the basic treatment options commonly used to help people with mental disorders.

But first, a clarification... While I generically use the term "mental disorders" and "mental health problems" throughout my online writings, I use these terms much more broadly than just defining specific DSM-IV diagnoses. A mental health problem could be anything from severe depression, to procrastination on doing school work, to relationship problems you don't have a clue on how to fix. The severity of a particular problem generally determines whether a person will seek treatment for it or not -- the more severe a problem is, the more likely treatment will be sought.

Self-Help
Many people when first feeling unsure about a situation, a feeling which stays with them for longer than ordinary (e.g., feeling down), or an ongoing problem, will first consult with a friend or family member, or go online or to a bookstore or library seeking help, enlightenment, and clarification. This is a good first step and in some cases, all that is necessary to obtain relief for the problem. That's one of the reasons I created Psych Central -- because the power of helping yourself (self-help) is often overlooked and under appreciated.

First Professional Stop
The second most common first stop in this care cycle is to consult a general practitioner or family physician. While I think this is better than not seeking help at all, I do think that a general practitioner (G.P.) doesn't have the necessary skills and experience to properly diagnose mental disorders and consider all aspects of a person's behavioral healthcare needs. In hundreds of experiences people have related to me, G.P.'s are quick to prescribe a medication for relief of the symptoms associated with the problem, while the core problem remains. Psychotherapy or counseling, if mentioned at all, is treated as almost like an afterthought.

By far and away, the best professional help you can seek is via outpatient care by a trained and experienced mental health professional. While there are many different types of mental health professionals available, a psychiatrist or psychologist is probably a good and safe first bet. These are the most highly-trained and often the most highly-skilled clinicians when it comes to diagnosis and assessment of your problem. Outpatient care refers to going to see this professional on a regular basis for a few months or a year, usually about once a week for psychotherapy and once a month for medication checkups.

Outpatient Care
Outpatient care can include the prescription of medication (by a psychiatrist or psychopharmacologist), or ongoing psychotherapy. We've come a long way from the days of psychoanalysis and the comedy associated with Freud. Modern psychotherapy as practiced by most psychotherapists today is relatively brief (12 to 14 sessions is not unheard of), solution-focused, and works on helping you resolve your problems with existing resources. Blame, exploring your childhood, dream interpretation, etc. generally are not a usual part of modern psychotherapy. The professional who does your initial evaluation and assessment can usually determine whether you will need medication, psychotherapy, or both. For mild disorders, relationship problems, or problems associated with school, psychotherapy usually fits the bill. For more severe or longer-lasting problems, a combination approach of psychotherapy and medication is usually appropriate. Your individual case may vary, though.

Inpatient Care
Sometimes a person will be so depressed or so anxious or so manic that they need to be stabilized on a medication before they can even minimally function in the regular world. While this is not unheard of, it is not as common as some people would have you believe. In these cases, a person is usually recommended and admitted for inpatient care. For instance, many times when someone who suffers from schizophrenia forgets to take their medication, they may need inpatient hospitalization to help stabilize their condition. Inpatient care is also used most often when a person is feeling suicidal or homicidal. Once the medication starts working, these symptoms of depression (e.g., suicidal ideation) gradually decrease and often disappear altogether. In a safe, controlled environment such as a hospital, the person's needs can be fully addressed and they can be helped back to health.

While some hospitals and inpatient care facilities often get a bad rap (and are the subject of most psychiatric abuse in society today), most inpatient care facilities are decent places. Some are very warm and caring, while others are more institutional-like. If you have the time and ability, it helps to shop around for such a facility in your community. Ask for recommended referrals from a number of different doctors and therapists.

Involuntary Commitment
In ever rarer circumstances, a person's inpatient care will be mandated by a doctor or a police officer. This mandate, referred to as involuntary commitment by many, most often refers to the 48-72 hour evaluation period a hospital can hold you. This period is most often used to evaluate, assess, and treat people who are actively suicidal or homicidal. While nobody wants to be held against their will or wishes, the alternative is more deaths through successful suicides. Suicidal ideation is a temporary symptom of severe depression, and as the depression is treated, suicidal ideas tend to go away. While involuntary commitment is an extreme example of treatment, and not one you are likely to come in contact with, it is something to be aware of. If you go to a doctor or therapist and tell them you want to kill yourself and tell them how you're going to do it and with what methods, it may be that you are hours or days away from doing so. Since people who suffer from this kind of severe depression may not be able to make clear, rational decisions, the decision to get treatment may be made for them.

In decades past, people were held against their wishes for years without a fair hearing or trial for reasons relating to their mental health. Generally, this is no longer the case today. Any detainment longer than the 48-72 hour evaluation period requires hearings before judges, and ongoing checks and balances within the system to try and help combat the history of abuse the system has suffered in some states. People are given lawyer advocates who look after the person's best interests, and not those of the hospital, doctors, or family. These systems, while not perfect, work. I'm not a big advocate of them, but I understand their continuing need in society.

Modalities
The most common type of psychotherapy is individual. Individual therapy is where you sit with a therapist for usually 50 minutes a week and talk with him or her about your problems. The therapist is not there to give you advice (any friend can do that!). Rather, the therapist will help you clarify issues in your life, help you discover new ways of coping with problems and stress, teach you new ways of dealing with people and work, and be a supportive figure throughout all of your work. A well-trained therapist can make all the difference in the world between effective, helpful therapy and bad, time-wasting therapy.

Group psychotherapy is the other common type of outpatient modality. In group therapy, a group of people sit around in a room and talk about their issues to the group. The group is led by one or two therapists, who help direct the group's session, and individual goals. While this may seem scarier to most people than individual therapy, it is often a more powerful modality. Group therapy is an attractive choice also because it costs less than individual therapy.

There are many other modalities available, including medication management (which are the appointments used to monitor your medication and ensure it is working properly and not causing you any harm), biofeedback (using computer equipment to help you learn how to monitor your body's physiology), and hypnosis which I won't go into here.

Places to Go
There are many places one can go to seek this kind of help. If you have insurance or are covered under a managed care plan, they have a referral system set up of mental health professional you can see at a low per-session fee. They may be individual practitioners, or a group practice of therapists.

If you don't have insurance, but are in college or at a university, the school's counseling office is where to turn. While most people think of the counseling office as a place to go for career decision help and problems (and indeed, there may be an independent office which does just that), they also help with all kinds of emotional, relationship, and studying problems. While the counseling centers I've talked to and worked at tended to focus on only the less serious problems (they would refer out anyone who had any type of serious mental disorder or suicidal ideation), it's a good place to get started.

If you can't afford a therapist, psychiatrist, or group therapy in your community, check into a community mental health center or check with your community's local mental health association. The community mental health center exists to provide quality mental health care to people who could otherwise not afford it. A sliding-fee scale is used, which allows you to pay for your sessions based upon your income. This can be a great boon. If your community does have such a center (usually run or funded by the county government), call your local mental health association. The fine folks there can usually help you track down a resource you can find in your community which may be of some assistance.

No matter what method you choose, keep one thing in mind... If it's seriously affecting your life, you should seek some type of help for the problem. Problems generally just don't go away on their own, or when they do, it is generally over a long period of time. Problems in living often require active help on your part. Good luck in finding the care and treatment which works best for you!

Last reviewed: By John M. Grohol, Psy.D. on 2 Nov 2005
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