Understanding mental health

Finding a good mental health expert

Finding the right mental health professional may require some trial and error but it can also be rewarding in the long run

Dr Garima Srivastava

We feel low or down at various points in our lives but are soon able to overcome these feelings on our own as time passes or sometimes with a little bit of support from those we are close to. But what happens when these low points overwhelm our emotional and mental resources and our ability to deal with these stressful situations effectively? When should we consider seeking professional help for any issues related to mental health?

One simple way of knowing the need for help is to gauge the extent to which the problem (which could be related to emotions, feelings, sadness, mood swings, anxiety/racing thoughts or interpersonal relationships, to name just a few) is interfering with your work, social or personal life and how distressing it is for you . Asking yourself or a loved one, will help you decide if it is time to think about seeking professional help.

Taking the first step of seeking help

Making up your mind to seek help is the first and most important step, but you may be unsure or hesitant of going ahead with this decision. You may fear being judged or labeled crazy by others. You may be advised by others that you need to “snap out of it,” or “pull yourself up.”

It is important to bear in mind that seeking help is no reason to feel ashamed. Many people blame themselves for their symptoms or feel guilty for their difficult behavior. When a person has symptoms of certain physical health conditions such as diabetes, hypertension, asthma or any other health problem, they are not ashamed to seek medical help. Similarly, even your mental health doctor will not judge you or your actions. You need to remember that wanting to seek help is the best thing you can do for yourself and it is the best way to start feeling better. Also, it is extremely important to remember that your family member or a caregiver can play a very important role in helping you especially when you are bogged down by stress and psychological distress, and you are not confident enough to talk about it or seek help.

Your choice matters

As you look for a mental health professional, keep in mind that you have the right to expect certain things, no matter who you are and what challenges you are facing. These include:

  • Privacy, confidentiality, dignity and respect
  • Sensitivity to your needs and cultural background
  • An understandable explanation of what ails you and all your treatment options
  • Freedom to find another professional if you are not satisfied with your treatment or don’t think it is working as well as it should be.

Before scheduling your first appointment, consider your preferences regarding whom you would be most comfortable talking to. Some factors include: gender, age, religion, language, and cultural background of the expert. It is perfectly alright to rule out some mental health professionals based on these criteria. Your comfort level is important because you may be establishing a long-term relationship.

Collaborative relationships help

It is important to bear in mind that your relationship with your doctor is a partnership. The two of you will work together to find a treatment plan that will help you feel better. You can be rest assured that all mental health professionals are ethically bound to maintain confidentiality of your ailment and what you say during treatment. It may be useful to know that a good therapeutic relationship is based on good rapport, empathy and unconditional positive regard, between the doctor and the patient. And they both need to put their effort in maintaining such a relationship.

How do I decide which type of professional is right for me?

Broadly, there are two kinds of treatments for mental health problems: psychological and psychiatric. For problems that are purely emotional and psychological in nature such as mild to moderate depression, anxiety, stress, etc, visiting a psychologist/psychotherapist will help you, but in some cases such as severe depression or obsessive compulsive disorder, a combination of medication along with psychological therapies, which can include psychological counseling, may be the best suited to help manage your symptoms. In case of severe psychiatric disorders such as paranoid schizophrenia, you may need only psychiatric medication to start with, until the hallucinations or delusions decrease.

In general, based on the severity of your symptoms and complexity of the diagnosis, you need to look for a mental health professional who is more skilled and has the expertise to treat your ailment.

If you are able to identify that the underlying basis of your problem is emotional or psychological in nature then it maybe best to directly approach a psychologist or a mental health counselor.

Once you have decided that you may need to visit a psychologist, the next important thing to keep in mind is to understand what kind of therapy/treatment you are looking for? While most mental health providers can provide treatment for a range of conditions, a mental health professional with a specialized training may be more suited to your needs. For example, if you have an eating disorder, you may need to see a psychologist who specializes in that area; for interpersonal conflict in a marriage, a marital & family therapist may be best suited to help you; and in case your child is having exam related anxiety, it may be a good idea to first approach the school counselor. Also, many people know what they want from a therapist specifically. For example, a therapist, who will listen to me, or who will help me set my goals and help me learn coping skills, etc.

If your mental health condition is more debilitating with more severe symptoms – for example, in case of severe depression, one may experience suicidal ideation, along with headaches, low mood, feelings of worthlessness, loss of appetite and sleep – you need to consult a psychiatrist who can treat you for some of these symptoms with antidepressants, and a psychologist will help you with cognitive behavior therapy to restructure your dysfunctional thoughts and feelings, and will be a facilitator in helping you revive your pleasurable activities.

Sharing your previous medical history

It is good to speak openly about your health history, including recurring physical problems such as headaches or stomach-aches, habits such as drinking, smoking, illegal drug use, or self abuse (cutting). Also tell the doctor about any previous treatment you have taken from a psychologist, social worker, or psychiatrist and how it helped you.

Taking medications

If you have any questions or concerns about taking medication, and their possible side effects, you need to clarify these doubts with the doctor. 

What kind of professionals can I choose?

  • Primary care doctor or family physician (MBBS or MD): Your family doctor would give you a thorough physical examination to find out if you have any other illnesses that might be contributing to your symptoms. They may inquire about any troubling/emotional issues, and when they identify that the problem is related to mental health, they may refer you to a psychiatrist or a psychologist.

  • Psychiatrist (MD): A psychiatrist is a medical doctor who specializes in treating illnesses that are psychiatric in nature, and they are qualified to prescribe medications. Your family doctor can diagnose and prescribe medications for mental health issues. Other types of mental health professionals generally cannot prescribe medications and you need to be aware of this fact.

  • Psychologist (MPhil, PhD): A psychologist has intensive training in psychological management of psychiatric disorders and other behavioral problems. They can help you learn coping skills and change the way you approach things. A psychologist can be trained in one of the following subjects, some which include: psychodynamic, Cognitive Behavior Therapy (CBT), Rational Emotive Behavior Therapy (REBT), client centred therapy (form of talk therapy), or an eclectic therapy (customized approach based on the needs of the patient).

  • Psychiatric Social Worker (Master in Social Work MSW): They work with individuals and families to assess emotional and social needs and develop treatment plans. They may monitor treatment, assist with crisis intervention, resource information, or offer counseling.

What is the duration of therapy?

Each psychotherapy session usually lasts anywhere between 45 to 60 minutes. In the first session, you will most probably do most of the talking. You will be required to tell the professional why you need help and what you expect from the treatment. The professional will tell you how they can help, and both of you will work together to set goals and develop a treatment plan. At every follow-up appointment, it’s important to evaluate whether target symptoms are increasing or decreasing in frequency, intensity (how bad) and duration (how long). This helps determine whether the interventions you and your doctor have tried are helping you move towards recovery.

Where can I look for a professional?

  • Your family doctor can give you a referral
  • Friends, family, community network – Sometimes a friend or relative’s doctor can recommend someone.
  • Check phonebook listings under categories such as community service, counselors, physicians, psychologists, psychiatrists, or social services organizations.
  • Look for non-profit, government or mental health organization websites that provide listings of professionals in your area.
  • Professional associations and some companies offer workplace employee assistance programme (EAP). If you are concerned about confidentiality, first find out the credibility of this programme and check if this service is confidential and legal.
  • Look for psychiatry or psychology departments in local hospitals or medical colleges.
  • Check your insurance network. If you have medical/health insurance, your insurance company may have a list of professionals that are “in the network”. They may also have rules for consulting experts who are not in their network.

What information should I get from the professional?

Getting to know about the professional is important and it depends on your personal needs and concerns.

Here are some questions you may want to ask:

  • What type of training and experience does the professional have?
  • What’s their treatment philosophy and method, to make make sure it suits your style and needs.
  • How long do the appointments usually last and how often will they be?
  • How do they handle billing?
  • How can you reach them in an emergency?
  • Whether they specialize in certain disorders or age groups? Some, for instance, work only with adolescents. Others specialize in depression, eating disorders or substance abuse, etc.

Finding the right mental health professional can be hard work, and may require some trial and error. But it can also be rewarding because it helps you:

  • Resolve short-term emotional and psychosocial problems such as stress or conflicts caused by particular situations or events.
  • Work through long-standing personal issues
  • Relieve disruptive or bothersome symptoms
  • Overcome personal challenges
  • Improve your relationships with others
  • Ultimately enjoy your life more

References:

Diagnostic and Statistical Manual of Mental Disorders (DSM) American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

White Swan Foundation
www.whiteswanfoundation.org