Answers To Your Questions
EMERGENCIES / URGENT NEEDS / CRISIS SITUATIONS
I am in a crisis. I am thinking about suicide. What should I do?
The most important thing to do is reach out for help. If you are experiencing emotional distress, a family crisis, or are having suicidal thoughts, call one of these 24-hour crisis lines for immediate help. They have trained counselors available 24 hours a day, seven days a week. Simply talking with someone who won’t judge or argue with you can help.
Suicide and Crisis Center of North Texas
The National Suicide Prevention Lifeline
Veterans Crisis Line
1-800-273-8255 – (Press 1)
If you feel you are a danger to yourself or others, call 911.
What do I do if I know someone who is thinking about suicide?
If you think a loved one or friend is suicidal or you discover plans for self-harm, it’s an emergency. Thoughts of death or suicide are a serious symptom of depression, so take any suicidal talk or behavior seriously. It's not just a warning sign that the person is thinking about suicide: it's a cry for help. Encourage them to seek treatment. Asking about suicide – and encouraging the person to get help –does not increase the risk of suicide. If possible, take him or her to the emergency room, where medical staff can help you deal with the crisis and keep your loved one safe.
If you’re concerned about your family member’s mental state or personal safety, and you can’t take him or her to the emergency room, contact one of these local resources or the National Suicide Prevention Lifeline. Talk to a skilled counselor by calling 1-800-273-TALK.
If there’s a chance they will hurt themselves or others, don’t leave suicidal individuals alone. If they will not seek help or call 911, eliminate access to weapons or other items they can use to harm themselves.
What are warning signs of suicide?
When someone is thinking about committing suicide, he or she may:
- Talk about killing or harming him- or herself
- Express strong feelings of hopelessness or being trapped
- Have an unusual preoccupation with death or dying
- Act recklessly, as if he or she has a death wish (for example, speeding through red lights)
- Call or visit people to say goodbye
- Get affairs in order, including tying up loose ends or giving away prized possessions
- Say things like “Everyone would be better off without me,” or “I want out,” or “I’m done.”
- Change suddenly from being extremely depressed to acting calm and happy
If you think a friend or family member is considering suicide, express your concern and seek professional help immediately. Talking openly about suicidal thoughts and feelings can save a life!
More info about suicide:
What do I do if my family member is in a mental health crisis?
If your loved one seems to be experiencing a mental health crisis, reach out and share your concerns in a calm, reassuring, nonjudgmental way. You might open a dialogue by saying, “I notice you don’t seem like yourself lately. What’s been going on?” Listen more than you talk. Demonstrate that they can trust you to provide support without judging or criticizing. Ask simple questions. Say, “I’m here. I care. How can I help you?
The next step can be seeking help from a mental health professional in North Texas who has the skills to understand and treat complex emotional and behavioral problems.
Learn more about how to respond in a crisis
What are signs that someone is struggling with mental health or emotional issues?
Some common signs that a friend needs help dealing with emotional issues or a mental health problem include:
- Depression or apathy that interferes with obligations or participating in social activities
- Lack of coping skills around day-to-day problems or extreme reactions to certain situations
- Extreme highs (mania) that may include rushed thoughts, bursts of energy, sleeplessness and compulsive behavior, e.g. excessive spending or promiscuous sexual behavior
- Severe anxiety or stress not appropriate to the situation
- Constant feelings of sadness or hopelessness
- Increased use of alcohol or drugs
Oftentimes, a decline in one’s emotional health can lead to isolation. The person suffering may feel ashamed, or become very secretive in order to hide the problem. If it seems that the individual has “dropped off the face of the earth” or is behaving in an unusual manner, it could signal a problem.
What planning can be done before a crisis?
It is far better to talk with your loved one before a crisis and figure out the best treatment options together. Work with your loved one in advance and write down ways to cope with symptoms as well as what to do if they become severe. Already having a plan can ease the stress on you and your loved one, and ensure that he or she receives the appropriate care.
DECIDING TO SEEK HELP
How do I know when it’s time to seek help for mental, emotional or behavioral problems?
It’s time to reach out when there are issues causing problems in your life, but you don’t know what to do, how to cope or how to make the necessary changes. A variety of warning signals may indicate the need for diagnosis, therapy, medication and/or other treatment by a mental health professional. These include alcohol or drug abuse, loneliness, depression, marital or family relationship difficulties, sexual problems, anxiety, unexplained physical problems, eating disorders, self-esteem or sexual identity issues, employment difficulties, and inability to set or attain goals, among others.
Do you feel stuck or have a sense that you are continually losing ground? Are you dealing with extreme job stress, struggling to adjust to a new situation or facing challenges in your interpersonal relationships? Sometimes we need a mental check-up in the same way we get other medical exams. Working with a mental health professional can help you find the right path and productive solutions. Whether you are seeking care for yourself, your spouse, your child or another loved one, do not worry about being labeled, or feel that you “should” be able to handle the situation. If the issue or condition affects your or your loved one’s daily life and is creating obstacles to achieving goals or interfering in the quality of life, it’s time to get help.
What are signs that I should seek professional help for my child who is struggling?
If your child seems anxious, depressed or angry beyond his or her years, seeking outside help is in order when:
- Your child is endangering himself or threatening to harm himself.
- Your other children are unhappy, frightened or upset by their sibling’s behavior, or a parent’s response to that behavior.
- The child’s behavior is interfering with his daily life, or the family’s functioning.
- Disagreements about how to handle a child’s problems put a strain on your marriage or partnership.
- You, as a parent, don’t know what to do.
If I have emotional problems or a mental illness, does it mean that I’m a bad person, weak, crazy, or have a moral failure?
Absolutely not! Mental health problems have nothing to do with being lazy or weak. Problems of the mind are not simply feelings, nor are they evidence of character flaws or a personal failing. They are often disorders of the brain – real medical illnesses. Many factors contribute to mental-health problems, including:
- Biological factors – such as genes, physical illness, injury or brain chemistry
- Psychological factors – life experiences, such as trauma, early loss or a history of abuse
- Social factors – such as culture, religion, environment, poverty
If someone were bleeding or were showing symptoms of a stroke, they wouldn’t be expected to “simply try harder” or “snap out of it.” They would be urged to get the care and treatment they need. Mental illnesses and substance abuse disorders can require the same range of services as any other illness—early detection and intervention; medication; office visits, therapy and rehabilitative services; patient and family education; crisis and emergency services; hospitalization; and peer-to-peer support.
The workings of the body can affect the mind and vice versa. Taking action to get help can also improve one’s physical health and overall wellbeing.
IS IT MENTAL ILLNESS?
What does it mean to have a mental illness?
Mental illnesses are medical conditions that disrupt a person’s thinking, feeling, mood, ability to relate to others, and daily functioning. Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life. Mental disorders fall along a spectrum of severity. Some people have relatively mild symptoms or manage their illnesses, making them virtually invisible to others. At the other end of the spectrum are individuals whose illnesses are so disabling that they are unable to work, go to school, live independently or function in society. Because mental illnesses are biologically based brain disorders, they are not related to a person’s character or intelligence. They cannot be overcome through willpower.
What is considered a serious mental illness?
Serious mental illnesses include depression, schizophrenia, bipolar disorder, obsessive-compulsive disorder (OCD), panic disorder, post-traumatic stress disorder (PTSD), and borderline personality disorder. All mental disorders fall along a continuum of severity.
What are key warning signs of severe emotional problems or mental illness?
If several of the following signs or symptoms are occurring, a serious condition may be developing.
- Recent social withdrawal and loss of interest in others.
- An unusual drop in functioning, especially at school or work, such as quitting sports, failing in school, or difficulty performing familiar tasks.
- Problems with concentration, memory, or logical thought and speech that are hard to explain.
- Heightened sensitivity to sights, sounds, smells or touch; avoidance of over-stimulating situations.
- Loss of initiative or desire to participate in any activity; apathy.
- A vague feeling of being disconnected from oneself or one’s surroundings; a sense of unreality.
- Unusual or exaggerated beliefs about personal powers to understand meanings or influence events; illogical or “magical” thinking typical of childhood in an adult.
- Fear or suspiciousness of others or a strong nervous feeling.
- Uncharacteristic, peculiar behavior.
- Dramatic sleep and appetite changes or deterioration in personal hygiene.
- Rapid or dramatic shifts in feelings or “mood swings.”
The presence of just one or two of these symptoms can’t predict a mental illness. However, if someone is experiencing several at the same time that are causing serious problems in his or her ability to study, work, or relate to others, he or she should be seen by a mental health professional. Guidance counselors, teachers or classmates are often the first to notice symptoms.
American Psychiatric Association
What is a psychosis?
Psychosis is an experience where a person has hallucinations or delusions, or very fragmented, disconnected thinking. It is typical in persons suffering from schizophrenia, some mood disorders and occasionally severe stress.
What causes psychiatric disorders?
Mental disorders arise from the interaction of biological, psychological and social factors. They result from one’s genetics or faulty brain chemistry (biological); personal history, affecting one’s thoughts, emotions and behaviors (psychological); as well as family history and the environment in which one is raised (social). Mental health problems may be prompted by excessive stress caused by a particular situation or series of events. Just like cancer, diabetes and heart disease, mental illnesses are often physical as well as emotional and psychological.
It is essential to get help for mental disorders, learning disabilities, and emotional and behavioral conditions. The good news is that proper care and treatment can provide relief and practical solutions for dealing with these issues.
Learn more about the biological, psychological and social factors:
Is anyone immune to mental illness?
Mental illnesses can affect individuals of any age, race, religion or income level. They do not discriminate.
Can mental disorders be prevented?
Prevention of mental, emotional and behavioral disorders focuses on addressing known risk factors – such as exposure to trauma – that can increase the chances of children, youth and young adults developing mental health problems. Promoting the social and emotional wellbeing of children and youth leads to:
- Higher overall productivity
- Better educational outcomes
- Lower crime rates
- Stronger economies
- Lower health care costs
- Improved quality of life
- Increased lifespan
- Improved family life
What’s more, the sooner children or adults are diagnosed and get treated for mental health, emotional or behavioral issues, the better their symptoms can be managed and potentially prevented from worsening. Research from around the world has shown that recognizing developing symptoms and early intervention can help reduce the severity of an illness. It may even be possible to delay or prevent a psychotic episode or major mental illness altogether.
How common are mental illnesses?
Mental disorders are quite common and affect individuals from every background:
- An estimated 54 million Americans suffer from some form of mental disorder in a given year.
- Nearly 28 percent of Americans will meet criteria for a mental disorder at some point in their lifetime.
- One in 17 adults suffers from a severe and persistent mental illness such as bipolar disorder, major depression or schizophrenia.
- One in 10 Americans over the age of 12 is affected by substance abuse disorders.
You probably know someone with a mental health problem and don't even realize it, because many people with mental health problems are highly active and productive members of our communities.
HOSPITALIZATION FOR PSYCHIATRIC TREATMENT
Sometimes people with depression, bipolar disorder, schizophrenia or other psychiatric disorders have symptoms that are most effectively addressed through inpatient treatment in a psychiatric facility. If you see warning signs (below) or suspect a potential crisis in yourself or a loved one, it’s best to know in advance what treatment options are available and what steps to take during – or ideally before – a crisis occurs.
When is it time to go to the hospital?
People may need to go to the hospital if they:
- Threaten or try to take their lives or hurt themselves or others
- See or hear things (hallucinations)
- Believe things that aren’t true (delusions)
- Need special treatments such as electroconvulsive therapy
- Have problems with alcohol or substances
- Have not eaten or slept for several days
- Are unable to care for themselves or their families, e.g., getting out of bed, bathing, dressing
- Have tried treatment with therapy, medication and support and still have a lot of trouble with symptoms
- Need to make a significant switch in treatment or medication under the close supervision of their doctor
- Have any symptom of mania or depression that significantly interferes with life
Copyright Depression and Bipolar Support Alliance
What does voluntary hospitalization involve?
Voluntary hospitalization takes place when a person willingly signs forms agreeing to be treated in the hospital. A person who signs in voluntarily may also ask to leave. This request should be made in writing. The hospital must release people who make requests within a period of time, depending on state laws, unless they are a danger to themselves or others.
Most psychiatric hospital stays are from five to ten days. There are also longer residential rehabilitation programs for alcohol or substance abuse, eating disorders or other issues that require long-term treatment.
Copyright Depression and Bipolar Support Alliance
How can I convince my loved one to check in voluntarily for psychiatric treatment?
- Explain that hospitalization is treatment to get the help he or she needs, not punishment. The individual is not going to an institution, an asylum or prison.
- Reassure your loved one that the hospital is a safe place where he or she can begin to get well.
- Tell them that getting help in a hospital is nothing to be ashamed of and does not mean they are “bad” or have failed in some way. Mental disorders are medical illnesses that can require more intensive treatment, just like diabetes or heart disease.
- Call the hospital in advance and find out more about admission, treatment and policies.
- Help your loved one pack comfortable clothing and safe items that are reminders of home.
- Offer the individual the opportunity to make choices in the process, such as what to take to the hospital, or who to go with, if this is desired.
Copyright Depression and Bipolar Support Alliance
COMMITTING SOMEONE TO INVOLUNTARY TREATMENT
What does involuntary treatment involve?
The most common type of involuntary mental health treatment is court-ordered commitment to an inpatient mental health facility. Involuntary hospitalization is an option of last resort when someone’s symptoms have become so severe that the individual will not listen to others or accept help. You may need to involve your loved one’s doctor, the police or lawyers to have them hospitalized.
Beyond committing someone to a hospital or psychiatric facility, involuntary psychiatric treatment can include involuntary medication or other treatments, such as electroconvulsive therapy, or commitment for outpatient treatment.
In a mental health crisis, your first priority will be to protect your loved one and others from dangerous or inappropriate behaviors that result from untreated or uncontrolled mental illness. Because your family member may not even realize or acknowledge being ill, using the court system or other officials to intervene may be necessary. Involuntary treatment or commitment may also involve the use of guardianship or conservatorship laws.
What are the different forms of court-ordered treatment?
To effectively advocate for intervention, it is essential to know the civil commitment standards for intervention in your state or the state where the family member lives. Different states use different names to describe each form of treatment, but following are the three basic forms of court-ordered treatment. All three are authorized by Texas state law.
- Emergency hospitalization for evaluation. This is sometimes called "psychiatric hold" A person is placed in a treatment facility for psychiatric evaluation. It is typically a short intervention of fixed duration (e.g., 72 hours).
- Civil commitment – inpatient. Also given different names depending on the state, civil commitment is a process whereby a judge orders a person with symptoms of mental illness who meets the state’s legal criteria to be held in a hospital beyond the emergency detention period. Civil commitment exists in all states, but the standards that must be met for it to occur vary from state to state.
- Civil commitment – outpatient. Assisted outpatient treatment (AOT), which has different names in different states (e.g., outpatient commitment in Texas), is a process whereby a judge orders a qualifying person with symptoms of mental illness to adhere to a mental health treatment plan while living in the community.
Source: Treatment Advocacy Center
Committing someone for mental health treatment in Texas
Texas civil commitment laws establish criteria for determining when court-ordered treatment is appropriate for individuals with severe mental illness who are too ill to seek care voluntarily. The state authorizes both inpatient (hospital) and outpatient (community) treatment, which is known in Texas as “court-ordered outpatient mental health services.” Texas is one of the 27 states whose involuntary treatment standard is based on a person’s “need for treatment” rather than only the person’s likelihood of being dangerous to oneself or others.
For temporary (90-day) inpatient commitment, a person must be mentally ill and EITHER:
- likely to cause serious harm to self or others; OR
- suffering ALL of the following:
- severe and abnormal mental, emotional, or physical distress;
- substantial deterioration of ability to function independently; AND
- inability to make rational and informed treatment decisions.
For temporary (90-day) outpatient commitment, a person must be ALL of the following:
- severely and persistently mentally ill;
- if untreated, destined to continue to suffer BOTH:
- severe and abnormal mental, emotional, or physical distress; AND
- deterioration of the ability to function independently, leading to an inability to live safely in community;
- unable to voluntarily and effectively participate in outpatient treatment.
Source: Treatment Advocacy Center
CHOOSING A MENTAL HEALTH PROFESSIONAL
What are the different types of mental health professionals?
Psychiatrists are medical doctors who diagnose mental disorders and employ a variety of treatments. They can provide evaluation, diagnosis and psychotherapy, and prescribe and monitor medication as well as other medical treatments.
Psychologists are doctors in psychology (Ph.D or Psy.D.) who use the same diagnostic system but usually treat patients with psychotherapy of various types. They can also administer many different types of tests and assessments to evaluate and treat mental issues.
Mental health services also may be provided by social workers, therapists, counselors and other professionals.
Which type of mental health professional can do the most comprehensive evaluation?
Depending upon their specific training and role, practitioners use different assessment tools and approaches for evaluation.
Psychiatrists understand the complex relationship between emotional and other medical illnesses. They evaluate medical and psychological data to make a diagnosis and work with a patient to develop a treatment plan. Because they are physicians, psychiatrists are qualified to assess both the mental and physical aspects of psychological disturbance. They can order or perform a full range of medical laboratory and psychological tests that, combined with interviews/discussions with patients, help provide a picture of your physical and mental state. A psychiatrist will pay attention to how you look and your mood, behavior, thinking, reasoning, memory, and ability to express yourself.
Psychological tests are usually administered and interpreted by psychologists, who often have advanced training in assessment and behavioral treatment. Licensed clinical psychologists use tests and other assessment tools to measure and observe a client's behavior to arrive at a diagnosis and guide treatment. Most of these tests are standardized, taken with paper and pencil or via computer. The results provide a point-in-time snapshot of behavior, cognitive functioning or mood by contrasting the individual results against a peer group.
The types of psychological tests they can administer and evaluate include achievement and aptitude, intelligence, career/occupational, personality and neuropsychological. They can also assess specific clinical issues, such as anxiety or depression.
A counselor who has had the appropriate academic courses and supervision also may administer occupational tests or achievement and aptitude tests, but most counselors do not have the training to administer personality tests.
Do you have to be referred by a physician to see a psychiatrist or therapist?
Generally, no. Unless your insurance plan requires you to see your primary physician before seeing a psychiatrist, it is not necessary to be referred. However, if you are referred to a psychiatrist by your doctor or therapist, it may convey greater urgency, and you may be able to get in sooner. You do not need to be referred to a psychologist or other therapist. If your employer offers an Employee Assistance Program with mental health benefits, it may include specific providers. And, if you plan to use insurance, you’ll need to make sure that the psychiatrist or therapist accepts your insurance plan. Not only can you find a psychiatrist or therapist using the North Texas Help online directory, you can see what types of payment methods, including insurance, are accepted.
What should I look for when selecting a mental health professional for my child or myself?
Selecting a mental health professional is an important decision. The right match can make all the difference in the success of your or your child’s treatment. Consider both the practical aspects of obtaining care, as well as how you feel when you interact with the person.
Make sure the therapist has experience helping people whose problems are similar to yours. One therapist may be most experienced providing marriage and family therapy while another may be skilled in the treatment of substance abuse or co-occurring disorders. While some therapists feel most comfortable working with adults, other may prefer to work only with children or adolescents.
Here are some items to research online, and/or by calling the office.
- What are his/her areas of specialty?
- Does s/he see children or teenagers (if seeking help for your child)
- Does the mental health professional offer a sliding-scale fee based on income?
- Does he/she accept your health insurance or Medicaid/Medicare?
- What are their fees and payment policy? What credit cards are accepted?
- What are the provider’s credentials?
- Is he or she board-certified (psychiatrist) or licensed (therapist)?
- What is the therapist's or psychiatrist’s expertise?
- What is his/her education background?
- How many years has he or she been in practice?
There are certain traits that might make you feel more comfortable with a mental health professional. If these traits matter, use those preferences to narrow down your search.
Think about whether you would be more comfortable seeing:
- A man or woman
- Someone older or younger
- Someone who shares your religious, racial or cultural background
- Someone with a style that is more formal or friendly
Not only should you choose a professional based on their qualifications and skills, consider whether you would feel comfortable working together to achieve your goals. The professional’s ability to listen, his or her personality, and the connection you feel interacting are essential components of successful treatment.
Fortunately, the search for mental health professionals in Dallas-Fort Worth or the greater North Texas area who meet your needs is much easier with North Texas Help.
WORKING WITH MENTAL HEALTH PROFESSIONALS
How should I prepare for my first appointment with a psychiatrist or therapist?
Ask the receptionist at the provider’s office what they require and recommend. Find out upfront whether they accept your insurance/Medicare/Medicaid, and if so, make sure you have your insurance card and a driver’s license or other government-issued identification with you. Otherwise, ask what other forms of payment are accepted.
Particularly if seeing a psychiatrist, you may need to bring or provide access to your records from prior treatment. If the physician is performing an evaluation, and you or your family member has had a psychiatric hospitalization, expect them to ask for it.
You should also bring a printout or be able to list the medicines, vitamins and any herbal supplements you or your family member take, including dosages. It’s always a good idea to keep a list of your medications in your wallet.
Is it ok to bring a family member with me to the appointment?
Check first with the mental health professional’s office on what they allow or recommend.
What should I plan to ask or discuss during my first appointment?
The initial visit is largely a "getting to know you" session and will help your mental health provider understand your concerns and goals, and get an idea of how to proceed with your treatment. You might need to take psychological tests for assessment or complete some screening tests to identify symptoms of disorders. During this visit, plan to explain why you made the appointment and describe the feelings and problems that have led you to seek help.
Here are some good questions to ask when starting to work with a mental health professional:
- How would you describe the way you would work with me?
- May I include family members in my treatment? Can they come to appointments with me?
- What kind of therapy or treatment program do you recommend?
- How effective is it for dealing with conditions and problems like mine / my child’s?
- What benefits and any side effects should be expected?
- How much therapy/treatment do you recommend?
- How often and for how long would you anticipate seeing me?
- How long do you expect it to take before I begin feeling better?
- Will you coordinate my care with other treatment providers, and if so, how?
- If I have questions or concerns in-between sessions, how can I get in touch with you?
- Do you assign “homework” or reading to do between sessions?
It’s always a good idea to ask your provider questions. If you don’t understand a diagnosis or why a particular type of treatment is recommended, ask.
It’s also essential to be honest and forthright in discussing your concerns, symptoms and what you hope to gain from treatment. Although the role of a psychiatrist/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 individual. You will be sharing your most personal thoughts with this person, and that requires establishing a relationship built on two-way trust.
What else should I expect working with a therapist or psychiatrist?
Therapy should address your needs, goals, concerns and desires. Therefore, it is important that your provider tailors treatment to your specific needs and situation – he or she should not take a “cookie cutter” approach. What works for one person does not necessarily work for another. Different psychotherapies and medications are applied case-by-case.
Depending on your situation, therapy can be fairly short or longer-term. Often, people see their therapists once a week for 50 minutes. Your first session will be different from future visits. If you are under the care of a psychiatrist but not for psychotherapy, expect to come in periodically to discuss how you’re feeling on your medication. He or she may need to make changes accordingly and continue monitoring your progress. Similar to patients who suffer from migraines, your doctor may ask you to keep a chart or log of certain symptoms to better understand when they occur or what makes them better or worse.
You should expect that your discussions with your therapist or doctor are confidential. If you're concerned, ask. It’s typically understood that a therapist respects your privacy, as do members of your group, if you are participating in group therapy.
Will my mental health professionals coordinate with each other and/or with my other doctors?
Good communication between your mental health providers is important and most helpful. If your psychiatrist does not offer psychotherapy and/or you are working with another professional for counseling, they should periodically touch base on your progress and responses to treatment. He or she may also coordinate with your other physicians. Similarly, if a therapist refers you to a psychiatrist for treatment with medication, it is beneficial for them to coordinate and have the perspective to make changes in your treatment plan if needed.
Will they judge me or think I’m just crazy?
Absolutely not. Mental health concerns are as important as any other medical or physical condition. Your providers genuinely want to help you recover from mental disorders and overcome the stressors or challenges that are getting in the way of your personal relationships, ability to function effectively or quality of life. You should expect to be treated with respect and not be judged for dealing with a disorder of the brain or difficult life experiences that tax your ability to cope, and cause emotional, mental and/or physical distress.
DIAGNOSIS AND TREATMENT
How will I be diagnosed?
A psychiatrist, psychologist or other therapist will use specially designed interview and assessment tools to evaluate you (or your family member) for a mental disorder or condition. He or she will base the diagnosis on the intensity of the symptoms you report, how long they last, and the degree to which they cause problems in daily functioning. The mental health professional will also observe your or your loved one’s behavior and demeanor. He or she will then determine whether the symptoms and degree of dysfunction indicate a specific disorder.
A condition that falls within the scope of medical diagnosis – which includes mental disorders or psychiatric illnesses – should be diagnosed using well-established, scientifically based findings. Mental health professionals across the United States rely on the Diagnostic and Statistical Manual of Mental Disorders (DSM). Published by the American Psychiatric Association, the DSM is the standard classification of mental disorders that defines diagnostic criteria for every psychiatric disorder recognized by the U.S. health care system. It covers anything that can be listed as a nervous or mental disorder. The latest edition, DSM-5, incorporates significant scientific advances that allow practitioners to more precisely identify and diagnose mental disorders.
Sometimes it takes time to determine the correct diagnosis or even if there is a diagnosis to be made. If someone is being tested for rheumatoid arthritis, diagnosis is based on measured levels of inflammation present in the blood. Unfortunately in the psychiatric realm, there are no specific laboratory tests or imaging findings that determine a diagnosis. Instead, diagnosis is largely based on patterns of symptoms and behavior.
There are also psychological tests and screening inventories that are used, and occasionally some blood tests are helpful. For example, if someone is anemic or they have a thyroid problem, the symptoms may look like depression. However, the cause could be related to low iron in their blood or their metabolism. Therefore, your doctor may first ask you questions about your medical history, perform a physical exam and use tests to look for physical illness as the cause of your symptoms.
Keep in mind that the purpose of a diagnosis is not to label or stigmatize, but to establish a guideline for addressing the condition and pursuing the most appropriate channels of help.
What treatment options are available?
The treatment plan will depend on the individual, his or her mental disorder or condition, the goals of treatment and management of symptoms. Psychiatric disorders may be treated with medication, psychotherapy (talk therapy) and psychosocial treatments, or a combination of both. There are also brain-stimulation therapies, often employed for patients who cannot take medication or do not respond to other treatments. Learn about mental health treatments here.
What factors will affect the type of treatment that is recommended?
Each therapist or provider has to work with you to determine the best treatment plan for you and the concerns that brought you to treatment. If medications are necessary, a psychiatrist or other physician, or an advanced nurse practitioner, will need to be involved.
How long will my family member or I be under care?
The length of time under care is a very individual matter. It largely depends upon the goals for treatment. For some people, finding relief from symptoms is sufficient. Other individuals may want to spend more time looking at life experiences and gain a greater sense of self-understanding.
My family member/friend won’t follow recommended treatment. What can I do?
The National Alliance on Mental Illness (NAMI) offers this guidance:
In the United States, noncompliance to treatment is not a crime. Medication or therapy is not enforceable, except in the case of minors and those who are a danger to themselves or others.
If you feel like your family member or friend meets the criteria as a danger to themselves or others, you may contact 911 and ask for a crisis intervention officer to be sent to the location. Your community may also have a crisis intervention team (CIT) that could respond to an emergency situation. Your local NAMI Affiliate may be able to provide you with contact information for a CIT in your community.
NAMI State Organizations and NAMI Affiliates offer education courses and support groups to assist family, friends and caregivers of those living with the mental illness. NAMI Family-to-Family, NAMI’s 12-week free education course, is particularly helpful and will address many of your concerns. You will find that you are not alone, and the instructors and other families in the course have been through similar experiences. You will learn from their personal strategies to help you cope.
In extreme cases, when a person has a long history of noncompliance, assisted outpatient treatment (AOT) may be an option. (AOT) is court-ordered treatment (including medication) for individuals with severe mental illness who meet strict legal criteria. Generally, a violation of the court order can result in a hospitalization for further treatment. Your State NAMI Organization (Texas NAMI) or local NAMI Affiliate will have more information particular to your state laws concerning these procedures.
How do you know when it’s time to change course or professionals?
If you’re not sure you’re on the right course of treatment, it’s reasonable and appropriate to get another opinion. It’s also reasonable and appropriate to share that desire for a consultation with your current provider. If you request a consultation related to your concern, your provider ideally should respond, “Absolutely, and maybe we’ll both learn something from that.” He or she should not challenge you. It is vital that you feel comfortable and take an active role in treatment by asking questions of your providers. If you believe that a consultation will be helpful, don’t be shy.
What do I need to know about psychiatric medications?
Medication plays a key part in the treatment of psychiatric disorders. Medications may be the first-line treatment for many individuals with mental conditions. While they do not cure mental illness, prescribed drugs can significantly relieve symptoms and advance recovery – they make people feel better so they can function.
Keep in mind that you may have to try a few different medicines before you find the one that is right for you. In addition, many psychiatric medications have to be taken for several weeks before seeing results, and it can take six to eight weeks before gaining maximum benefit. All medicines should be taken as directed. Most medications for mental illnesses do not work if they’re not taken regularly, and extra doses can cause severe, potentially dangerous side effects.
Medications may be prescribed by a physician or by an advanced nurse practitioner who works under the supervision of a physician. Fortunately, there are many very effective medications to treat mental disorders and conditions. You have the right to know what is being prescribed and why before you or your child start taking it – the expected benefits, as well as any potential downsides or side effects. If there are other medications that might be appropriate, you might want to know why he or she recommends the one being prescribed over others. Your doctor should give you the opportunity to ask questions about your medication and to answer them candidly. He or she should be able to answer questions such as:
- What is the name of the medication and what is it supposed to do?
- What is its track record of effectiveness?
- When should it begin to take effect and how soon before I see results?
- How and when should the medication be taken? Should it be taken with food, on an empty stomach, or does it matter?
- How long should I expect to be taking it, and when do I stop?
- What are the primary side effects and what should be done if they occur? Are there ways to minimize them?
- What food, drinks or other medicines should be avoided while taking this medication? Can I still take aspirin, Advil, vitamins and/or herbal supplements?
- Is it safe to drink alcohol while on this medication?
- What do I do if a dose is missed?
- Is the drug available in a generic version?
- How do you monitor medications? How will we know when it’s time to stop taking this medicine, or if the dose will need to be adjusted?
The best sources of information on specific medications are the physician prescribing them and the information sheets packaged with your medicine. Your pharmacist is another good resource. Other information on medications is widely available. Other reliable sources for information on mental health medications include:
General information about specific medications – National Alliance on Mental Illness
Are psychiatric medications addictive?
The majority of medicines used in psychiatric treatment do not have potential for addiction. Some sedatives/hypnotics and some anti-anxiety drugs may be potentially addicting if not used properly. A discussion with your physician is the best way to understand if a medication has the potential for addiction.
How will the psychiatrist choose a medication?
Before writing a prescription, your doctor needs to know your medical history, the other medications you are taking, and relevant life plans – for example, if you plan to get pregnant.
Factors that can influence the medications chosen and their effect include:
- Type of mental disorder, such as depression, anxiety, bipolar disorder, ADHD, schizophrenia
- Age, sex and body size
- Expected results
- Potential risks or side effects
- Physical illnesses
- Family history/genetics
- Habits like smoking and drinking
- Liver and kidney function
- Other medications and herbal/vitamin supplements
- Dietary concerns
- Medication costs
After taking the medication for a short time, you should tell the doctor about favorable results as well as side effects. You may also be asked to keep a chart or log to identify patterns of symptoms and track what makes them better or worse.
How long will I need to be on my medication?
It will depend on many factors – your diagnosis, your symptoms, issues causing your symptoms, the medication, and how you respond, among others. Some people recover quickly from their symptoms and only need their medications for a short time. For example, an individual diagnosed with depression may feel much better after just a few months of taking medication and may never need it again. In contrast, people who suffer from serious mental illnesses like schizophrenia and bipolar disorder, or who have ongoing or severe depression or anxiety, may need to remain on medication for a much longer time.
I’ve been taking my medication and I’m starting to feel better. Can I stop taking it?
It is important to ask your doctor when – and how – the medication should be stopped. Some prescribed drugs cannot be stopped suddenly, because the patient may experience symptoms of withdrawal, which can be extremely unpleasant. If you and your doctor believe it is a good idea to try coming off the medicine, it may be necessary to slowly decrease the dosage of medications under his or her supervision to avoid these symptoms.
Sometimes people want to stop taking their medication when they feel their symptoms are under control or because the side effects are bothersome. The problem is that at least half of the time, the symptoms come right back. If you or your child are taking medication, it is essential that you work together with your doctor before making decisions about any changes in your treatment.
My medicine is making me feel bad. What should I do?
Unfortunately, all medications carry a risk of side effects. It is important to try to find the right balance between reducing symptoms and managing side effects. If you have a problem with your medication, be sure to talk to your doctor about it.
Some people experience side effects from medications and others don't. You should talk with your doctor and your pharmacist about how you feel and whenever there are side effects that might make you want to stop your treatment. Most side effects can be effectively managed, perhaps by your doctor changing the dosage or the form of the medication, or even when you take your medication. It is important that your doctor and pharmacist work together to make sure your medications are working safely and effectively.
ACHIEVING THE BEST RESULTS
How can I get the most out of care?
Treatment likely will work best if there is a partnership between you and your mental health professional(s). It’s a two-way street – take an active part in counseling sessions and appointments with your doctor and/or therapist.
- Share your goals for treatment. What are the behaviors or issues you care about most?
- Maintain an open mind. Be willing to consider new ways of behaving and thinking that might improve the quality of your life. We all resist change, so don't be surprised if you are tempted to quit right before some real changes happen.
- If you feel you're not making progress, tell your provider. A good psychiatrist/therapist will want to work with you so you can get the most out of your sessions. After discussing your concerns, if you're still not comfortable, you might consider meeting with another professional for advice and potentially change providers.
- Be open and honest. Your psychiatrist/therapist can't really help you if you don't share the whole picture. Don't say you're fine if you're not.
- Absorb and apply your therapy. You might consider writing your thoughts and feelings in a journal or using other methods to focus on what you've been discussing in therapy. Think about ways to use ideas from therapy in your daily life.
How can I best support someone who has a mental disorder or who is dealing with mental health problems?
As a friend or family member of someone who is coping with a mental disorder, know that your support is important in their recovery. Treatment can be very effective and the majority of people with psychiatric disorders and other mental conditions can return to stable, productive lives. Maintain hope and continue to work with your loved one and his or her health care providers to find treatments that work. Remind your loved one in a positive way that you are there for support.
Some people are able to stabilize quickly after starting treatment; others take longer and need to try several treatments, medications or medication combinations before they feel better. Talk therapy can be helpful for managing symptoms during this time. If your friend or family member is facing treatment challenges, the person needs your support and patience more than ever. Education can help you both find out all the options that are available and decide whether a second opinion is needed. Help your loved one to take medication as prescribed, and don’t assume the person isn’t following the treatment plan just because he or she isn’t feeling completely better.
RECOVERY/QUALITY OF LIFE
Can people recover from mental illness? Is there a cure?
Most people with mental health problems can get better. Treatment and recovery are ongoing processes that happen over time. The first step is getting help. Recovery may mean different things for different people, but recovery from mental illness is real and attainable. The National Consensus Statement on Mental Health Recovery, issued by the Substance Abuse and Mental Health Services Administration, offers a simple definition:
“Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.”
Two key principles to keep in mind: 1) Recovery is a process, not an event. 2) The journey is unique for each individual. That process incorporates more than just a focus on mental health and medications. Recovery from serious mental illness also must include a focus on overall wellness. That means achieving and maintaining physical health while undergoing continuous treatment.
As you become familiar with your own or your loved one’s illness, you will start to recognize those unique signs and patterns of behavior that signal the need to seek timely, effective care. Staying in tune with these signs and acting on them can often prevent relapses.
Learn more about recovery: http://www.mentalhealth.gov/basics/recovery/index.html
I am recovering from mental illness. How do I learn about social activities, volunteer opportunities and getting back to work while in recovery?
Meaningful activity, which includes school, volunteer work, part-time work and full-time employment, plays a vital role in recovery. It provides a sense of purpose while enabling you to meet new people and make friends. As people recover from a mental health condition, they also face varied challenges related to work – how much and what they can do, and how much support they need.
Although your goal may be to have a paying job, volunteer work is another form of meaningful activity for many people with mental health conditions. It can even serve as a bridge to paid employment. There are volunteer centers for a number of cities within North Texas; if your community does not have one, search for volunteer opportunities online at http://www.volunteermatch.org/.
Helpful links on getting back to work, volunteering and social opportunities: http://www.mentalhealthamerica.net/meaningful-work-and-recovery
COSTS, INSURANCE, AND FINANCIAL ASSISTANCE
How do I pay for mental health services?
As of 2014, employer-paid and individual health insurance policies have to provide fair coverage of mental health and substance use services to comply with the Affordable Care Act (Obamacare). If you have insurance, review your policy to see what it covers. Even with health insurance that covers mental health services, check with your insurance company to make sure that your doctor or therapist accepts your insurance. Be aware that some psychiatrists and therapists do not accept insurance. If yours is one of them, you will need to get the diagnostic code, and you can submit the bill to your insurance company using out-of-network benefits. If you do not have insurance, you will need to pay the provider’s fee out of pocket.
There are some clinics, nonprofits and faith-based organizations that charge for services on a sliding-scale basis depending on one’s ability to pay. You will need to find out whether the provider accepts individuals on Medicaid or Medicare, the types of insurance accepted (if applicable), and available payment options.
If you are searching for a mental health provider in North Texas, you can search our online directory for providers who accept insurance and see their payment policies.
I can’t afford my prescriptions or medical insurance. Where can I go for financial assistance?
The ever-increasing costs of psychiatric medications can create a hurdle for patients trying to manage their symptoms and maintain their wellbeing. Fortunately, there are several avenues for obtaining assistance with the cost of prescribed medications, summarized by the National Alliance on Mental Illness (NAMI):
There are three primary types of assistance that can help with the cost of prescription medications:
- Government programs offer assistance to qualified individuals with financial needs through state and county prescription assistance programs, state Medicaid offices, and the federal “Extra Help” program for those with Medicare Part D coverage.
- Nonprofit organizations provide information and resources that help with prescription costs, co-pays, premiums and diagnosis-related expenses.
- Many pharmaceutical companies offer medication-assistance programs to low-income individuals and families.
Get the details on these prescription drug assistance programs:
What kinds of financial or public assistance are available for mental health treatment?
Those seeking treatment who have Medicaid can see a private psychiatrist if the psychiatrist accepts Medicaid. In the seven counties of North Texas, Medicaid mental health and addiction services are provided by NorthSTAR, the regional public mental health system. This managed-care program is operated by an insurance company called ValueOptions, and serves eligible residents of Dallas, Ellis, Collin, Hunt, Navarro, Rockwall and Kaufman counties. In other parts of Texas, community mental health centers serve low-income patients.
To qualify for NorthSTAR you have to meet State financial guidelines. You MUST apply in person to become enrolled in NorthSTAR at one of several NorthSTAR provider locations across the seven counties. To find the location nearest you, please refer to the Provider Directory or contact ValueOptions at 1-888-800-6799.
Learn about qualifications for NorthSTAR enrollment: http://www.ntbha.org/enrollment.aspx
Enrollee Handbook and Provider Directory: http://www.valueoptions.com/northstar/members/resources/NorthSTAR_Provider_Directory.pdf
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