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Finding
a Mental Health Professional
If
you or someone you care about is having a hard time with mood swings,
feelings, emotions, situations or memories, you may have decided it’s
time to seek professional help. If sadness, guilt, feelings of
worthlessness, anxiety, racing thoughts, problems with sleeping or
eating or any other symptoms have started to interfere with your work,
social or personal life, or if you experience a sudden change in mood
that makes you feel “not yourself,” a visit to a professional may
help you.
You
may be unsure about talking to a health care professional about your
thoughts and feelings, and this brochure can help you through that
process. You are not alone. Many people worry about seeing a doctor to
talk about mental health issues. Some think they will be labeled
“crazy” or that they will be judged. You may have been told by
others that you needed to “snap out of it,” “control yourself,”
“pull yourself up,” have more faith, or that your symptoms are your
fault. This is not true, and you are not “crazy”. Seeking help is
the best thing you can do for yourself, and the best way to start
feeling better.
As
you search for a health care professional, keep in mind that you have a
right to expect certain things, no matter who you are, what challenges
you are facing or how much money you have. These include:
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Privacy,
confidentiality and respect
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Sensitivity
to your needs and cultural background
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An
understandable explanation of what is the matter and all of your
treatment options
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Freedom
to express yourself
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Freedom
to find another professional if you are not satisfied with your
treatment or don’t think it’s working as well as it should
Your
relationship with your doctor should be a partnership. The two of you
will work together to find a treatment plan that will help you feel
better. You should never feel intimidated by your doctor or feel that
you are wasting his or her time. A good doctor, despite time
limitations, will make an effort to listen to you and understand you.
How
do I decide which type of professional is right for me?
To
get a better idea of your own needs, it might be helpful to answer some
questions and/or make a list of your symptoms and issues.
What
are the main things I’m looking for help with? (Example: I need help
working through issues with my family, I’m having trouble sleeping, I
can’t stop getting angry all the time, there are problems in my
marriage or relationship.)
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Am
I looking for talk therapy? If so, what kind of therapist do I need –
someone who will listen to me, someone who will help me set goals,
someone who will help me learn coping skills?
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Do
I have any concerns or questions about taking medication?
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What
has my health history been like? Include recurring physical problems
such as headaches or stomachaches, and habits such as drinking, illegal
drug use, prescription drug abuse, or self-abuse (cutting). Also include
any treatment you’ve had with a psychologist, therapist, social worker
or psychiatrist in the past and how it helped you.
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What
options do I have to pay for treatment? (You may need to call your
insurance company or Medicare/Medicaid provider to find out what is
covered. If you will be paying out-of-pocket, you may want to make a
budget and see how much money you can afford to spend per week or per
month.)
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What
kinds of professionals do I have to choose from?
Primary
care doctor or family doctor (MD or DO) Your
family doctor should give you thorough physical examination to find out
if you have any other illnesses that might be contributing to your
symptoms. Your family doctor may talk to you about troubling issues or
prescribe medication for you, or he or she may refer you to a
psychiatrist or psychologist. Primary care physicians are trained to
treat a variety of illnesses, and can effectively treat mild to moderate
depression that responds well to treatment.
Psychiatrist
(MD or DO) A psychiatrist is a
medical doctor who specializes in treating illnesses of the brain. If
your primary care doctor is not comfortable making a diagnosis, is
unsure of your diagnosis, or believes you may need a combination of
treatments, he or she may refer you to a psychiatrist. Some
psychiatrists offer talk therapy and medication, while others see
patients to prescribe and adjust medications only.
Psychologist
(PhD, PsyD, EdD, MS) A
psychologist has intensive training in illnesses of the brain and can
help you feel better by teaching you coping skills and helping you
change the way you approach things. Your appointment with a psychologist
will usually be about 50 minutes long, and you will have a chance to
talk about what is happening in your life and what you can do to get
through it. In most
U.S.
states, a psychologist cannot prescribe
medication.
Social
worker (DSW, MSW, LCSW, LICSW, CCSW) or Counselor/Therapist (MA, MS,
MFCC, MFT, LPC, LCPC) Social
workers, counselors and therapists are highly trained professionals who
work with thought- and action-related coping skills. Their methods are
similar to psychologists’ methods.
Psychiatric
nurse (APRN, PMHN) Psychiatric
nurses work with individuals and families to assess needs and develop
treatment plans. They may monitor treatment, assist with crisis
intervention or offer counseling.
Most
professionals use a combination of approaches, and alter their approach
to best help the person they are treating. They may also hold group or
family therapy sessions. Some people find it helpful to get feedback
from a group; others are more comfortable talking one-on-one.
No
one type of professional is better than another. The most important
thing is your ability to work with the person, talk honestly and openly,
and make progress. Choose the one that is the best fit for you in terms
of your needs, your comfort level, and your finances.
Sometimes
people see more than one professional. For example, a person might get
medication from a family doctor, and then see a social worker for talk
therapy.
Where
can I look for a professional?
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Your
family doctor can give you a referral.
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Your
workplace employee assistance program. (If you are worried about
confidentiality, first find out if this service is confidential.)
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Your
insurance network. If you have insurance, your insurance company may
have a list of professionals that are “in the network” and rules
for seeing those who are not.
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Friends,
family, community centers or places of worship. Sometimes a friend
or relative’s doctor will recommend someone, since some people
don’t feel comfortable seeing the same person a close friend or
relative is seeing.
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Professional
associations.
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Your
city or state mental health department. (Check the community,
government or Blue Pages section of your phone book.)
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Local
hospitals, or universities that have teaching hospitals.
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A
local doctor referral service.
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Recommendations
from people at your DBSA support group.
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DBSA’s
online referral program.
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What
should I tell the professional?
Many
people find it difficult to “open up” to a new doctor, especially if
they are talking about feelings and emotions. Take another look at the
list “What are the main things I’m looking for help with?” Bring
it with you to your first appointment. It can be a good way to start
talking about the main things that are causing problems in your life, or
the things you want to improve. The following list can also be helpful.
Check
if “yes”:
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Has
anyone in my biological family been diagnosed with depression,
bipolar disorder or another mental illness?
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Has
anyone in my family had to “go away for a while” or had a
“nervous breakdown”?
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Has
anyone in my family abused alcohol or drugs (illegal or
prescription)?
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Has
there been trouble with chronic pain, headaches or stomach problems
in my family?
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Have
there been other medical illnesses in my family?
If
you answered “yes” to any of the above, describe:
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Have
any major changes taken place in my life lately? (Include changes to
your life situation such as a new job or a new home, and physical
changes such as trouble sleeping, loss of appetite or other illnesses.)
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What
medications am I taking (for all illnesses)? What medications have I
taken in the past? How did they work?
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How
much have I been drinking? What about drug use?
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Have
I had thoughts of death, suicide or self-harm, now or ever?
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If
you or someone you know has thoughts of death or suicide, contact a
medical professional, clergy member, loved one, friend or crisis hotline
such as 1-800-273-TALK immediately.
What
are my main concerns or fears about treatment? (Example: I get
uncomfortable talking about my feelings; I usually don’t stick with
things I start; I don’t have the time for weekly appointments.)
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Do
I have any special needs for extra privacy and confidentiality?
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Remember
that seeking help is no reason to be ashamed. You would not be ashamed
if you asked for help with symptoms of diabetes, asthma or any other
health problem. Your doctor should not judge you or your actions. If,
after a few appointments, you feel your doctor is judging you, it may be
helpful to talk to him/her about it, or look for another doctor that you
feel is more accepting.
After
you have found some health care professionals that look like they fit
your needs, call the office of one and make an appointment. Most of the
time you will only need to give your name and phone number to the person
who sets the appointment – you will be able to explain your reasons
for seeking help during the appointment. If you have concerns about
privacy, bring them up during the call.
If you need help right away, let the person know. You don’t
need to go into detail, just say you are in a crisis situation. If the
first doctor you call can’t see you soon enough, call other doctors
until you can find one who is able to help you quickly.
What
should I expect at my first appointment?
In
your first session, you will probably do most of the talking. You should
tell the professional why you are there and what you would like to get
from treatment. The professional will tell you how he or she can help,
and the two of you will work together to set goals and develop a
treatment plan. After the professional gets to know more about you and
your situation, he or she may be able to give you an idea of how long
treatment will take and when you can expect to feel better. Most
treatment today is goal-oriented and it does not necessarily go on
indefinitely.
What
should I find out from the professional?
This
will depend on your personal needs and concerns, but here are some
questions you may want to ask:
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What
type of training and experience have you had?
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What’s
your treatment philosophy/method?
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How
long do appointments usually last and how often will they be?
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How
do you handle billing? Do you offer a sliding scale?
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How
can I reach you in an emergency?
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How
will I know if I’m making progress?
If
you and the professional you’re seeing make a list of short- and
long-term goals at the beginning of treatment, you’ll be able to check
the list and see if you’re closer to reaching any of those goals.
It’s helpful to keep a journal or a DBSA Personal Calendar to track
your progress – how you feel each day and how you deal with difficult
situations. You and your professional should also set a time when you
will look back and review your progress. Improvement won’t happen
overnight, and the problems you’re having may not completely
disappear, but you should be able to see some change, even if it’s
just a better understanding of your own thoughts and feelings. Many
people who keep journals or Personal Calendars are surprised when they
look back to see that they have made a lot of progress. Another helpful
tool to track your progress is the “How is my treatment plan
working?” worksheet.
It
is also helpful to learn everything you can about mood disorders (and
any other illnesses you have) and their treatments. Check your local
library for other books and reference materials. You can also ask your
pharmacist for information if you are taking medication, or find
information at www.nlm.nih.gov/medlineplus/.
What
if I’m not making progress?
As
hard as professionals try, sometimes they may give you an incorrect
diagnosis or lack the time to pay attention to your unique needs. If,
after honestly looking at your goals and your feelings before and after
treatment, you believe that you are not getting better, you have a right
to seek a second opinion (as you would with any illness), and to have
the best treatment possible. You do not have to stay with your current
professional. But if you are taking medication, never stop taking it
without the supervision of a medical professional, to avoid harmful
effects.
Look
for additional referrals and start again, using the knowledge you’ve
gained from your time in treatment. Don’t let one unsuccessful
experience make you unwilling to try treatment again. And don’t blame
yourself. Sometimes the match of professional and patient personalities
doesn’t work out, or a patient might make more progress using a
different method of treatment. Keep trying and don’t give up hope.
There is a way for you to feel better.
Let
your doctor know you won’t be returning for further treatment, and ask
that copies of your records be forwarded to the next professional you
see. Be courteous and remember to cancel any appointments with enough
advance notice.
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How
can a DBSA support group help me?
If
you think you might have depression or bipolar disorder, a DBSA support
group is a helpful, reliable, knowledgeable group of people who know
what you are going through and can help answer the question, “What
next?” and other questions you have.
DBSA
group participants are people with mood disorders and their families who
share experiences, discuss coping skills and offer hope to one another
in a safe and confidential place. DBSA support groups provide the caring
and assistance that is important to lasting recovery, and are a valuable
addition to therapy and/or medication. People who attend say that the
groups:
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Provide
a safe and welcoming place for mutual acceptance, understanding and
self-discovery.
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Give
them the opportunity to reach out to others and benefit from the
experience of those who have “been there.”
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Motivate
them to follow their treatment plans.
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Help
them to understand that mood disorders do not define who they are.
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Help
them rediscover their strengths and humor.
People
who had been attending DBSA groups for more than a year were also less
likely to have been hospitalized for their mood disorder during that
year, according to a DBSA survey.
How
can I deal with financial and insurance issues?
There
is no easy answer to this question. Unfortunately, mental illnesses
sometimes are not insured at the same level as other illnesses.
Sometimes mental health coverage is not offered at all, or a person is
unable to get health insurance. Here are some things you can do to try
to reduce the cost of your treatment.
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Talk
to your health care provider(s) and try to work out lower fees or a
payment plan.
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Use
community or state-provided services, many of which offer a sliding
payment scale.
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Space
out your allowable psychotherapy visits over time and work on
developing skills you can use between visits.
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If
you are taking medication, ask your doctor to contact the
pharmaceutical company that makes your medication and see if you are
eligible to receive free medication. Ask if your doctor has any free
samples of your medication to give you.
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Ask
your doctor to contact your insurance company and ask if they will
allow more treatment for you.
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If
you are having a hard time getting insurance because you’ve had
treatment for mental illness, your state may have a risk pool, which
offers insurance for hard-to-insure individuals. There is often a
waiting list, and this insurance is often costly, but it is an
option to consider. For more information, visit www.healthinsurance.org/riskpoolinfo.html
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Get
help before there is a crisis. A brief appointment to talk about how
you’re feeling or adjust your medication can prevent more costly
interventions later.
There
is hope.
Right
now you might be dealing with symptoms that seem unbearable, and it can
be difficult to have patience as you search for a professional and go
through treatment. The most important thing you can do is believe that
there is hope. Treatment does work, and most people can return to
stable, productive lives. Even if you don’t feel 100% better right
away, its important to stick with treatment and remember that you are
not alone.
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How
is my treatment plan working?
This
worksheet can help you check your progress and find out which issues
need to be discussed at future appointments. You may want to make copies
and use one each week.
WEEK
OF _________________________________
NEXT
APPOINTMENT _________________________________
On
a scale of one to ten, how do you feel? (circle the number)
1
2 3 4
5 6 7
8 9 10
1=sad,
tired, anxious, tense, irritable, withdrawn
10=happy, rested, relaxed, energized, involved in life
Check
any words that describe how you felt this week:
_
Trouble concentrating
_
Sad/Crying
_
Joyful/Pleased
_
Overeating/Not eating
_
Slept too much/Trouble sleeping
_
Irritable/Angry/Worried/Anxious
_
Calm
_
Don’t care/Pessimistic
_
Lazy/No energy
_
Interested/Involved in life
_
Aches and pains
_
Guilty/Hopeless/Worthless/Overwhelmed
_
Difficult to concentrate or make decisions
_
Wanted to be alone
_
Happy/Content
_
Thoughts of death or suicide
_
Working well/Clear thinking
_
Alcohol/Substance use
_
Active
_
Other: _________________________________
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Have
my family, co-workers or friends said anything about my mood? If so,
what?
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What
difficulties did I have sticking with my treatment plan? (medication,
talk therapy, support groups, etc.)
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Did
my medication make me feel bad in any way? How?
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I
experienced the following side effects this week:
_
Nausea
_
Sexual difficulties
_
Constipation
_
Dizziness
_
Weight gain/loss (___ lbs.)
_
Shortness of breath
_
Shaking
_
Dry mouth
_
Other:
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In
what ways am I feeling better than last week?
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Do
I think I could be doing better? _ Yes _ No
If
yes, in what ways?
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Questions
to ask my doctor:
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Goals
for my next appointment:
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Symptom
Checklist
This
checklist can help you prepare for a first-time discussion with your
professional, or evaluate your progress from day to day or week to week.
However, it is not meant to help you diagnose yourself. Only a health
care professional can diagnose you.
Symptoms
of depression
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Prolonged
sadness or unexplained crying spells
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Significant
changes in appetite and sleep patterns
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Irritability,
anger, agitation
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Worry,
anxiety
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Pessimism,
indifference
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Loss
of energy, persistent exhaustion
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Unexplained
aches and pains
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Feelings
of guilt, worthlessness and/or hopelessness
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Inability
to concentrate; indecisiveness
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Inability
to take pleasure in former interests; social withdrawal
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Excessive
consumption of alcohol or use of chemical substances
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Recurring
thoughts of death or suicide
Symptoms
of mania
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Increased
physical and mental activity and energy
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Exaggerated
optimism and self-confidence
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Grandiose
thoughts, inflated sense of self-importance
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Excessive
irritability
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Aggressive
behavior
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Decreased
need for sleep without feeling tired
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Racing
speech, racing thoughts
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Impulsiveness,
poor judgment
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Reckless
behavior such as spending sprees, impulsive business decisions,
erratic driving and sexual indiscretions
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In
severe cases, delusions and hallucinations
If
you or someone you know has thoughts of death or suicide, contact a
medical professional, clergy member, loved one, friend or crisis hotline
such as 1-800-273-TALK immediately.
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