| A lot of the time I just sleep and the house
doesn't get picked up. And dinner is late
most nights. Sam yells at me for this but
then he is sorry. What's wrong with me?
I hope you can help me. Letters like this are written every day by people who have problems - problems they find too great to bear alone. These people need help. Many choose to suffer in silence, rather than admit they need help. This often leads to more serious problems that are even harder to handle. Usually people write to a Federal agency because they do not know where else to turn. Often, this agency refers them to their clergy or doctor, who may refer them to someone who specializes in solving personal problems. Sometimes troubled individuals may not attend a place of worship and may not have a family doctor. Or, if they visit a doctor, they may go in for what they consider to be strictly "physical" symptoms, and be reluctant to discuss what is really troubling them. But they need not keep their troubles bottled up within themselves. There are places available in their own communities where they can get help, and in the back of this pamphlet is a list of places that can be called if help is needed. Asking for help is not an easy thing for many people to do, but is a wise move when a person feels that something is wrong.
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Some people have many questions about what mental health services are, but they need not feel alone. Many who write to the Government ask the same questions. Some of the most commonly asked questions, and their answers, go something like this:
Q. When I do need help, where can I go?
A. There are over 3,000 mental health organizations throughout the country. For information about resources available in your community, contact your local mental health center or one of the local affiliates of national organizations listed in the back of this pamphlet. These agencies can provide you with information on services designed to meet the needs of those suffering from mental disorders such as depression, schizophrenia, anxiety, and phobias. In addition, they will have information regarding services designed for specific cultural groups, refugees, the elderly, children, and homosexuals.
Q. I don't have adequate personal finances, medical insurance, or hospitalization coverage - where would I get the money to pay for the service I may need?
A. In publicly funded mental health centers, such as those funded by State and municipal governments, the cost of any of the services generally is calculated by what you can afford to pay. So, if you have no money, or very little, services are still provided. This is called a sliding-scale or sliding-fee basis of payment. In a private organization, you would have to pay the full cost of the services, less the amount paid by your insurer or some other payment source.
Many workplaces make assistance programs available to their employees, often without charge. These programs are designed to provide confidential mental health services, including individual psychotherapy, family counseling, and assistance with problems of drug and alcohol abuse.
Q. Wouldn't it be better just to tough it out? I don't like to bother other people with my problems, and things could blow over if I just hang on.
A. That's like having a toothache and not going to the dentist. The results are the same - you keep on hurting and the problem will probably get worse.
Q. Suppose I decide to go ahead and visit a mental health center. What goes on in one of those places?
A. A specially trained staff member will talk with you about the things that are worrying you.
Q. Talk? I can talk to anyone for free - why pay a doctor?
A. You're quite right. If you have a wise and understanding friend who is willing to listen to your problems, you may not need professional help at all. But often that's not enough. You may need a professionally trained person to help you "dig out" what's really bothering you. Your friend probably does not have the skills to do this.
Q. How can just talking make problems disappear?
A. Well, when you're talking to someone who has professional training or 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 your problems are so severe or painful that you may need some medication to go along with the talking and listening.
Q. Are psychiatrists the only ones who can help?
A. No. A psychiatrist is a medical doctor, and medical doctors are the only doctors who can prescribe medication. However, a therapist does not have to be a psychiatrist. A number of psychologists, social workers, nurses, group workers, mental health counselors, and others have been specially trained and licensed to work effectively with people's mental and emotional difficulties.
Q. Since I work all day, it would be hard to go to a center during regular working hours. Are centers open at nights or on weekends?
A. This can be arranged, too. Just contact the center for an appointment, which may be set up for a time that is convenient.
Q. I am also asking for others in my family. But I know that the idea of going in to a "mental health center" would seem threatening to my spouse. Could I just pretend that it's something else?
A. No, indeed. It's better to talk your spouse into it than to lie. Don't compromise trust by being deceptive.
Q. Actually, I think my spouse could be helped by coming in. What should I do about that?
A. This is something you can discuss with someone at the center. Marital of family therapy is available when a problem exists that involves more than one family member.
Q. Does therapy for mental and emotional problems always work?
A. Sometimes it does, and sometimes it doesn't. It depends on you and the therapist. It is important to share your concerns in a serious, sincere, and open manner. Only if you are completely honest and open can you expect to receive the best support and advice. There are times when you may not "click" with a particular person, and someone else - or some other method - may be more suitable for you. You can ask your therapist for a referral to another mental health professional, or, if you prefer, you can call one of the associations listed in this booklet for the name of other therapists in your area.
Q. Does a mental health center provide services for children?
A. Yes, children's services are an important part of any center program. Children usually respond very well to short-term help if they are not suffering from any severe disorders. Families often are asked to participate and are consulted if long-term treatment is needed for a child.
Q. I have an elderly parent who has trouble remembering even close members of the family. He is physically still quite active and has wandered off a number of times. Could someone help with this?
A. A staff person at a center could advise you about ways you could best care for your parent. You may be referred to a special agency or organization that provides services designed especially to meet the needs of elderly people.
Q. Is a mental health center the only place to go for help?
A. No, there are alternatives. Many mental health programs operate independently. These include local clinics, family service agencies, private psychiatric hospitals, private clinics, and private practitioners. There are also many self-help organizations that sponsor gatherings for group discussions to deal with problems associated with bereavement, suicide, depression, schizophrenia, drugs, alcohol, eating disorders, sexual abuse, rape, and coping with the problems of aging parents - to name a few. There are private practitioners who specialize in treating one or more of these problems. You may contact local chapters of organizations listed in the back of this pamphlet to learn about various services available in your community.
Q. I have a friend who says she could use some professional help, but she is worried about keeping it confidential.
A. She needn't worry. Confidentiality is basic to therapy, and the patient has the right to control access to information about her treatment. Professional association guidelines plus Federal and State laws underscore the importance of confidentiality in therapist-client relationships and govern the release of records. Some insurance companies require certain information from the therapist as a condition for payment, but that information can be released only if the patient gives written permission. If your friend wants to know exactly who gets information and what kind of information is released, she should ask her insurance provider and discuss it in detail with the therapist.
Q. If I go to a mental health center, what kind of treatment will I get?
A. A professional at the center will work with you in determining the best form of treatment for your needs. Depending on the nature of the illness being treated, psychotherapy and/or drug therapy may be recommended. Sometimes, joining in with a group of people who have similar problems is best; at other times, talking individually to a therapist is the answer.
Q. I have a relative with a serious mental problem. Can I have that person committed to a mental hospital?
A. A mentally ill or troubled person should be in a hospital only if it is absolutely necessary. In general, most mental health professionals believe that mentally ill persons should be treated in the community and should live as part of the community to the extent possible. That's why mental health centers and community support and rehabilitation programs stress the importance of having different services available: day care, night care, weekend care, and outpatient treatment through regular visits to an office or clinic. Most State laws, however, do provide for short-term (72 hours to a week) emergency detention and evaluation of seriously mentally ill persons who are unwilling or unable to make a decision to ask for treatment.
Q. To emergency cases wind up as long-term patients in mental hospitals?
A. Generally, no. Mental hospitals are used today for short-term crisis intervention when there are no other community services available, and they are used when a person needs extra care to stabilize a medical condition or drug treatment regimen. Also they serve the small percentage of patients who need long-term, structured, supervised care and treatment in a protective setting.
Q. I have heard people use the term "involuntary commitment." What does this mean?
A. In an emergency (e.g. where a person is likely to endanger self or others), it is possible for someone to be admitted to a hospital for a short period against his or her will. The exact procedures that must be followed vary from one area to another, according to State and local laws. At the end of the emergency commitment period, the State must either release the individual, obtain his or her voluntary consent to extend commitment, or file an extended commitment petition to detain the person involuntarily. Most States require an emergency commitment hearing to be held within 2 to 4 days after hospital admission to justify continued confinement.
WARNING SIGNALS
Many people are not sure how to judge when a person needs professional help for mental problems. There are some behaviors - especially if they persist or become severe - that may be signs of trouble:
1. Is he acting differently than he usually does? 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 she complain of episodes of extreme, almost uncontrollable, anxiety or "nervousness"? One sign of an emotional problem is "free floating" anxiety that is unrelated to any normal concern, such as a child's illness or a backlog of bills.
3. Does he become aggressive, rude, and abusive over minor incidents? Does he 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.
Any of these symptoms, if they continue for any length of time, may suggest a need for professional help. Fortunately, early identification and treatment of the problems causing this behavior can often make these symptoms disappear.
WHAT TO DO IN EMERGENCY SITUATIONS
If a person becomes violent, gets completely out of control, or tries to commit suicide, there are several things you can do:
1. In a dangerous crisis, call the police. Often the police are the best-equipped, most available resource, especially when a crime has been committed or when there is a strong possibility that the person may do physical injury to himself or others.
Once the emergency situation has been brought under control, if the troubled individual is already in treatment, call his therapist.
2. In a nonviolent crisis, calling the police may be a poor choice. for example, if an individual hasn't eaten for a substantial period of time - call his physician or therapist. If he doesn't have one, get him to a hospital emergency room where there are doctors on duty - even if you have to call an ambulance to get him there. Look in the Yellow Pages under "Ambulances" or call the fire department or rescue squad. Look under the list of emergency numbers in the front of your phone book, or call the operator if you can't find a number in a hurry.
A physician can tell you where and how to get help. Or the doctor may be able to provide help even if he or she is not a mental health specialist. Also, the doctor may be able to treat any injuries in the case of violence, a suicide attempt, or a drug or alcohol overdose.
Many members of the clergy are trained to deal with emergencies, or they can refer you to help.
Call the mental health hotline, drug hotline, crisis hotline, suicide prevention center, "free clinic," or Alcoholics Anonymous chapter, if your area has such services. Their telephones often are staffed around the clock. Look for a number in the list of emergency or community service numbers in the front of your phone book, or you can find a listing in the white pages under "Alcoholics Anonymous," "Suicide," "Mental Health," or ask the operator for help.
Call the nearest mental health center. If it's not listed that way in the phone book, look for it under "Hospitals," "Mental Health Clinics," or "Physicians" in the Yellow Pages.
Mental health centers generally provide a wide range of services. Included in these are:
1. Partial hospitalization - a patient might spend occasional days, nights, or weekends at the center, living at home and going to work as much as possible.
2. Outpatient care - a patient goes into the center's clinic for treatment that has been set up on a regular appointment basis.
3. Inpatient service - a patient stays at the hospital where care is provided.
4. 24-hour emergency service - available at any time of the day or night.
5. Consultation, education, and prevention - services for schools, community organizations, institutions, and businesses to assist in dealing with mentally ill persons and to develop programs that help prevent emotional disorders.
TREATMENT METHODS
The goals of treatment are to reduce symptoms of emotional disorders; improve personal and social functioning; correct distorted thinking; develop and strengthen coping skills; and promote behaviors that make a person's life better. Biomedical therapy, behavioral therapy, and psychotherapy are basic approaches to treatment that may help a person overcome problems. There are many specific types of therapies that may be used alone or in various combinations.
BIOMEDICAL THERAPIES
Drug treatment for emotional, behavioral and mental disorders has benefitted many patients, and drug treatment often is combined with psychotherapy. The drug that a physician prescribes depends on the nature of the illness being treated as well as on an assessment of the patient's general medical condition.
Electroconvulsive treatment (ECT) is used only for cases of major depression, delusions and hallucinations, or life-threatening sleep and eating disorders that cannot be effectively treated with drugs. Modern methods of administering ECT employ low "doses" of electric shock to the brain along with sedatives and relaxants to minimize the unpleasantness to patients.
BEHAVIORAL THERAPY
In behavioral therapy, learning principles are used to systematically change troublesome thinking patterns and behaviors. The individual can learn specific skills to obtain rewards and satisfaction. Such an approach may involve the cooperation of important persons in the patient's life to give praise and attention to desirable changes. Behavioral therapy includes an array of methods such as stress management, biofeedback, and relaxation training.
PSYCHOTHERAPY
Psychotherapy is accomplished through a series of face-to-face discussions, in which a therapist helps a person to talk about, define, and resolve personal problems that are troubling. Psychotherapies generally appear to be more effective and appropriate than drugs or ECT for less severe forms of emotional distress.
Long-term psychotherapy, lasting from several months to several years, emphasizes the study of underlying problems that started in childhood. Short-term psychotherapy, lasting for several weeks or months, is used when the problem seems to result from a stressful life event such as a death in the family, divorce, or physical illness. The goal of the therapist is to help the patient resolve the problems as quickly as possible. Often this takes only a few visits.
The following is a list of a few types of psychotherapy:
Psychoanalysis, a long-term therapy, emphasizes how the patient's unconscious motivations and early patterns of resolving issues are important influences in his or her present actions and feelings.
Psychodynamic psychotherapy 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.
Cognitive therapy aims to identify and correct distorted thinking patterns that can lead to troublesome feelings and behaviors.
Family therapy involves discussions and problem-solving sessions with every member of a family - sometimes with the entire group, sometimes with individuals.
Couple 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 involves a small group of people who, with the guidance of a therapist, discuss individual issues and help each other with problems.
Play therapy is a technique used for establishing communication and resolving problems with young children.
OTHER TREATMENTS
Some treatments that are called "adjunctive" are used in combination with other therapies, and sometimes they are used alone. They include occupational, recreational, or creative therapies, as well as some that focus on special education. A mental health professional can help a client find the kind of therapy, or combination of therapies, that is best suited to his or her situation.
REHABILITATION SERVICES
Many individuals with serious mental illness find it difficult to work, learn, socialize, and live independently outside a hospital. A number of communities now offer rehabilitation services, either through freestanding programs that are similar to clubs, or through mental health centers. These agencies offer a variety of skill-building activities to assist clients in learning, living, working, and developing interpersonal skills that will help them live as independently and productively as possible in the community.
THE HELPING PROFESSIONALS: 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 3 years of specialty training. A certified psychiatrist has, in addition, practiced for 2 years and passed the 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 drugs and medical therapies. Child psychiatrists specialize in working with children; geriatric psychiatrists concentrate on helping the aged.
PSYCHOLOGISTS
The field of psychology includes many specialties - clinical treatment, testing, community organization, industrial relations, laboratory research, and many more. 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 psychologist has completed a doctoral degree from a program with specialized training and experience requirements and has successfully completed a professional licensure examination.
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
Individual therapy, diagnosis, referral, consultation, and group therapy are some of the tasks that social workers are trained to perform. Psychiatric social workers have master's degrees in social work and have completed field-placement programs designed to train them in basic techniques in several areas, including therapy, community organization, administration, and consultation.
PSYCHOTHERAPISTS
Psychotherapists are mental health professionals who treat patients. Some people who call themselves psychotherapists do not have adequate training. If you doubt the credentials of a therapist, check with one of the professional associations listed under "Information Resources."
MENTAL HEALTH COUNSELORS
A clinical mental health counselor provides professional counseling services involving psychotherapy, human development, learning theory, and group dynamics to individuals, couples, and families. The promotion and enhancement of healthy, satisfying life-styles 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 and several years clinical supervision as required before they are certified by the National Academy of Certified Clinical Mental Health Counselors.
CASE MANAGERS AND OUTREACH WORKERS
These individuals assist severely or chronically mentally ill individuals, including the homeless mentally ill, to obtain the services they need to live in the community. Most chronically mentally ill persons 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.
Helping professionals work in a variety of settings, such as mental health centers, outpatient clinics, private and group practice, general hospitals, psychiatric hospitals, and prisons.
INFORMATION RESOURCES
If you, or someone you know, can benefit from the services of a mental health professional, mental health center, or one of the organizations described in this brochure, don't hesitate to take advantage of these useful services.
For referrals to a physician, psychiatrist, psychologist, contact your local medical bureau or local department of mental health listed in the telephone book. Don't forget that your own physician or clergy is usually aware of places in your community to get help.
The following are some excellent information sources:
For psychiatrists;
American Medical Association 535 North Dearborn St. Chicago, IL 60610 (312) 645-5000
American Psychiatric Association 1400 K St. NW Washington, DC 20005 (202) 682-6000
National Association of Private Psychiatric Hospitals 1319 F St. NW Washington, DC 20004 (202) 393-6700
For psychologists:
American Psychological Association 1200 17th St NW Washington, DC 20036 (202) 955-7600
For psychiatric nurses: American Nurses' Association 2420 Pershing Rd. Kansas City, MO 64108 (816) 474-5720
For social workers:
National Association of Social Workers 7981 Eastern Ave. Silver Spring, MD 20910 (301) 565-0333
For mental health counselors:
American Mental Health Counselors Association 5999 Stevenson Ave. Alexandria, VA 22304 (703) 823-9800, Ext 383 (1-800) 354-2008
American Association for Marriage and Family Therapy 1717 K St. NW Washington, DC 20006 (202) 429-1825
For psychosocial rehabilitation programs: International Association of Psychosocial Rehabilitation Services P.O. Box 278 McLean, VA 22101 (703) 237-9385
For State mental health centers and programs:
National Association of State Mental Health Program Directors 1101 King St. Suite 160 Alexandria, VA 22314 (703) 739-9333
For outpatient programs and mental health service facilities: American Association for Partial Hospitalization, Inc. 1411 K. St. NW Suite 1000 Washington, DC 20005 (202) 347-1649
National Council of Community Mental Health Centers 12300 Twinbrook Pkwy. Suite 320 Rockville, MD 20852 (301) 984-6200
There are also a number of self-help organizations. The underlying philosophy of self-help organizations is that the best helpers are often those who have experienced similar problems. These groups typically provide emotional support and a variety of forms of practical help for dealing with problems that their members share in common.
Among the self-help organizations which have chapters in most cities are:
The National Alliance for the Mentally Ill 1901 North Fort Myer Dr. Suite 500 Arlington, VA 22209 (703) 524-7600
National Alliance of Mental Patients P.O. Box 618 Sioux Falls, SD 57101 (605) 334-4067
National Depressive and Manic Depressive Association Merchandise Mart P.O. Box 3395 Chicago, IL 60654 (312) 993-0066
National Foundation for Depressive Illness, Inc. 20 Charles St. New York, NY 10014 (212) 924-9171 (1-800) 248-4344
National Mental Health Association 1021 Prince St. Alexandria, VA 22314-2971 (703) 684-7722
Recovery, Inc. 802 North Dearborn St. Chicago, IL 60610 (312) 337-5661
There are many self-help or mutual support groups that provide assistance in particular areas such as phobias, bereavement, obsessive-compulsive disorder, anorexia and bulimia, and AIDS. Due to space limitations, we are unable to list them all here. Information about self-help groups can be obtained from:
The National Mental Health Consumer's Association 311 South Juniper St. Room 902 Philadelphia, PA 19107 (215) 735-2465
National Self-Help Clearinghouse Graduate School and University Center City University of New York 33 West 42nd St. New York, NY 10036 (212) 840-1259
Self-Help Clearinghouse St. Claires - Riverside Medical Center Denville, NJ 07834 (201) 625-7101
Self-Help Center 1600 Dodge Ave. Suite S-122 Evanston, IL 60201 (312) 328-0470
All material appearing in this volume is in the public domain and may be reproduced or copied without permission from the National Institute of Mental Health. Citation of the source is appreciated.
Department of Health & Human Services Public Health Service Alcohol, Drug Abuse, and Mental Health Administration Rockville, MD 20857
DHHS Publication No. (ADM) 87-214 Alcohol, Drug Abuse, and Mental Health Administration Printed 1975, Revised 1980, 1987
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