Understanding Choices: Mental Health Care is Available in Varied Forms
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.
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 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 helped 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 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.
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.