Different Types of Mental Health Professionals

                  When you are first looking for help with a mental health disorder, the number of different mental health professionals can be confusing.  In today’s post I will try to make sense of some of the options.  I am not a mental health professional.  By no means is this list meant to be authoritative or exhaustive.  I am a person with lived mental illness experience who has seen several professionals about my illness.  My intent in sharing this information is to provide assistance to those trying to navigate the mental health system.  It can be an overwhelming process especially when a person is struggling.

                  You may need more than one of these professionals.  I have a team that includes four members.  That is not always necessary.  From my personal perspective, each member of my mental health team adds to my treatment and healing and are instrumental.  I believe a team approach is beneficial to living with mental illness. 

                  Let’s look at some different mental health professionals.

Psychiatrist

                  A psychiatrist is a licensed medical doctor.  They are either an MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine).  Psychiatrists have completed a residency training in psychiatry.  They address both the mental and physical aspects of mental illness.  Psychiatrists diagnose mental health conditions.  Once they have diagnosed a patient, psychiatrists prescribe and monitor medication.  They also can provide therapy.  Psychiatrist can also prescribe alternative treatments for mental illnesses including transcranial magnetic stimulation (TMS), ketamine, and electric convulsive treatment (ECT).  

 

Psychologist

                  A psychologist has a doctorate degree in clinical psychology.  This can be a Ph.D. or a Psy.D.  They are licensed by their state.  Psychologists evaluate a person’s mental health.  They use clinical interviews, psychological evaluations, and tests.  A psychologist uses the information they gain from these tools to make a diagnosis.  They provide individual and group therapy.  Psychologist often use psychotherapy (talk therapy) with patients.  Some types of therapy used by psychologists include cognitive behavioral therapy (CBT), dialectal behavior therapy (DBT), interpersonal therapy, humanistic therapy, and psychodynamic therapy. 

 

Psychiatric Nurse Practitioner

                  A psychiatric nurse practitioner has a Master of Science (MS) or Doctor of Philosophy (Ph.D.) in nursing with a specialized focus in psychiatry.  They have either PMHNP-BC, which is board certification in psychiatric nursing, or they have NCLEX, which is National Council Licensure Examination.  Psychiatric nurse practitioners provide assessment, diagnosis, and therapy for patients with mental illness or substance use disorders.   Depending on their state, they can prescribe and monitor medication.  A psychiatric nurse practitioner blends nursing and psychiatric expertise when treating patients.  

 

Therapists/Counselors

                  Therapists and counselors have a master’s degree (MS or MA).  They can evaluate a person’s mental health.  When working with individuals they use therapeutic techniques based on specific training programs.  There is different licensing for therapists and counselors.  LPC stands for Licensed Professional Counselor.  LMFT stands for Licensed Marriage and Family Therapist. LCADAC stands for Licensed Clinical Alcohol and Drug Abuse Counselor.   Therapists work with people on understanding their thoughts, feelings, and choices.  

 

Social Worker

                  A social worker has a Master of Social Work (MSW) degree.  These professionals can evaluate a person’s mental health.  They use therapeutic techniques based on specific programs. Social workers are trained in case management and advocacy services.  Their role is often to empower individuals with mental illness to lead lives that are fulfilling and independent.  

 

Primary Care Provider

                  A primary care provider (PCP) is a doctor (MD), physician’s assistant (PA), or nurse practitioner (NP).  This provider can prescribe medication.  They can refer a patient to providers who specialize in mental health.  In the best scenarios a primary care provider works with other mental health professionals to provide the quality care.

 

                  Often, the first line of defense against mental illness is the primary care provider.  They are usually the provider who is going to see the patient most often prior to diagnosis.  Primary care providers should screen for mental health disorders and refer patients to the appropriate mental health care provider.  Once the patient has a mental health care provider, the PCP should work collaboratively with that provider to ensure the patient’s care.  

                  I have seen all the above providers except a social worker.  In my experience the best mental health professionals are the ones who listen not only to what the patient is saying, but also to what the patient is not saying.  They are empathetic and patient centered.  High-quality mental health care professionals treat the whole patient by being aware of their needs.  They ask meaningful questions.  They are not quick to slap a label on a person.  Instead, they see the person as an individual with an illness that they can treat.  

                  It is important to be comfortable with your mental health providers.  It is okay to try out professionals to ensure you have the right fit.  Being able to talk to your mental health care provider is crucial.  Even if you are not someone who is comfortable talking, there needs to be a comfort in the communication you have with your provider.  A good provider will support you in the communication aspects of treatment.  Don’t worry if you try a mental health provider and don’t feel there is a fit.  But make sure you try someone else. Don’t give up because a provider didn’t meet your needs.  We all deserve high-quality mental health care providers.  The right one for you is out there.  As an example, I have seen several psychiatrists over the years.  I had to learn that it was okay to change psychiatrists.  I have finally found the right one.  You will know when you have the right provider.  Trust yourself. 

                  There are a lot of great mental health providers out there.  If you are looking for one, ask your medical group for the names of providers.  You can ask your PCP to recommend someone.  There are also a lot of new ways to find a provider online, but that is for another post.  It is my hope that everyone can find the high-quality mental health providers like I have found.  It truly makes a difference.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Mental Illness and Primary Care

      What happens when we deny our mental illness? The other day I had a conversation with my primary care provider, Cristina, that caused me to think about this. I always think about people with depression as not being listened to or taken seriously. Talking to Cristina I realized that the opposite could happen. A primary care provider can recognize the signs of depression and be met by resistance from the patient. What happens in that situation? It is not like the provider can use bloodwork or scans to show the patient that the depression exists. 

So, why would a person not want to hear that he or she has depression. The first thing that comes to my mind is stigma. Society doesn’t exactly make it easy to accept a mental health diagnosis. Often, we are taught to hide our emotions or tough it out. Mental illness is often joked about. People use mental health diagnoses in the wrong context. For example, someone who likes things neat and orderly might say they have OCD. That’s not OCD. I have a friend who suffers with OCD. I have seen her struggle. Believe me OCD is not just wanting things clean. It is much more involved and debilitating.  Unfortunately, it is a common perception in society that people with OCD are neat freaks. 

Likewise, depression is not just being sad. As I’ve discussed many times on this blog, depression is much more than being sad. There is a sense of hopelessness.  Often, people with depression fight a desire to escape life.  Depression is so much more than a passing sadness. I recently heard someone say, “I am so depressed. My favorite restaurant is closing.”  Trust me. That is not depression.  Depression is all-encompassing.  It affects every aspect of a person’s life. The word depression is used too casually, and it leads to a lack of understanding.  

Unfortunately, mental illnesses are often trivialized and misunderstood. It makes sense that some people would resist a mental health diagnosis. Who wants to be labeled with an illness that is misunderstood and even mocked?

Back to the primary care provider. They are often the first health care provider to recognize a mental illness. I don’t know the statistics, but I have read that primary care providers prescribe a significant amount of anti-depressant medications that are prescribed in the United States.  I am not an expert.  So, I don’t want to cite numbers or pass judgement on this.  However, it seems to me that if primary care providers are that involved in treating mental illness, we need to give them more education and support.   

How do primary care providers assist their patients in navigating their illness?  They are important in recognizing the signs of a mental illness.  Often, they use a paper and pencil screening tool to gauge how their patients are doing mentally.  They pick up on signs by talking to their patients.  Symptoms of depression sometimes surface as physical complaints.  These can include aches and pains, fatigue, sleep disturbances, gastrointestinal issues, and changes in appetite to name a few.  An astute primary care provider will investigate mental health causes along with looking at physical reasons for the symptoms.  This provider treats the whole patient.  He or she understands that there are many facets to a patient’s health.

Often, when a person is depressed, he or she feels alone. There is a darkness surrounding them. Life may seem hopeless. It is hard to talk about these feelings with others. You believe you are alone and that no one else understands. Reaching out for help is difficult, sometimes impossible. Add to this being aware of the stigma surrounding depression. It is possible for a person to go into denial and refuse to acknowledge the depression is impacting him or her. When someone else brings it up, even a primary care provider, different things can happen. The person may experience a sense of relief that there is a reason for how he or she is feeling. This is the person who will accept the diagnosis. He or she is more likely to accept therapy and/or medication. On the other hand, the person may go into denial. He or she knows something is not right but doesn’t believe it can be depression. This is the person who refuses therapy and medication. 

A doctor can’t force treatment on a person.  The patient in denial is likely to continue struggling. This is a tragic in a time when there are so many treatments for depression such as therapy, support groups, medication, TMS (transcranial magnetic stimulation), and ketamine. The provider can encourage the patient to accept treatment, but the patient needs to be willing to accept that treatment.  I would imagine it would be frustrating for the provider to recognize a mental illness, such as depression, and not be able to provide treatment.  

I believe we need to have more conversations about mental health.  Being open and honest about mental health is the only way we are going address this issue.  The stigma surrounding mental health needs to be significantly reduced.  Doctors, physician’s assistants, and nurse practitioners need to be able to address mental health openly.  This will allow them to start treatment and refer people to specialists.  People with mental illness deserve to be treated by psychiatrists, psychologists, and therapists.  The primary care provider is the link to these specialists.  That is why their role is so important. 

When a patient refuses to accept a mental health diagnosis he or she is refusing the treatment that can help.  I know from a lifetime of experience that treatment is vital to living with depression and anxiety.  The same is true of any mental health disorder. As a society we need to work to give primary care providers the education and support they need to address mental health issues.  We need to spread awareness of mental illness.  Hopefully, this will help people be more open to accepting a mental health diagnosis.  Supporting organizations like NAMI, (National Alliance on Mental Illness) is an important way to spread awareness and eliminate stigma.  

Continue following my blog.  I hope to address this issue in more depth in future posts.  

 

 

 

 

 

Turning Hurtful Words into Healing

           I am very open about my mental health, but I wasn’t always this open.  I used to hide my mental illness in shame.  I didn’t think others would understand. It took hurtful words from a health care provider to make me realize that I shouldn’t be ashamed of my mental illness.  In fact, my experience with this health care provider made me realize that it was time for me to use my voice to help myself and others who struggle with mental illness. 

            The story of how this health care provider hurt me is in my memoir, “Traveling the Healing Journey: Finding the Light in Mental Illness”.  I am going to share it here, too, because it was an instrumental event in my journey.  In my book I refer to this health care provider as E.  I will do so here as well.  I could use her name, but in my heart, I have forgiven her.  Actually, as you will see, I may owe her a debt of gratitude.  

            In 2017 I had to change primary care providers.  The one I had been comfortable with left the clinic I was going to.  Before she left, she recommended that I see E for my health care needs.  She told me that I could trust her and that she was a good provider.  I was hesitant, but I made the change.  The first visit I had with her was okay, uneventful.  It was the next time I saw her that I had a terrible experience.

            I saw E for my yearly physical.  I always get a little anxious when I have medical appointments, but I was doing fairly well when I went into the exam room.  The appointment started okay.  There is a part of the annual physical exam that I have never been able to have completed because of my anxiety, but providers have always tried.  Usually, I would take something to relax me before starting and the provider would do their best to calmly talk me through it.  I was never able to get through that part of the exam, but no harm was ever done.  The provider just moved on to the next part.  When it came time for that part of the exam E read my records and said she wouldn’t do it.  She said I had to go somewhere else for it.  I tried to tell her I wanted her to do it and that I had already taken medicine to get me through it.  She looked straight at me and said, “No.  You are a liability.” I couldn’t understand what she had said.  Why was she calling me a liability?  I felt like there was something wrong with me.  She was blaming me for something that was caused by my anxiety.  I froze.  I didn’t know what to say.  I know I had tears in my eyes, but she just ignored me.  She moved on to the next part of the exam.

            She told me to lie down so she could examine my breasts.  In my head thoughts were swirling.  What was wrong with me? Why can’t I be like other women?  Then I realized she was about to touch me.  Knowing I often get jumpy when I am touched, I wanted to warn her so she wouldn’t think she was hurting me.  I said, “Sometimes I jump when I am touched, but it doesn’t hurt.”  E looked at me and said in a way that sounded very sarcastic to me, “I can’t examine you, if I can’t touch you.” I wanted to run out of the exam room.  I needed to get away, but I was trapped. Somehow, I managed to let her finish the exam.  I couldn’t get to my car fast enough.  Once safely away from her and in my car, I broke down in tears.  

            Was my anxiety my fault?  Depression and anxiety have been a part of my life for as long as I can remember.  No health care provider had ever made an issue about the way E had.  I couldn’t get her words out of my head.  “You are a liability,” kept echoing in my mind. 

            As soon as I talked to my psychologist, Dr. Klein, I told him what happened.  I cried as I told him.  It was obvious how much those words had hurt me.  He tried to reassure me that I was not a liability, and that E was wrong for saying it.  I just couldn’t get those words out of my head.  It took two weeks for Dr. Klein to convince me to speak up.  I had received one of those feedback emails from E’s office.  I wrote that I had a really bad experience and that I was never going back.  I didn’t explain what had happened.  I just said I was never going back because of my last appointment.  

The next day I received a call from a woman in the office.  I don’t remember her name or title.  She asked me why I didn’t want to go back.  I told her what E had said and that it was very hurtful.  She apologized.  She said it sounded like an issue of poor word choice.  At that time, I wasn’t at a point where I could explain how E had hurt me and how it was issue of her mistreating me because of my mental illness, not just poor word choice. The woman was kind.  She told me that she would like me to continue going to this office and that I could see someone else moving forward.  I was hesitant.  She recommended a physician’s assistant, named Greta.  She promised me that Greta was different.  She said she was kind and understanding and assured me that I would like her.  I was overwhelmed with the whole situation and really didn’t want to go through the process of finding a new primary care provider.  So, I agreed.  The woman told me she would tell the doctor in charge about my experience.  

I never received an apology from E.  I never saw her again.  There was no acknowledgement of how she had hurt me because of my mental illness.  Soon my hurt turned to anger.  I spent a lot of time discussing my feelings surrounding this incident with Dr. Klein.  I didn’t understand how it was okay for a health care provider to not only dismiss my mental illness but insult me over it.  E made it seem like my anxiety was my fault.  I wondered how many other people she had done that to.  Was it common for her to be flippant with patients with mental illness or was I her only target?  I started thinking more about the effect her words had on me.  With Dr. Klein’s help I realized I hadn’t done anything wrong.  My anxiety wasn’t my fault.  I have an illness and a primary care provider should be understanding of mental illness. 

It is at this point that I realized I couldn’t sit back and allow myself to be treated that way.  I had to stand up for myself.  This experience led me into mental health advocacy.  I finally understood that I had a voice, and I could use it to stand up for myself and others with mental illness.  I began looking for mental health organizations.  My writing became focused on mental illness.  I stopped hiding my depression and anxiety.  I began speaking about mental illness. I learned to tell my story and looked for opportunities to share it.

Hurtful words led me into mental health advocacy.  For that I am grateful.  The work I have been able to do since that day allows me to forgive E.  I will never forget, but I have forgiven.  Her words echo in my head like a rallying cry urging me to use my voice to fight the stigma surrounding mental illness.

The primary care providers I have had since that terrible experience, Greta and Cristina, have shown me that not only can a primary care provider understand the needs of a patient with mental illness, but they also need to be able to understand.  I am grateful that I found providers who care and understand.  

I hope through my advocacy work more health care providers learn about mental illness and how to treat patients.  Mental illness is an illness.  It is no more the patient’s fault than a cancer diagnosis.  My goal is to use my experience to educate others.  I want my experience to serve a purpose.  If you are health care provider, I urge you to learn more about mental illness and how to understand your patients.  If you have a mental illness, I urge you to remember that you have an illness and you do not need to be ashamed of it.  

Sometimes I think I would like the opportunity to speak to E.  I know it has been several years and she likely doesn’t remember her hurtful words.  I would just like to explain how she hurt me and let her know that those words changed me.  Her hurtful words led me into mental health advocacy.  I now have a voice that I will continue to use to help myself and others.  Fortunately, her hurtful words led to good.  So, if you’re out there, E, thank you for giving me a reason to find my voice.