Mental Healthcare 101
Helen Rose
November 30, 2018

If you or someone you know is having thoughts of suicide, call 911 or the National Suicide Prevention Hotline 24/7 at 1-800-273-8255

I had coffee with a dear friend today. We’ve known each other for years and I admire her so much. She’s one of the kindest people I have ever had the pleasure of knowing. She mentioned she’s been dealing with some anxiety and as we spoke I realized that she didn’t know much about navigating mental healthcare. Talking with her made me think about how much I’ve learned over the last several years.

I started navigating the mental healthcare system at age 18, and at 25 I’m now pursuing a career in the field (for now – more developments on that coming soon) and realizing that mental healthcare is still incredibly misunderstood and stigmatized.

I’ve developed a brief overview of mental healthcare based on my personal and educational experience, as I’m a firm believer that knowledge is only useful when shared.

Please note that this is an extremely basic overview and does not include some things like insurance considerations, which can play a significant role. I’m happy to answer any specific questions to the best of my ability or refer you to someone who may be able to answer them.

What is mental health?

In social work, a big part of assessing a client’s needs is a bio-psycho-social-spiritual assessment:

Bio refers to the physical health and conditions of the body.

Psycho refers to the clients’ emotional state and how their thoughts, feelings, and thought patterns effect the rest of their life.

Social refers to their networks – their families, friends, communities, etc. and how they interact with them

Spiritual refers to how they answer “the big questions” – about the self, the meaning and nature of life, etc.

All these factors come together to give the social worker a holistic understanding of the client and their needs. Mental health has components in each of these categories.

According to mentalhealth.gov, “Mental health includes our emotional, psychological, and social well-being. It affects how we think, feel, and act. It also helps determine how we handle stress, relate to others, and make choices.”

Stigma surrounding mental health

I don’t like using all caps, but I’m going to make an exception because this is really important:

MENTAL HEALTH IS JUST AS IMPORTANT AS PHYSICAL HEALTH.

MENTAL HEALTHCARE IS HEALTHCARE.

ADDRESSING YOUR MENTAL HEALTH DOES NOT MAKE YOU WEAK.

TAKING RESPONSIBILITY FOR YOUR MENTAL HEALTH MAKES YOU STRONG.

ANYONE WHO TELLS YOU OTHERWISE HAS THEIR OWN ISSUES TO DEAL WITH AND COULD ALMOST DEFINITELY BENEFIT FROM MENTAL HEALTHCARE.

Why do people may pursue mental healthcare interventions?

First and foremost, one does not need to be in crisis or near it to seek mental healthcare. Preventative care is a great thing, as is taking time to check in with oneself, participate in self-reflection, and practice self-care.

If not for preventative care, then one may seek behavioral health interventions, such as cognitive behavioral therapy (talk therapy), psychoanalysis (tell me about your mother…), or psychopharmaceutic intervention (medication) for a multitude of reasons, including:

• Stress – normal daily stress, chronic stress, or stress from big life changes/events
• Relationship concerns
• Difficulty with communication or social interaction
• Feeling sad or nervous often
• Smoking cessation
• Drug/alcohol abuse
• Trauma
• Anything that effects their baseline level of functioning (eating, sleeping, productivity)

A good rule of thumb is if you think you might need help, you need help.

Types of mental healthcare providers (not an exhaustive list):

• Psychiatrists are medical doctors who specialize in psychology. They can prescribe medication.
• Psychiatric Nurse Practitioners are nurse practitioners who specialize in psychology. They can prescribe medication.
• Psychologists hold a doctorate degree in psychology. They often focus on assessment and research and can facilitate counseling.
• Licensed Clinical Social Workers hold a master’s degree in social work and have completed 3000+ hours of clinical practice. They are qualified and licensed to facilitate therapy and diagnose mental health conditions.
• Licensed Professional Counselors hold a master’s degree in counseling and are qualified and licensed to facilitate therapy and diagnose mental health conditions.

It’s important to note that some of these titles are protected – phrases like “Licensed Professional Counselor” “Psychiatrist” and “Social Worker” can only legally be used by people with the proper certification and credentials. However, words like “therapist” and “counselor” are not necessarily protected and could be used in a misleading way. Always ask specific questions about a professional’s education, licenses, and credentials if you are unsure.

Seeking mental healthcare

1. Assessment
   • Many people broach the subject of mental healthcare first with their general practitioner or family doctor. Often, GPs will refer clients to a mental health professional. I would almost always advise seeking a referral to a mental health provider over having your GP manage your mental health treatment – consider it like seeing a cardiologist for a heart condition. Your GP can probably treat it, and there are also specialists who only treat that particular system, so they are more knowledgeable about that specific system.
   • The mental health professional will assess the client’s needs and develop a treatment plan.
2. Therapy (not an exhaustive list)
   • Cognitive behavioral therapy is common. This is what most people think of when they think of therapy. It’s a 1:1 session with a therapist where the therapist and client talk about what’s going on in the client’s life and their thoughts and emotions surrounding those events. CBT focuses on identifying and challenging ineffective thought patterns.
   • Psychoanalysis is more retrospective than CBT, focusing on past experiences and traumas and how they are affecting the client in their present circumstances. There are lots of newer therapies, such as EDMR, that work specifically with trauma as well.
   • Dialectical behavioral therapy is a skills-based therapy. Clients learn a variety of skills to help them with distress tolerance, mindfulness, interpersonal effectiveness, and emotional regulation. DBT is often used with clients with severe depression or anxiety or personality disorders. DBT skills can be incorporated into other therapies to suit the client’s needs.
3. Medication
   • Sometimes, therapy is not enough to manage a client’s symptoms. There can be many reasons for this, including biological factors or recurring depression with suicidal ideation. Typically, a therapist and client will discuss the possibility of introducing medication to the client’s treatment plan and the therapist will refer the client to a psychiatrist or psych RN for medication.
4. Maintenance
   • Neither medication nor therapy alone can “fix” one’s mental health concerns. It’s often a matter of “skills plus pills.”
   • Mental health must be maintained daily through adherence to treatment plans and self-care. It’s like exercising the body – it’s not enough to hit the gym once, we must go often to maintain our physical health.
   • A client’s mental health needs evolve with them. Some clients may start out needing weekly therapy sessions and twice monthly checkups with their medication provider. As clients experience longer stretches of stability and learn new skills to help them manage their symptoms, then medications may be adjusted and therapy appointments may become more spaced out.
   • It’s important to note that this process looks different for every client. There is no set timeline for healing – it is an ongoing process and it is not linear. Setbacks are normal and not an indication of failure.

Again, this is not a comprehensive overview, but I hope it’s enough to give a basic idea of the system and some of how it works. If you have any questions I’d be happy to try and answer them or help find the answer.