Compiled by NAMI PA, Main Line, www.NAMIpaMainLine.org
Finding a mental health professional who meets your specific needs takes some planning. It’s not enough simply to find a licensed therapist. Think about the severity of your symptoms, medication needs, type of therapist and type of therapy that may be best for you. It is also important to know if your health insurer will cover part of all of the fees. For helpful tips on choosing the right mental health professional go to Mayo Clinic or to SAMHSA’s National Mental Health Information Center; both articles are reprinted below. The third article below is called “Helping Your Psychiatrist Help You”, from bp Magazine, summer 2009.
MENTAL HEALTH PROVIDERS: FINDING ONE TO SUIT YOUR NEEDS by Mayo Clinic staff
Choosing mental health providers can be challenging. Try to match your needs with their experience and specialty. Here’s what to consider — and which questions to ask.
If you’ve never seen a mental health provider before, you may not know how to find one who suits your specific needs. Here are some issues and tips to think about, along with questions to ask potential mental health providers.
Consider the types of mental health provider
You may not realize just how many types of mental health providers are available until you start looking for one. Should you see a family practice doctor? A psychiatrist? psychologist? social worker?
Most mental health providers have either master’s degree-level or doctoral-level training. There are a number of titles for master’s degree-level mental health professionals. Licensed professional counselor (LPC) and master of social work (MSW) are common examples. Mental health providers who have doctoral-level training include psychologists and medical doctors who specialize in mental health (psychiatrists). Family medicine doctors also can diagnose mental health conditions and prescribe medications.
Keep these factors in mind when choosing among the various types of mental health providers:
- Your concern or condition. While most mental health providers can provide treatment for a range of conditions, a mental health provider with a specialized focus may be more suited to your needs. For example, if you have an eating disorder, you may need to see a psychologist who specializes in that area. On the other hand, if you’re dealing with teenage conflicts, you may want to consult a marriage and family therapist. You may need to see more than one mental health provider to meet your needs.
- Whether you need medications. Only certain mental health providers can prescribe medications. Your family doctor can diagnose and prescribe medications for mental health issues. However, depending on your concern and the severity of your symptoms, your doctor may recommend consulting a psychiatrist — a medical doctor who specializes in diagnosing mental health conditions and managing mental health medications. Other types of mental health providers generally can’t prescribe medications.
- The severity of your condition. In general, the more severe your symptoms or complex your diagnosis, the more expertise and training you need to look for in a mental health provider. Medications prescribed by your family doctor, seeing a counselor or a combination of the two may be enough. However, mental health issues that are more serious — schizophrenia or severe depression, for example — may require seeing a psychiatrist, a psychologist or both.
- Your health insurance coverage. Insurance policies vary widely on coverage of mental health providers. Check your coverage beforehand. Your insurance policy may have a list of specific mental health providers covered, or may only cover certain types of mental health providers. Your insurance company or Medicare or
Medicaid can tell you what types of mental health providers it provides coverage for and what your benefit limits are. Some insurance plans, for instance, authorize more visits to a nurse, social worker or psychologist than to a psychiatrist, whose fees are usually higher.
Do some legwork to find mental health providers
Finding the right mental health providers takes some legwork. Here are some ways to find mental health providers:
- Ask your health insurance company for a list of covered providers. This list may also be available on the Internet.
- Seek a referral or recommendation from your other health care providers, such as a family doctor or pediatrician.
- Ask trusted friends, family or clergy.
- Check phone book listings under such categories as community service numbers, counselors, physicians, psychologists or social services organizations.
- Search nonprofit, government or mental health organization websites that provide listings of providers in your area.
- Ask your company’s employee assistance program (EAP) for a referral.
- Contact a local or national mental health organization or medical society.
Research the characteristics of mental health providers
Your legwork doesn’t stop once you have some potential mental health providers in mind. Before scheduling your first appointment, consider your preferences regarding whom you would be most comfortable talking to. Some factors include:
- Cultural background
Don’t feel bad about ruling out some mental health providers based on these criteria. Your comfort level is important because you may be establishing a long-term relationship. Even tone of voice or appearance may matter to you. Although you usually won’t know how mental health providers look ahead of time, some clinics, organizations or associations post pictures and biographies online.
Ask mental health providers lots of questions
Once you’ve found a few mental health providers who seem like they may suit you, it’s time to call and ask a few more questions. In some cases, a receptionist may be able to answer most of your questions. You may be able to directly ask some mental health providers questions on the phone, or they may ask you to come in for an initial session.
Here are some issues to consider asking mental health providers about, either on the phone or at your first appointment:
- Their education, training, licensure and years in practice. Licensing requirements can vary widely by state.
- Office hours, fees, length of sessions and which insurance providers they work with, or if they work with Medicare or Medicaid.
- Their treatment approach and philosophy, to make sure it suits your style and needs.Whether they specialize in certain disorders or age groups. Some, for instance, work only with adolescents. Others specialize in eating disorders or substance abuse.
Don’t hesitate to ask lots of questions. Finding the right match is crucial to establishing a good relationship and making sure you’re getting the best treatment.
Evaluate progress with your mental health provider
Once you choose a mental health provider, make sure the match is working. If you don’t feel comfortable after the first visit, talk about your concerns at your next session. Or consider finding a new mental health provider. As time goes by, think about how you feel and whether your needs are being met. Don’t feel compelled to stay with a mental health provider if you’re not comfortable.
Finding the right mental health provider can be hard work, and may require some trial and error. But it can also be rewarding. It may help you:
- Resolve short term problems such as stress or conflicts caused by a particular situations
- Work through long-standing personal issues
- Relieve disruptive or bothersome symptoms
- Overcome personal challenges
- Improve your relationships with others
- Ultimately enjoy your life more
- Factsheet: Mental illness and the family: Finding the right mental health care for you. Mental Health America. http://www.nmha.org/farcry/go/information/get-info/mi-and-the-family/finding-the-right-mental-health-care-for-you/mental-illness-and-the-family-finding-the-right-mental-health-care-for-you. Accessed Feb. 24, 2009.
- Finding mental health services. National Health Information Center. http://mentalhealth.samhsa.gov/publications/allpubs/fastfact2/default.asp. Accessed Feb. 24, 2009.
- How do I choose a therapist? Psychology Today. http://therapists.psychologytoday.com/rms/content/therapy_choose.html. Accessed Feb. 24, 2009.
- Choosing the right mental health therapist. National Health Information Center. http://mentalhealth.samhsa.gov/publications/allpubs/KEN98-0046/default.asp. Accessed Feb. s4, 2009.
- Finding help: How to find help through psychotherapy. American Psychological Association Help Center. http://www.apahelpcenter.org/articles/article.php?id=52. MH00008 April 9, 2009
© 1998-2009 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only. “Mayo,” “Mayo Clinic,” “MayoClinic.com,” “EmbodyHealth,” “Reliable tools for healthier lives,” “Enhance your life,” and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research.
CHOOSING THE RIGHT MENTAL HEALTH THERAPIST from SAMHSA
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.
Can a therapist share what I have said during therapy?
You can rest assured that all mental health professionals are ethically bound to keep what you say during therapy confidential. However, therapists also are bound by law to report information such as threats to blow up a building or to harm another person, for example.
What are the steps for choosing a therapist?
- See your primary care physician to rule out a medical cause of your problems. If your thyroid is “sluggish,” for example, your symptoms-such as loss of appetite and fatigue-could be mistaken for depression.
- After you know your problems are not caused by a medical condition, find out what the mental health coverage is under your insurance policy or through Medicaid/Medicare.
- Get two or three referrals before making an appointment. Specify age, sex, race, or religious background if those characteristics are important to you.
- Call to find out about appointment availability, location, and fees. Ask the receptionist:
- Does the mental health professional offer a sliding-scale fee based on income?
- Does he or she accept your health insurance or Medicaid/Medicare?
- Make sure the therapist has experience helping people whose problems are similar to yours. You may want to ask the receptionist about the therapist’s expertise, education, and number of years in practice.
- If you are satisfied with the answers, make an appointment.
- During your first visit, describe those feelings and problems that led you to seek help. Find out:
- What kind of therapy/treatment program he or she recommends;
- Whether it has proven effective for dealing with problems such as yours;
- What the benefits and side effects are;
- How much therapy the mental health professional recommends; and
- Whether he or she is willing to coordinate your care with another practitioner if you are personally interested in exploring credible alternative therapies, such as acupuncture.
- Be sure the psychotherapist does not take a “cookie cutter” approach to your treatment-what works for one person with major depression does not necessarily work for another. Different psychotherapies and medications are tailored to meet specific needs.
- Although the role of a therapist is not to be a friend, rapport is a critical element of successful therapy. After your initial visit, take some time to explore how you felt about the therapist.
- If the answers to these questions and others you come up with are “yes,” schedule another appointment to begin the process of working together to understand and overcome your problems. If the answers to most of these questions are “no,” call another mental health professional from your referral list and schedule another appointment.
What is the difference between psychiatrists and clinical social workers?
Two kinds of therapists warrant special note: psychiatrists and clinical social workers. Psychiatrists are medical doctors and can prescribe medication. Clinical social workers are trained in client-centered advocacy and can assist you with information, referral, and direct help in dealing with local, State, or Federal government agencies. As a result, they often serve as case managers to help people “navigate the system.” Clinical social workers and many other mental health professionals cannot write prescriptions. However, nurse practitioners that specialize in psychiatry and mental health can prescribe medication in most states. And, under a new law, psychologists in New Mexico can prescribe medications after receiving training (New Mexico State Legislature, 2002).
For more information:
For information on finding services in your area, write, call, or e-mail SAMHSA’s National Mental Health Information Center. The Center can also provide you with a list of community mental health centers and hospitals that provide psychiatric services in your State
SAMHSA’s National Mental Health Information Center
P.O Box 42557
Washington, DC 20015
http://www.samhsa.gov/ KEN98-0046 04/03
Other Referral Sources:
American Association of Marriage and
112 South Alfred Street
Alexandria, VA 22314-3061
American Psychiatric Association
1000 Wilson Blvd., Suite 1825
Arlington, VA 22209-3901
Toll Free: 888-357-6850
American Psychiatric Nurses Association
1555 Wilson Boulevard, Suite 515
Arlington, VA 22209
American Psychological Association
750 First Street NE
Washington, DC 20002-4242
Mental Health America
2000 N. Beauregard Street, 6th Floor
Alexandria, VA 22311
Telephone: 703-684-7722 or 800-969-6642
115 E. 23rd St., 9th Floor
New York, NY 10010
Note: These are suggested resources. This is not meant to be a complete list.
Please note that this online publication has been abridged from the printed version. KEN98-0046 04/03
Helping Your Psychiatrist Help You. by Steven Weisblatt, MD., bp Magazine, summer 2009
Due to a variety of factors, psychiatric consultations often last less than an hour and follow-up visits often last just 15 minutes. In that time frame it’s nearly impossible to adequately review what has happened since your last visit. Given this limited psychiatric “face time,” it’s critical that you describe your symptoms and changes that have occurred quickly and accurately. If you and your doctor can spend less time clarifying the status quo you can spend more time discussing how treatment can be moved forward so you can achieve remission and function at your best.
To that end, always come to our appointment with notes prepared—and be prepared to take notes. This increases the likelihood that you won’t forget to tell the doctor something important and allows you to jot down instructions, points you wish to discuss later in the session, or topics you want to research online.
At the beginning of the appointment, tell your doctor if you’ve had adverse effects from any prescribed medications. These include but are not limited to tremors, fatigue, appetite change, and hair loss. This conversation should be a priority; you need to be clear about these adverse effects before further treatment plans are made.
From the first consultation, it’s important that you and your doctor agree not only on your diagnosis but the symptoms and signs particular to you. These should be noted as your “targets” of treatment and should be followed over time. When all signs and symptoms disappear, you can say you’re in remission, the treatment goal you should seek. Note that symptoms are things you feel or experience, while signs are behaviors noticed by others, including your parents, spouse, children, colleagues, therapist and doctor.
In my practice I give out clipboards and pens and ask patients and whoever accompanies them to make two lists. Under the headings of “depressive behaviors” and “manic/overarousal behaviors” we list all symptoms and signs the patient has currently and, separately, past symptoms and signs. These become the target symptoms we use to evaluate the efficacy of treatment.
Discussing symptoms and signs is more useful than general comments about how you’ve been functioning because they’re specific to your diagnosis. For example, when you tell your doctor, “I had a good week,” “I’m feeling OK” or “The medication is working,” it isn’t clear if a) you’re symptom-free, b) you’re experiencing fewer symptoms under stressors similar to those reported during your prior visit or c) you haven’t had any change in symptoms but merely a good week because of fewer stressors. This type of communication doesn’t illuminate how you’re responding to the doctor’s interventions. What’s more, it sets the stage for further confusion as the visit progresses.
It’s more useful to discuss the presence of symptoms and signs specific to your diagnosis. It gives a more accurate, quicker sense of how “symptomatic” you are if we track decreased sleep, racing thoughts, amplified anxiety, depressed mood and irritability than if we track whether or not you are arguing with your spouse, doing more household duties, or cursed at the driver who cut you off. Whereas these anecdotes can “round out” the presentation to the psychiatrist, the behaviors described may have changed due to other factors and may not reflect whether our illness has changed since the last appointment.
At every follow-up appointment, it’s critical to establish whether target symptoms are increasing or decreasing in frequency (how often), intensity (how bad) and duration (how long). This helps determine whether the interventions you and your doctor have tried are moving you toward remission. To be sure a change in the severity of your symptoms is real, it’s important to know if circumstances in your life have changed. A decrease in amplified anxiety, racing thoughts and irritability during vacation or an increase of those symptoms during final exams may not reflect a change in the severity of symptoms but only a change in the amount of stress you’re under.
Visits to the doctor can be stressful—and they’re almost always too brief. However, if you prep in advance—possibly with the help of a trusted friend or family member—you can get the most out of your session.
Steven Weisblatt, MD is a clinical assistant profession of psychiatry at SUNY Downstate Medical Center in Brooklyn and practices in NY and PA.