Mental illness used to be a shameful word. If a family had a mentally ill member, their name was unmentioned, and inquires as to their well-being would be returned with oh, they are fine, they have their ups and downs. Admitting that you saw a psychiatrist would have people look at you like you were dangerous, or maybe even worse, you would be treated with pity and condescension. Some people would have a Nervous Breakdown, spend a week or two in a psychiatric unit, and the neighbors and co-workers would whisper about the in hushed tones, again a mixture of fear and pity. Fortunately we have come and long ways in how mental illness is treated, and how society sees people who are mentally ill.
There are two very broad, general categories which will drive people to seek professional help:
- Severe, chronic, persistent mental illness these re disorders such as schizophrenia or bipolar disorder. These are very serious and disabling, and require aggressive and ongoing treatment in order for the person to have any quality of life.
- The other category is people who have no history of severe chronic, persistent mental illness, but are under tremendous stress and life changes. Their ability to cope and function normally has been comprised.
A good starting point is to define mental illness. The definitive guide to understanding mental illness is the DSM-5, (Diagnostic and Statistical Manual of Mental Disorders, 5th edition). That being said, it should be noted that many professionals consider this latest, 5th edition to be the absolute worst ever produced, but it is what we have to work with. The DSM lists every recognized mental disorder, outlining the symptoms in lists. If the patient has a certain number of symptoms from the lists, they are diagnosable with the illness. This criterion for mental illness can be very broadly defined, which is the major criticism of the DSM-5. A child who has frequent temper tantrums? They may have DMDD (Disruptive Mood Dysregulation Disorder). If you drink too much coffee, and get anxious and restless, you have Caffeine Intoxication. If you drink coffee regularly then stop and get headaches and fatigue that is Caffeine Withdrawal. Technically these are mental illnesses, specifically, Substance Abuse disorders.
There are other ways, and better ways to understand mental illness, based on the prior editions of the DSM.
Criterion for abnormal behavior:
Behavior which lacks effectiveness, is counterproductive to goal achievement and problem solving, and makes matters worse.
- Statistical deviance
The majority of a given sample of people will not indulge in the behavior.
- Violation of current cultural norms
According to the unwritten, widely accepted rules of the individual’s culture of origin, the behavior is unusual.
- Observer discomfort
The behavior is considered to be disturbing to others if witnessed. This reflects a violation of cultural norms.
The behavior is resistant to efforts to change or manage it.
The behavior results in adverse effects in multiple areas of life- educational, occupational, or social- it infiltrates and makes life unmanageable.
The behavior continues for a long period of time.
- Recurrent or cyclical
The behavior will fade, and then re-emerge, in predictable cycles, or will occur unpredictably
The behavior causes the individual significant distress.
Dangerous to self or others through overt acts of harm- e.g., suicidality, or covert neglect – e.g., not feeding self- harm results.
Confidentiality and Privacy
Anything you tell your PCP (Primary Care Physician, or Primary Care Provider) and a mental health professional is confidential and enforced by federal law, and professional ethics. Confidentiality is not 100%. If you are using health insurance, your insurance company will receive a claim, which will have to include that you are seeing a mental health care provider and have a mental health diagnosis. Confidentiality must be ethically circumvented in the case of someone who is suicidal or homicidal, or if there is any indication that a child, elderly person, or handicapped person is being subjected to harm. Anyone else who wants information about not only what you and your therapist talk about, but even acknowledgment that you see a therapist will need a waiver. This is a legal document that the patient voluntarily signs to allow communication with a specified third party, about specified topics. This person could be a physician, another mental health provider, or family member.
Once the need has been established to see someone, you have to know where to start, and the difference between the different types of mental health providers.
If you have a PCP, this is probably going to be the easiest and best way to start. Tell your physician what you are experiencing, and they should be able to refer you to someone for counseling. The physician may determine that medication is needed, and if within the scope of their competence, they might be willing to write you a prescription for it. If they feel like what you are dealing with is too complex for their training, they may refer you to a psychiatrist.
County Mental Health Crisis Services
Almost every county in the US has a mental health crisis service. You generally do not need a referral for this. You can walk in, and depending on how busy they are, you may be seen within minutes. If they are very busy, it might be hours. A mental health crisis service does not provide long term care. They will offer a visit to stabilize someone in distress, and then provide referral for appropriate follow up.
A psychiatrist is a medical doctor who specialized in treatment of mental illness. They do this by prescribing medication, and by psychotherapy.
A psychologist has an advanced degree, either a Ph.D., or a Psy D (Doctor of Psychology). In some states, a psychologist can be licensed with a master’s degree What makes a psychologist different from other mental health care providers is they do psychological testing, in addition to psychotherapy.
LCMHC (Licensed Clinical Mental Health Counselor)
This is person with a master’s degree in psychology or counseling, who has passed a state licensure exam, and reached the required numbers of hours of training. They cannot prescribe medication. They use psychotherapy.
MFT (Marriage and Family Counselors)
Marriage and family counselors, also known as couples counselors, specialize in seeing people in relationships, wither married, dating, or related. They have at least a master’s degree, and a state license as an MFT. They may also be dually licensed as psychologists or LCMHCs.
MSW (Master’s in Social Work)
Social workers perform basically the same functions as LCMHC.
LADC (Licensed Alcohol and Drug Counselor)
LADC’s specialize in the treatment of chemical dependency, behavioral addictions such as gambling, and addiction related issues such as domestic violence, criminality, and PTSD.
If you have psychological issues which are leaving you distressed and you are having difficulty keeping up with your responsibilities, don’t wait for it to get better. See someone.