Improved and expanded mental health care has taken center stage in our national conversation. When we talk about broad, political challenges like gun violence, the failures of our mental health care system often become paragraph one. When we acknowledge ongoing social concerns like rampant anorexia among young women, we wonder why those same girls aren’t receiving the treatment they so painfully need.
Getting the right therapy to the right people is clearly a huge challenge. It is so big, in fact, that it could become overwhelming. So overwhelming that we might all give up before we try, become discouraged instead of encouraged, accept the status quo instead of expect progress.
But we know that a small step for one person can be a big leap for all people. (Hi, Neil. I modified you.) That small step in the mental health context may just be empowering those who are ready to get the help they need by showing them where to go, or empowering the loved ones on the sidelines who want to know how to get there. Consider this post a hand being extended, ready to hold yours. One step at a time.
Let’s define the road map first. What follows are my suggestions and insights — guideposts for charting a path to recovery. They do not represent the only approach towards finding treatment, but they are at least an approach. They are not medical advice, but are resources for getting to that advice. They are based on some research and a lot of experience.
When I was 18 years old, I started feeling like I was carrying around a load of bricks. Everything felt heavy. My body, my clothes, my thoughts. Which was odd, because I was severely underweight. Months went by, and the view from my eyes just became grayer. I couldn’t stop crying, I had a hard time getting dressed, and one afternoon I found myself curled up in the back hall of my childhood home, screaming. Just, screaming.
Finally, my parents and I realized that this wasn’t situational. I wasn’t going to shake it off, and adding or subtracting some material element to my life wasn’t going to provide a fix. So my well-worn overalls and I made our way to a pyschiatrist’s couch. I got up from it with a prescription and a huge sigh of relief. He said there was something wrong with me! We were going to fix this! We were going to fix me!
Fifteen years have passed, and I’ve been in and out of four doctors’ care and a couple different dosages. That might seem like a lot, but it was worth every second…even the agonizing ones. Now, I can recognize an oncoming downturn like I recognize an oncoming cold, and I know what my mental Vitamin C is.
I never wanted to hurt someone else, but I certainly thought about hurting myself more than I already was. I didn’t, though. You don’t have to – and she doesn’t have to, or him – either.
REMEMBER: IF YOU OR SOMEONE YOU KNOW IS IN AN EMERGENCY, CALL 911 AND/OR THE NATIONAL SUICIDE PREVENTION LIFELINE AT 1-800-273-TALK or go here.
Assuming a non-emergency situation, first thing’s first: you, or he/she, need(s) to accept the fact that help must be accepted. This is perhaps the most dangerous element of mental health care. Like the alcoholic who doesn’t think he drinks too much, the mentally infirm will not be able to begin a meaningful recovery if they cannot admit there’s anything to recover from, or do not have faith that there is a way out. Advice for getting to this point is hard to give, but removing the stigma of mental illness and encouraging loved ones to intervene, sooner rather than later, and again and again and again, will go a long way towards inspiring or compelling this acceptance. In making mental illness part of the conversation, we need to make conversations about mental illness part of the norm.
Next, you need to find someone qualified to both talk to and receive treatment from. Mental health professionals come in many different shapes and sizes. The two most widely-known are psychiatrists and psychologists. In the most general of terms, psychiatrists can prescribe medicine (Prozac, Zoloft, etc.) because they are medical doctors; psychologists cannot, because they are not (they have advanced graduate degrees). Both, however, can provide talk therapy. So can licensed mental health counselors and clinical social workers. Psychiatric nurses can also provide a range of treatment and other assistance. Keeping an open mind about a potential provider is important as you grapple with other factors like cost, location, availability and specialities.
If you are in college or graduate school, your school most likely has resources available to help you. You should contact the on-campus counseling center or its equivalent and explore your options. Often, these services, including at least the initial visits, are free of charge. In the three colleges/grad schools I attended, this was the case. You may be able to receive all of your therapy on campus, or your on-campus counselor can help you find the treatment you need from the off-campus community.
If you don’t have this kind of network to take advantage of, you still have a variety of ways to find help. Once, I asked my general practitioner for a referral, so you can always start there. Or you can get a referral from someone else you trust who has also received counseling. If neither of those alternatives is available, to the Internet you go. While a Google search might do the trick, you can also use the following websites to search for providers in your area: here and here.
Now you’re ready to schedule an appointment. Your call may be answered by a receptionist, as it would be in any other doctor’s office. Or, if your selected provider works on his/her own, you might go directly to their office voicemail, and they’ll call you back. Either way, you’ll be asked for some general information and you’ll be given dates/times to choose from. Also either way, you should let them know if you need to be seen immediately or as close to immediately as possible. This is also a good time to discuss their payment options.
Payment, of course, can open a huge can of worms. Therapy is expensive, some forms more expensive than others, and fewer providers are accepting health insurance. That’s why it’s important to consider the range of service-providers, as a licensed social worker might be able to charge less than a psychiatrist. In an ideal world, you would not have to sacrifice the type and quality of care you get because of money concerns, but this is not an ideal world. I’m of the mind that some help is better than none at all. And it should not be assumed that lower cost means lower quality.
If you do have health insurance, you might want to find a provider who accepts yours, or who is willing to help you with the paperwork required for filing claims. If you don’t have insurance, or want to use a provider who doesn’t accept yours, you should discuss alternative payment plans or sliding-scale fees. And if you have no money to pay for treatment, you can go to the Substance Abuse and Mental Health Care Services Administration website, as their mission is to help people find health care services, regardless of ability to pay.
So you’ve made your appointment. Here’s what you can expect from your first visit: your provider will likely have a waiting room. Don’t worry – there is usually no one else in there. You will either flip a light switch or signal in some other way that you’ve arrived (per your provider’s instructions), or your provider will come out and get you. Their office will probably look like what you imagine it will: soft lighting, muted colors, a couch facing a chair, and discreetly-placed boxes of Kleenex. Your provider will likely guide you through this initial visit, with questions about what is happening in your life and what might have gotten you to this place. The meeting will probably last around 45 minutes, and at some point along the way, you two will discuss a plan: how often you will meet, how long your meetings will be, what treatment strategies are on the table, et cetera. The provider should also give you his/her contact information and instructions on what to do in an emergency. You should ask any questions you might have. Any.
Subsequent visits will evolve depending on the approach of your provider. You may have to begin the session with whatever is on your mind, or your provider may be more of a guide that helps steer the conversation. You should not be nervous about “having something to say,” and you should always, always be completely honest. I often said things like “I don’t know what to say” or “I don’t know how to explain this,” and then 43 minutes later I would realize I hadn’t stopped talking. Sometimes, I’d just sit there and cry. It’s okay. You don’t have to have a prepared script. Just go, and go with it.
All mental health professionals, on campus or off, paid by you or paid by someone else or paid by no one, have to keep whatever you tell them confidential. They may, however, be required to take certain steps if they believe you might harm yourself or someone else. They may also need to share your diagnosis and related information with your insurer, if any. If you have questions about the scope of your provider’s confidentiality obligations, ask them.
How long you continue seeing a mental health care provider is largely up to you and him/her. If you find you’re not getting what you think you need from your meetings, you should both discuss it with your current provider and consider finding an alternative provider. And you might find yourself stopping and then starting up again. I stopped therapy after college, and then years later, as a working adult, returned….to the very same psychologist I’d been seeing in college. Worry less about the end than about the beginning and the middle.
If you’ve gotten to the end of this very long post, good for you. If you’re still feeling confused or scared, it’s okay. If there’s something more you think I might be able to do for you, email me. (firstname.lastname@example.org). I’m not a doctor, but I’m happy to be a friend.
Above all, find the therapist. Make the appointment. Go talk.
You can do it.
You only need to move one step at a time.
Featured image via Shutterstock.