Frequently Asked Questions

When should I use mental health or substance abuse services?
If stress, or interpersonal or job-related tension, is interfering with your daily life or if a medical condition is causing you mental anguish, you may want to seek mental health care. If habitual use of legal or illegal substances is negatively affecting your health and/or your daily life, you should seek treatment for substance abuse. In either circumstance, you should seek care as soon as possible, before you feel that you can no longer cope with the situation. These problems are just as important, and treatable, as medical problems.

Warning Signals
Many people are not sure how to judge when professional help for mental problems may be needed.

There are some behaviors that may be signs of trouble:
1. Is the person acting differently than usual? Could this change be linked to something that has happened recently? Any event, such as the death of a close relative, loss of a job, marital break-up, or even something positive – like a job promotion – can trigger a troublesome emotional reaction.

2. Does the person complain of episodes of extreme, almost uncontrollable, anxiety or "nervousness"? One sign of an emotional problem is "free floating" anxiety that is unrelated to a normal concern, such as a child's illness or a backlog of bills.

3. Does the person become aggressive, rude, and abusive over minor incidents or talk about groups or individuals "out to get me"? If such remarks are made in all seriousness, and if violent behavior occurs, it is likely that help is needed and should be sought.

Any of these symptoms, if they persist or become severe, may suggest a need for professional help. Fortunately, early identification and treatment of the problems causing this behavior often can make these symptoms disappear.

How do I Choose the Right Mental Health Therapist?

Why is this choice so important?
Therapy is a collaborative process, so finding the right match - someone with whom you have a sense of rapport - is critical. After you find someone, keep in mind that therapy is work and sometimes can be painful. However, it also can be rewarding and life changing.

What are the steps for choosing a therapist?

Who are the Helping Professionals?
Helping professionals work in a variety of settings, such as mental health centers, outpatient clinics, private and group practice, general hospitals, psychiatric hospitals, nursing homes, jails, and prisons. They also work in residential treatment centers, partial care organizations, family or social service agencies, and the psychiatric departments of university medical centers or teaching hospitals.

Who They Are – What They Do

Psychiatrists
A psychiatrist is a medical doctor who specializes in mental disorders, is licensed to practice medicine, and has completed a year of internship and three years of specialty training. A board-certified psychiatrist has, in addition, practiced for at least two years and passed the written and oral examinations of the American Board of Psychiatry and Neurology. Psychiatrists can evaluate and diagnose all types of mental disorders, carry out biomedical treatments and psychotherapy, and work with psychological problems associated with medical disorders. Of the mental health professionals, only psychiatrists can prescribe medications. Child psychiatrists specialize in working with children; geriatric psychiatrists concentrate on helping the aged.

Psychologists
Psychologists who conduct psychotherapy and work with individuals, groups, or families to resolve problems generally are called clinical psychologists, counseling psychologists, or school psychologists. They work in many settings – for example, mental health centers, hospitals and clinics, schools, employee assistance programs, and private practice. In most states, a licensed clinical psychologist has completed a doctoral degree from a university program with specialized training and experience requirements and has successfully completed a professional licensure examination.

The field of psychology also includes those who specialize in such areas as testing, community organization, industrial relations, and laboratory research.

Psychiatric Nurses
Psychiatric nursing is a specialized area of professional nursing practice that is concerned with prevention, treatment, and rehabilitation of mental-health-related problems. These nurses are registered professional nurses who have advanced academic degrees at the master's degree level or above. They conduct individual, family and group therapy and also work in mental health consultation, education and administration.

Social Workers
Psychiatric (or clinical) social workers have master's or doctor's degrees in social work, have completed a field supervision program, and are licensed/certified. In addition to individual, family, and group counseling and psychotherapy, they are trained in client-centered advocacy. This includes information, referral, direct intervention with governmental and civic agencies, and expansion of community resources.

Mental Health Counselors
A clinical mental health counselor provides professional counseling services that involve psychotherapy, human development, learning theory, and group dynamics to help individuals, couples, and families. The promotion and enhancement of healthy, satisfying lifestyles are the goals of mental health counselors, whether the services are rendered in a mental health center, business, private practice, or other community agency. Clinical mental health counselors have earned at least a master's degree, had supervised experience, and passed a national examination before they can be certified by the National Board for Certified Counselors, Inc. (NBCC).

Case Managers and Outreach Workers
These individuals assist persons with severe mental illness, including some who may be homeless, to obtain the services they need to live in the community. Most persons with severe mental illness need medical care, social services, and assistance from a variety of agencies, including those dealing with housing, Social Security, vocational rehabilitation, and mental health. Because such services are uncoordinated in many areas, case managers provide a critical function to monitor a person's needs and assure that appropriate agencies get involved. In many instances they also act as advocates for the client.

Case managers can be nurses, social workers, or mental health workers and can be associated with mental health centers, psychosocial rehabilitation programs, or other agencies. Case management and outreach services are frequently provided by teams that may include people who are recovering from a mental illness who function as peer counselors, case management aides, or outreach workers.

Mental Health Research and Services
The core mission of the National Institute of Mental Health is to understand, treat and prevent mental illness. Research into the kinds of mental health services that will support this mission plays an important role. The Center for Mental Health Services provides national leadership in mental health care delivery and policy development to facilitate accessible, comprehensive and quality mental health and support services.

The institute and the center, in cooperation with consumer and family groups, professional organizations and other federal and state agencies, work to advance the application of scientific findings and practice-based knowledge to improve the range of effective prevention and treatment services.

What are some of the different kinds of traditional therapies?

Interpersonal Psychotherapy:
Through one-on-one conversations, this approach focuses on the patient's current life and relationships within the family, social, and work environments. The goal is to identify and resolve problems with insight, as well as build on strengths.

Family therapy:
This involves discussions and problem-solving sessions with every member of a family – sometimes with the entire group, sometimes with individuals.

Couple therapy:
This method of therapy aims to develop a more rewarding relationship and minimize problems through understanding how individual conflicts get expressed in the couple's interactions.

Group Therapy:
This form of therapy involves groups of usually 4 to 12 people who have similar problems and who meet regularly with a therapist. The therapist uses the emotional interactions of the group's members to help them get relief from distress and possibly modify their behavior.

Cognitive Therapy:
This method aims to identify and correct distorted thinking patterns that can lead to feelings and behaviors that may be troublesome, self-defeating, or even self-destructive. The goal is to replace such thinking with a more balanced view that, in turn, leads to more fulfilling and productive behavior.

Behavioral Therapy:
As the name implies, this approach focuses on behavior-changing unwanted behaviors through rewards, reinforcements, and desensitization. Desensitization, or Exposure Therapy, is a process of confronting something that arouses anxiety, discomfort, or fear and overcoming the unwanted responses. Behavioral therapy often involves the cooperation of others, especially family and close friends, to reinforce a desired behavior.

Cognitive/Behavioral Therapy:
A combination of cognitive and behavioral therapies, this approach helps people change negative thought patterns, beliefs, and behaviors so they can manage symptoms and enjoy more productive, less stressful lives.

Electroconvulsive Therapy:
Also known as ECT, this highly controversial technique uses low voltage electrical stimulation of the brain to treat some forms of major depression, acute mania, and some forms of schizophrenia. This potentially life-saving technique is considered only when other therapies have failed, when a person is seriously medically ill and/or unable to take medication, or when a person is very likely to commit suicide. Substantial improvements in the equipment, dosing guidelines, and anesthesia have significantly reduced the possibility of side effects.

Biomedical Treatment:
Medication alone, or in combination with psychotherapy, has proven to be an effective treatment for a number of emotional, behavioral, and mental disorders. The kind of medication a psychiatrist prescribes varies with the disorder and the individual being treated.

Light Therapy:
Seasonal affective disorder (SAD) is a form of depression that appears related to fluctuations in the exposure to natural light. It usually strikes during autumn and often continues through the winter when natural light is reduced. Researchers have found that people who have SAD can be helped with the symptoms of their illness if they spend blocks of time bathed in light from a special full-spectrum light source, called a "light box."

Play Therapy:
Geared toward young children, this technique uses a variety of activities - such as painting, puppets, and dioramas - to establish communication with the therapist and resolve problems. Play allows the child to express emotions and problems that would be too difficult to discuss with another person.

Psychodynamic psychotherapy:
May be either long- or short-term, and examines important relationships and experiences from early childhood to the present in an effort to analyze and change unsettling or destructive behaviors and to resolve emotional problems. One form of psychodynamic psychotherapy is psychoanalysis, a long-term, intensive therapy that emphasizes how the patient's unconscious motivations and early patterns of resolving issues are important influences in his or her present actions and feelings.

Psychoanalysis:
This approach focuses on past conflicts as the underpinnings to current emotional and behavioral problems. In this long-term and intensive therapy, an individual meets with a psychoanalyst three to five times a week, using "free association" to explore unconscious motivations and earlier, unproductive patterns of resolving issues.

What are alternative approaches to mental health care?
An alternative approach to mental health care is one that emphasizes the interrelationship between mind, body, and spirit. Although some alternative approaches have a long history, many remain controversial. The National Center for Complementary and Alternative Medicine at the National Institutes of Health was created in 1992 to help evaluate alternative methods of treatment and to integrate those that are effective into mainstream health care practice. It is crucial, however, to consult with your health care providers about the approaches you are using to achieve mental wellness.

What are some of the different kinds of alternative approaches?

Diet and Nutrition - Adjusting both diet and nutrition may help some people with mental illnesses manage their symptoms and promote recovery. For example, research suggests that eliminating milk and wheat products can reduce the severity of symptoms for some people who have schizophrenia and some children with autism. Similarly, some holistic/natural physicians use herbal treatments, B-complex vitamins, riboflavin, magnesium, and thiamine to treat anxiety, autism, depression, drug-induced psychoses, and hyperactivity.

Pastoral Counseling - Counselors working within traditional faith communities increasingly are recognizing the need to incorporate psychotherapy and/or medication, along with prayer and spirituality, to effectively help some people with mental disorders.

Animal Assisted Therapies - Working with an animal (or animals) under the guidance of a health care professional may benefit some people with mental illness by facilitating positive changes, such as increased empathy and enhanced socialization skills. Animals can be used as part of group therapy programs to encourage communication and increase the ability to focus. Developing self-esteem and reducing loneliness and anxiety are just some potential benefits of individual-animal therapy (Delta Society, 2002).

Expressive Therapies

Art Therapy: Drawing, painting, and sculpting help many people to reconcile inner conflicts, release deeply repressed emotions, and foster self-awareness, as well as personal growth. Some mental health providers use art therapy as both a diagnostic tool and as a way to help treat disorders such as depression, abuse-related trauma, and schizophrenia. You may be able to find a therapist in your area who has received special training and certification in art therapy.

Dance/Movement Therapy: Some people find that their spirits soar when they let their feet fly. Others - particularly those who prefer more structure or who feel they have "two left feet" - gain the same sense of release and inner peace from the Eastern martial arts, such as Aikido and Tai Chi. Those who are recovering from physical, sexual, or emotional abuse may find these techniques especially helpful for gaining a sense of ease with their own bodies. The underlying premise to dance/movement therapy is that it can help a person integrate the emotional, physical, and cognitive facets of "self."

Music/Sound Therapy: It is no coincidence that many people turn on soothing music to relax or snazzy tunes to help feel upbeat. Research suggests that music stimulates the body's natural "feel good" chemicals (opiates and endorphins). This stimulation results in improved blood flow, blood pressure, pulse rate, breathing, and posture changes. Music or sound therapy has been used to treat disorders such as stress, grief, depression, schizophrenia, and autism in children, and to diagnose mental health needs.

Culturally Based Healing Arts
Traditional Oriental medicine (such as acupuncture, shiatsu, and reiki), Indian systems of health care (such as Ayurveda and yoga), and Native American healing practices (such as the Sweat Lodge and Talking Circles) all incorporate the beliefs that:

Acupuncture: The Chinese practice of inserting needles into the body at specific points manipulates the body's flow of energy to balance the endocrine system. This manipulation regulates functions such as heart rate, body temperature, and respiration, as well as sleep patterns and emotional changes. Acupuncture has been used in clinics to assist people with substance abuse disorders through detoxification; to relieve stress and anxiety; to treat attention deficit and hyperactivity disorder in children; to reduce symptoms of depression; and to help people with physical ailments.

Ayurveda: Ayurvedic medicine is described as "knowledge of how to live." It incorporates an individualized regimen—such as diet, meditation, herbal preparations, or other techniques—to treat a variety of conditions, including depression, to facilitate lifestyle changes, and to teach people how to release stress and tension through yoga or transcendental meditation.

Yoga/meditation: Practitioners of this ancient Indian system of health care use breathing exercises, posture, stretches, and meditation to balance the body's energy centers. Yoga is used in combination with other treatment for depression, anxiety, and stress-related disorders.

Native American traditional practices: Ceremonial dances, chants, and cleansing rituals are part of Indian Health Service programs to heal depression, stress, trauma (including those related to physical and sexual abuse), and substance abuse.

Cuentos: Based on folk tales, this form of therapy originated in Puerto Rico. The stories used contain healing themes and models of behavior such as self-transformation and endurance through adversity. Cuentos is used primarily to help Hispanic children recover from depression and other mental health problems related to leaving one's homeland and living in a foreign culture.

Relaxation and Stress Reduction Techniques

Biofeedback: Learning to control muscle tension and "involuntary" body functioning, such as heart rate and skin temperature, can be a path to mastering one's fears. It is used in combination with, or as an alternative to, medication to treat disorders such as anxiety, panic, and phobias. For example, a person can learn to "retrain" his or her breathing habits in stressful situations to induce relaxation and decrease hyperventilation. Some preliminary research indicates it may offer an additional tool for treating schizophrenia and depression.

Guided Imagery or Visualization: This process involves going into a state of deep relaxation and creating a mental image of recovery and wellness. Physicians, nurses, and mental health providers occasionally use this approach to treat alcohol and drug addictions, depression, panic disorders, phobias, and stress.

Massage therapy: The underlying principle of this approach is that rubbing, kneading, brushing, and tapping a person's muscles can help release tension and pent emotions. It has been used to treat trauma-related depression and stress. A highly unregulated industry, certification for massage therapy varies widely from State to State. Some States have strict guidelines, while others have none.

Technology-Based Applications
The boom in electronic tools at home and in the office makes access to mental health information just a telephone call or a "mouse click" away. Technology is also making treatment more widely available in once-isolated areas.

Telemetric: Plugging into video and computer technology is a relatively new innovation in health care. It allows both consumers and providers in remote or rural areas to gain access to mental health or specialty expertise. Telemedicine can enable consulting providers to speak to and observe patients directly. It also can be used in education and training programs for generalist clinicians.

Telephone counseling: Active listening skills are a hallmark of telephone counselors. These also provide information and referral to interested callers. For many people telephone counseling often is a first step to receiving in-depth mental health care. Research shows that such counseling from specially trained mental health providers reaches many people who otherwise might not get the help they need. Before calling, be sure to check the telephone number for service fees; a 900 area code means you will be billed for the call, an 800 or 888 area code means the call is toll-free.

Electronic communications: Technologies such as the Internet, bulletin boards, and electronic mail lists provide access directly to consumers and the public on a wide range of information. On-line consumer groups can exchange information, experiences, and views on mental health, treatment systems, alternative medicine, and other related topics.

Radio psychiatry: Another relative newcomer to therapy, radio psychiatry was first introduced in the United States in 1976. Radio psychiatrists and psychologists provide advice, information, and referrals in response to a variety of mental health questions from callers. The American Psychiatric Association and the American Psychological Association have issued ethical guidelines for the role of psychiatrists and psychologists on radio shows.

How to Pay for Mental Health Services?
Resources for the uninsured:

What can I expect from my insurance plan?
Insurance coverage for mental health (MH) and substance abuse (SA) benefits differs among plans, employers, and States. State laws may require insurers to provide a standard, minimal offering of MH and/or SA benefits although insurers are free to provide additional coverage. In general, mental health benefits are not as extensive as medical/surgical benefits and will require higher deductibles and co-payments in addition to any regular, fixed payments.
The following are common types of managed care health insurance plans:

How can just talking make problems disappear?
When you're talking to someone who has professional training and has helped many others with problems similar to yours, that person is able to see the patterns in your life that have led to your unhappiness. In therapy, the job is to help you recognize those patterns – and you may try to change them. There may be times, however, when you will need a combination of "talk" therapy and medication.

Since I work all day, it would be hard to go to a center during regular working hours. Are centers open at night or on weekends?
Often centers offer night or weekend appointments. Just contact the center for an appointment, which may be set up for a time that is convenient for both you and the center.

Does a mental health center provide services for children?
Yes. Children's services are an important part of any center's program. Children usually respond very well to short-term help if they are not suffering from a severe disorder. Families often are asked to participate and are consulted if the child is found to have a serious disorder – such as autism, childhood depression, obsessive-compulsive disorder, attention deficit hyperactivity disorder, or anorexia nervosa or bulimia – and long-term treatment is needed.