Mental wellness is as important to a healthy and fulfilling life as physical wellness. Most people understand it’s important to see a doctor for certain symptoms or to treat a physical injury. And while annual physicals may not be necessary for everyone, most of us understand that periodic “well” visits with our regular doctor can mean long-term benefits as we get older.
But when it comes to seeking help for our mental health, we aren’t always sure why it’s necessary or even a good idea. That’s unfortunate, since one out of every five people in the United States will be diagnosed with a mental illness in any given year (most commonly depression or an anxiety disorder), and nearly half will experience at least one mental illness in their lifetime. And mental illness plays a major role in the onset, progression, and outcome of many other major conditions. For instance, depression is a major risk factor for heart disease and diabetes and plays a big part in determining their management and outcome.
Mental illness itself is also a major risk factor for premature death. Suicide, commonly associated with depression and a history of other mental health problems, is the 4th leading cause of death among adults in the United States ages 18 to 65 and the 10th leading cause overall.
One major reason mental health does not get the attention it merits is the stigma that’s been attached to mental illness. Many of us see mental illness as a weakness rather than a disease, something that comes from a character flaw or a personality issue. Another misconception is that mental illnesses can be neither prevented nor cured once they occur. But people who get the proper treatment do get better—and many recover completely.
When to get help
Whether it’s your own problem or that of someone you care about, hiding a mental health problem—or denying that it exists—only delays the help you need and increases the likelihood the problem will get worse. The type of help you or your loved one may need can only be determined after a diagnosis, and that requires a review of a person’s symptoms, medical history, and circumstances. Where to start? You can begin by talking with your primary care doctor about symptoms that have been troubling you, such as persistent sadness, feelings of hopelessness or panic, or difficulty sleeping. He or she can help determine whether the symptoms may be caused by a physical problem (an underactive or overactive thyroid, for example) or whether you should speak with a mental health professional for more evaluation.
Some signs that may indicate a need to contact a professional include:
- anxiety or chronic depression that seems to have no immediate cause
- compulsive behavior
- difficulty communicating
- an eating disorder
- fits of weeping
- grief that becomes overwhelming and unmanageable
- signs of drug or alcohol abuse
- sudden or unexplained aggressive behavior
- sudden personality changes
- thoughts of suicide or a suicide attempt
- unreasonable fears or overwhelming feelings of panic
Contemplating, threatening, or attempting suicide is a medical emergency. If you or a loved one are at risk for suicide, don’t hesitate. Call the National Suicide Prevention Hotline at 1-800-273-(TALK) 8255. If there is an imminent threat of harming yourself or someone else, call 911 for emergency help.
It may be difficult to accept the fact that you or someone you care about needs help. But admitting a problem exists is often the first step in solving it. No form of therapy is a guaranteed cure, and frequently more than one type of treatment is needed. For instance, medication along with talk or behavioral therapy are often used together. And in the process of getting help, you may work with more than one type of mental health specialist—for example, a psychiatrist who prescribes antidepressants or other medication, plus a psychologist or counselor whom you see for talk therapy. For definitions of these and other mental-health specialists, see next section.
A glossary of mental health professionals
(listed in alphabetical order)
Licensed professional counselors (LPCs). Also called licensed mental health counselors or licensed clinical professional counselors, depending on the state, these professionals have a master’s degree and are trained to work with individuals, families, and groups in treating mental, behavioral, and emotional problems and disorders. They may work in private practice or in schools, community mental health centers, agencies, or organizations.
Marriage and family therapists. Many states also license counselors who specialize in marital and relationship problems or child-parent problems. Marriage and family therapists can also treat individual problems such as anxiety and depression. The emphasis in treatment is on short-term cognitive and behavioral therapy. Therapists undergo about the same amount of training as social workers and mental health counselors. You will need to check with your insurance company to see whether your plan covers marriage or couples therapy.
Psychiatric nurses. This special area of nursing is concerned with the prevention and treatment of emotional and mental disorders. Psychiatric nurses are registered nurses with advanced degrees. They may conduct individual and group therapy in or out of hospitals. They also work with communities to help assess a community’s mental health needs. Advanced practice psychiatric nurses can work as primary mental health care providers, and many of them have their own practices. Psychiatric nurses have the authority to write prescriptions in every state of the country. Some states, however, impose certain restrictions including physician oversight on the prescriptions.
Psychiatrists. Psychiatrists are medical doctors—MDs or DOs (doctor of osteopathic medicine)—with several years of postgraduate training in the diagnosis and treatment of emotional and mental disorders using various forms of psychotherapy and medications. They can prescribe drugs and can also hospitalize patients when necessary. They may treat a range of problems, from severe psychoses to milder emotional disorders, and may use many different types of psychotherapy, from short-term therapy to long-term psychoanalysis. Some psychiatrists may specialize in child, adolescent, or geriatric psychiatry. Some may specialize in eating disorders or in drug or other substance abuse problems. It’s common for psychiatrists to work as a member of a team. For instance, the psychiatrist may oversee the prescribing and use of medication while another professional provides the counseling.
Psychoanalysts. A psychoanalyst may be an MD or a DO who has completed a 4-year residency in psychiatry; a PhD or PsyD in clinical psychology, social work, or another mental health discipline; or have a master’s degree in a clinical field such as social work, family therapy, counseling, or psychiatric nursing. After meeting the professional qualifications for the discipline, the psychoanalyst candidate must have 6 to 10 years of postgraduate psychoanalytic training. Although conventional psychoanalysis is a long-term treatment that can continue for years, many analysts see clients for short-term psychotherapy. Members of the American Psychoanalytic Association have received rigorous training from psychoanalytic institutes approved by the association. However, other institutes also train analysts, and almost anybody who has met the licensing requirement can legally call himself or herself a “psychoanalyst.” Psychoanalysis relies heavily on talk therapy and focuses on understanding the unconscious psychological forces, such as wishes and desires, that influence conscious actions and interactions.
Psychologists. Clinical psychologists may conduct psychotherapy with individual patients or may work in businesses, schools, mental health centers, or hospitals. Requirements for licensing vary from state to state; practicing psychologists usually must have a doctorate plus postdoctoral training. In some states, psychologists are licensed to write prescriptions as part of the treatment plan.
Psychotherapists. If you choose someone who practices under this title, ask about his or her training and background. Virtually anyone can use this title, so psychotherapists may or may not be trained, licensed, or qualified. Some psychotherapists without a license may be working under supervision while qualifying for a license in your area. If you are uncertain about credentials, check with the appropriate local professional associations.
Social workers. The single largest group of professionals in the mental health field, social workers may direct clinics or have private practices. And they are often active in community programs, such as drug-abuse treatment. Clinical social workers have a master’s degree and can offer psychotherapy or counseling and a range of diagnostic services. You may need to check to make sure your health insurance will cover private treatment from a social worker.
Finding the right help
When you’re looking for a practitioner, educational and licensing qualifications are important, but you should consider other factors as well. What kind of therapist is he or she, and does this person provide the kind of therapy you need? There is no simple answer, but there are certain guidelines.
- If you or a family member has a serious psychological illness, such as severe depression, bipolar disorder, or schizophrenia, look for a practitioner who is also a physician, because hospitalization and close monitoring of psychotherapeutic drugs may be necessary.
- If you are dealing with less severe emotional difficulties (problems in your job, loneliness, marital tensions, or a divorce), you may do just as well with a trained, qualified therapist who is not a medical doctor.
- When interviewing potential therapists, ask them about their approach to therapy. What kind of problems do they address? How do they approach therapy? For instance, do they focus on deeply rooted issues that you may not even be aware of before therapy begins? Or do they focus on more immediate concerns and work on helping clients change the way they think about or react to the world around them? Different approaches will resonate with different people. Some therapists may use a combination of approaches; you can find directories of the various therapy types, including cognitive-behavioral therapy (CBT), psychodynamic therapy, interpersonal therapy, psychoanalysis, and mindfulness-based therapy, at the websites of the National Institute of Mental Health, the American Psychological Association, and the UK-based Counselling Directory.
- Ask how long therapy typically lasts. Therapists may offer anything from years of psychoanalysis to single group or individual sessions. It’s important to find out how your therapist works and how you feel about the process.
Whatever form of therapy you opt for, shop around before making a commitment, just as you would before choosing a primary care doctor. Find out what’s available and what it costs. Talk with several therapists, if you wish, and compare approaches. Some people feel more comfortable with a therapist of the same sex. Most people will want to be sure that the therapist is comfortable with them, too—that he or she can treat emotional or sexual problems without prejudice. You’ll be charged for trial visits to most therapists. But some therapists may be willing to discuss their methods over the telephone without charging.
Resources for Mental Health Information
Here's a directory of national and local organizations, agencies, and professional groups that provide mental health information and can help you find practicing professionals in your area.
Evaluating the care you get
A therapist’s credentials and reputation are important, but so are your own feelings. You should ask yourself if you feel comfortable with your therapist and if you believe this person is helping you. You also should be able to express your concerns openly with your therapist.
If you don’t “click” with one therapist, you consider finding another. What professionals call “a positive therapeutic alliance” is important to making progress—which means, essentially, that you need to see your therapist as understanding and helpful. Be sure that both you and your therapist or group leader understands your goals—even if they’re as vague as simply feeling less miserable. If you have doubts, express them to your therapist.
Do expect the same courtesy and level of professionalism, including confidentiality, from a therapist that you would from any doctor. Harsh criticism from a therapist is not appropriate, nor is group therapy that involves intimidation or verbal abuse. A sexual relationship or any out-of-the-office close personal relationship between a therapist and a patient is unethical and potentially damaging to the patient.
Paying for mental health care
Costs of mental health treatment can range widely depending on the type and duration. Psychoanalysis can go on for years at a cost of thousands of dollars annually; short-term therapy is less costly. Drugs, if you require them, can also be expensive, though many are now available as less-expensive generics. Many doctors and clinics have fee scales and try to charge what their patients can afford.
Since the Affordable Care Act took effect, most individual and small employer health plans are required to cover mental health and substance use disorder services. That includes plans purchased through the Health Insurance Marketplace. In addition, most plans cannot charge you more or exclude coverage for “preexisting conditions,” including mental illnesses. Check with your insurance company for the exact coverage your plan provides and to find in-network providers.