I Want Help

When you’re not feeling like yourself, you may be wondering where to start. Good news: you’ve taken a huge step just by asking this question. Dr. Jennifer Cheavens, Licensed Clinical Psychologist and Professor of Psychology at the Ohio State University, typically starts by asking new clients three key questions: Is it harder for you to function during the day? Are you lagging or more distracted at your job, in classes or around the house? Have some tasks become impossible? Are your challenges ongoing? Do you have troubling feelings and/or thoughts throughout the day? Have you been feeling “off” throughout the day, for more than two weeks? Do you have trouble coping in multiple areas of your life? Are you struggling across-the-board or are your struggles more limited (only with certain people or in one part of your life)? What if I answered YES to all three questoins above? It’s a good idea look into treatment with a psychologist, psychiatrist or licensed clinical social worker. We’re here to help you understand the kinds of mental health providers available and how to find treatment. What if I answered NO to some of the questions above? According to Dr. Cheavens, getting help may still make sense for you, even if you don’t meet all the criteria above. You may just fit less neatly into one of the diagnosis categories that insurance companies typically cover. (Remember, though, each insurance situation is unique.) You still deserve to feel better. For you, a psychologist or psychiatrist could help, but someone less specialized—and oftentimes less expensive—could treat you too. In fact, speaking to someone objective always has the potential to help. You could try a licensed clinical social worker, marriage/family therapist, substance use specialist, or even a life coach. Support groups can offer relief too.

The truth is, you’ll have to ask. It’s normal to feel a little anxious when it comes to addressing the mental health of someone close to you. We’re glad you’re here. Because planning for the conversation—and managing your own expectations—can make all the difference.

Since we can’t peek inside people’s heads, we have to rely on their outward behavior to get clues about how they’re feeling. According to Linda Jakes, Executive Director of Concord Counseling, it’s important to observe behaviors in an objective way. It’s easy to take things personally, especially if they lash out or stop getting in touch. Instead, try to make mental notes of any changes you see. You can also ask others if they’ve noticed the same changes. Your best bet is to put yourself in the shoes of the person you think is struggling. That means doing your very best not to add to their burden. Remember to be gentle and stay away from anything that sounds like blame. Think about using the word “I” in describing what you’ve observed. And don’t be afraid to ask a direct question about how they’ve been feeling. According to Ms. Jakes, it’s really not the time to talk about your feelings other than the concern you feel. This could even be a chance to help lift them up.

This is where it’s important to manage your expectations. Responses can range from relief, tears or anger to shutting down completely. Commit to being open to wherever the conversation goes. Your primary goal here is to acknowledge and validate them as they share with you. Keep in mind that you may not get the response you expect or want to hear. The person who’s struggling might not feel comfortable thinking or talking about it, which may mean you’ll have to talk with them more than once. Your key message to someone suffering? “I’ll be with you, even when it’s hard.” These phrases may be helpful: I can see that this is painful for you. This must be hard for you. I believe in you. (with a hug) I’m in this with you. Let’s think of ways I could support you? Your brain may say that there’s nothing that can help you, when really, there is. I think we can figure things out together. This is not your fault. I’m going to keep checking back with you.

We all want to “fix” things, but this is one time where trying too hard can push away the person you’re trying to help. Use your best judgment when it comes to introducing the idea of getting professional help—for many people, the thought of speaking to “a stranger” may produce extra anxiety. Mental illnesses have a way of tricking the brain into thinking there’s no way out and that there’s no way they can be helped. To make it worse, some of the most common conditions (like depression and anxiety) can completely sap energy and motivation. The key to your conversation is to let them know they DO have options. Some tips: Suggest that this is something people can’t handle alone (without saying “YOU can’t handle this”). Offer to research therapies and therapists to get things started. Offer to drop them off or stay in the waiting room during therapy appointments. Tell them that there are lots of different ways to get help and to think of therapy as simple guidance. Try to dispel the myth that people can think their way out of mental health issues. Tell them that therapists are objective observers who can almost always see things that they can’t. Offer to be a sounding board—someone who will listen without trying to fix them. Remind them that any poor past experiences with therapy should not dictate whether they reach out for help today. Use a shoe analogy—therapists are not one-size-fits-all. Share your own positive experiences with therapy or medication if it helps. Offer to join them while they do errands or any task that feels difficult for them.

There are lots of mental health care professionals out there. Some work on an inpatient basis at hospitals or psychiatric facilities. Others offer outpatient care at community mental health clinics, schools, hospitals and private practices. The National Association of Mental Illness, or NAMI, has more details about each type of provider listed below: FOR ASSESSMENT AND TALK THERAPY: This first group of providers all offer some form of psychotherapy or just “therapy,” for short. These are umbrella terms for any kind of one-on-one or group therapy. These providers are all trained to evaluate, diagnose and provide treatment by talking through problems with you. So, what makes them different? Mostly, it’s their approaches, specialties, levels of training and education. Psychologists hold a doctoral degree (Ph.D. or Psy.D.) in clinical or counseling psychology. They have different specialties or ways of conceptualizing and treating difficulties. For example, cognitive behavioral therapy (CBT) is form of treatment many offer. Among therapists, psychologists are trained to treat people with diagnosable conditions. Counselors and Clinicians have master’s degrees (M.S. or M.A.) in mental health fields like psychology or education. These providers may have titles like Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT) and Licensed Clinical Alcohol & Drug Abuse Counselor (LCADAC). Pastoral counselors are clergy members trained in clinical pastoral education who can diagnose people and provide counseling. Their education is equivalent to a doctoral degree in counseling. Clinical social workers hold master’s degrees (MSW) in social work with up to two years of supervised therapy experience before becoming state licensed. Social workers generally offer more affordable therapy and focus on how people’s environments affect their mental health. They can also refer you to a psychologist or psychiatrist if you need more or different kinds of treatment. Titles for social workers include Licensed Independent Social Worker (LISW) or Licensed Clinical Social Worker (LCSW). Social workers can also help you identify resources in the community, like housing, educational and occupational resources. FOR PRESCRIPTIONS AND MEDICATION MANAGEMENT: In most states, it takes a medical professional to prescribe and manage your medication. Medication can work—either alone or in conjunction with talk therapy—to help ease your symptoms. While any doctor you trust can be your prescriber, you may look to someone specially trained in mental health like a psychiatrist or psychiatric nurse practitioner. Psychiatrists are licensed medical physicians (MD or DO) who specialize in mental health disorders. They’re trained to diagnose patients, then prescribe and monitor medications. Some offer talk therapy too. Many have extra training in areas like child and adolescent mental health, substance use disorders or psychiatry for seniors. Psychiatric mental health nurse practitioners (PMHNP), like psychiatrists, are trained in mental health and can diagnose patients, then treat them with therapy. In some states, nurse practitioners can also prescribe and monitor medication. The major difference from psychiatrists? Education and credentials—nurse practitioners can practice with a master’s degree (MS) or doctorate degree (versus a medical degree). Primary care physicians can also prescribe and manage medications, though they don’t generally have training in the specifics of mental health. In fact, any doctor you feel confident about can too. The same goes for most family nurse practitioners (FNP). It’s often a good idea for a doctor or FNP to consult with mental health providers. WHAT KIND OF SPECIALTIES ARE OUT THERE? Grief Pregnancy and post-partum issues Substance use disorders Eating disorders Issues that stem from health concerns Chronic suicidality Marriage and family challenges Children and adolescents Seniors

Anxiety and depression are the most common reasons people seek treatment. If you suffer from one of these, it may help you to know that you’re not alone. But remember, no matter how common your diagnosis, your pain is unique to you. A good provider will treat you based on your individual needs.

OUTPATIENT CARE: Routine outpatient care (ROP): Individual and group therapy; medication prescribing and management Intensive outpatient program (IOP): Multiple, 4 to 6-hour visits per week for several weeks; group, individual, family therapy Partial Hospitalization: 5-7 days (no overnight stays) per week in a hospital environment; often evaluation by psychiatrist; group, individual, family therapy INPATIENT CARE: Inpatient acute care: Short-term, 24-hour hospital care to stabilize psychiatric crises; medication management, consultation, group therapy, plus a family session to plan aftercare Inpatient residential care: 24-hour residential care to stabilize a patient in crisis; often 30+ days; group, individual and weekly family therapy

These steps come from the National Association for Mental Illness (NAMI): Think about the kind of care you might need. Are you looking primarily for help with medication or a practitioner who can do talk therapy? Start searching. You could start by asking your primary care doctor, family, friends or fellow support group members for recommendations. Check your insurance website for a list of covered providers who are accepting new patients. If you’re a student, call your counseling center. Most importantly, stay objective—only consider practitioners with experience that matches your needs. If you get in touch with someone who isn’t taking patients but is an expert in what you think you need, you can ask them for recommendations. Interview practitioners. Once you’ve narrowed down possible providers, talk with them. If you can swing it with insurance, make more than one appointment to avoid waiting time if your first choice is not a fit. Ask about their specialties, experience and treatment approaches. Be ready to give details about why you’re looking for help. Evaluate them. You’ve found a good fit when you feel comfortable talking openly with a provider after several sessions. Trust your instincts here. You can also ask yourself questions like, “Do I trust this provider? “Do my needs seem accepted and respected?” “Does this feel like teamwork?”

Effective therapy takes real work, but most of the time, it’s worth it. Therapy doesn’t work like magic. At times, it’s about sitting in the discomfort most of us avoid day-to-day. That’s what makes it real work, rather than a quick fix. But when it’s hard to feel vulnerable, remember this: your commitment to keep showing up can be a path to gaining more control over the way you feel. Also, keep in mind that experienced therapists have seen all kinds of patients—so it’s extremely unlikely you’ll share anything that shocks or surprises them.

With mental health, it can feel like any amount of waiting is too much. First, go ahead and make the appointment anyway. Just having a plan can make you feel better and you never know when a cancellation might move up your date. In the meantime, you can get ahead of the work most therapists recommend by: creating healthier sleep patterns getting some exercise spending some time outdoors enlisting support from the people around you practicing mindfullness techniques like meditation (take a look at our class offerings that might be helpful to you)

Insurance can be an overwhelming subject, especially when you’re not feeling 100%. If your energy’s low, assign the research about benefits to a friend or family member who’s asked how they can help you. Depending on where you get treatment, you may have access to a patient advocate who can help make sure your insurance will pay for your sessions before you start. Benefits will vary based on variables like: your insurance plan the type of provider you use your diagnosis the kind of treatment you need (inpatient, outpatient, for example) the treatment setting (hospital, community health center, private practice, for example) Keep in mind, some highly experienced practitioners don’t take insurance at all, which means they take only out-of-pocket payments. In some cases, you may still be able to run these appointments through your insurance to get partial reimbursement for an “out-of-network” provider. On the other hand, community mental health centers may offer low-cost or free care on a sliding scale. Medicare and certain social services offered by the government could also help, if you qualify. If you’re unsure whether a provider takes your insurance, you (or a friend) can check your insurance website or call that provider directly.

Try to get comfortable with the fact that this could happen. Think about shoes. A bad fit doesn’t mean you’ll stop wearing all shoes, but it will take some effort to find some new ones. It can be hard to think about starting over with someone new, but the key here is not to give up.