It might be hard to admit something is wrong. It may be particularly difficult to get past feelings of fear, guilt and the persistent stigma that cling to mental health issues. However, if your family is in crisis due to a loved one’s mental illness or behavioral problems, take action.
But it’s easy to be confused by the myriad mental health services available: When do you see a psychiatrist, or a psychologist? What is the difference? Why were you referred to a social worker? What is the role of a family therapist? What do all of those letters following someone’s name really mean? What should you look for?
Look for licensing
First and foremost, make sure the professional you are considering with is licensed in the state of Maryland. Licensing means the state has verified their credentials. Their credentials indicate that he or she has successfully completed the required educational courses (undergraduate and graduate work). After graduate school most practitioners must spend months, often years, completing an internship or residency in their specialty or a sub-specialty in order to qualify for licensing. Also, licensed practitioners agree to abide by an established code of ethics, and agree to regularly complete continuing education requirements. State boards oversee licensing exams; they investigate complaints, protect the public, set standards of care and serve as an information resource.
In Maryland, for example, the State Board of Physicians oversees not only medical doctors, but physician assistants, psychiatric assistants, and even radiation therapists. For mental health service providers the relevant ones are the Board of Physicians, Board of Professional Counselors and Therapists, Board of Social Work Examiners, Board of Examiners of Psychologists, and there is even a State Board for the Certification of Residential Child Care Program Administrators. These Boards fall under the Maryland’s Department of Health and Mental Hygiene and regardless of the specialty the overarching mission of all boards is to insure that consumers receive quality service in accordance with the laws of Maryland.
Be advised: in many states literally anyone can call themselves a therapist and set up a practice — no license required and no oversight provided.
Most mental health services are provided by a psychiatrist (her or she will have an MD or DO after their name), psychologists (Ph.D, Psy.D – both degree designations mean the same thing, and simply depends on the graduate school attended), licensed clinical social workers (LCSW; an MSW means a Masters degree in social work was completed), or licensed clinical professional counselor (LCPC), and licensed clinical marriage and family therapist (LCMFT). There are also licensing requirements for alcohol and drug counselors.
Match the problem with the expertise
Any professional should be willing to explain the meaning of the letters after their name, answer questions about their training, how long she’s been practicing, and if he has significant experience in helping people like you. If you meet with someone at their office, typically their degrees and licenses are framed and on display. Look for them.
Don’t get sidetracked by the Hollywood portrayal of therapists, with open-ended talk therapy sessions exploring your dreams and how you feel about your mom. Most mental health providers employ shorter, more limited forms of therapy such as cognitive behavioral therapy (CBT). Treatment is rarely open-ended, it’s usually collaborative, and there is often homework and an emphasis on learning self-counseling skills. According to Mary K. Alvord, Ph.D., of Alvord, Baker & Associates, LLC, a fee-for-service practice based in Silver Spring and Rockville, “CBT tends to be focused and specific. It involves short-term work and might only involve a few sessions. Psychiatry is now pretty much medication management,” she says.
Parents of children under treatment should expect to be active participants, says Dr. Alvord. She suggests looking for an evidence-based treatment program, such as CBT. “The Internet has been great in terms of educating the public on the symptoms of mental illnesses.” The best provider for you largely depends on your particular problem and the provider’s area of expertise. The two should be in sync. For example, if you are diagnosed with depression, look for a psychiatrist with a history of treating depression, or a social worker experienced in working with patients with post-traumatic stress disorder (PTSD) will likely be assigned to your family member who’s been diagnosed with PTSD.
Licensed clinical social workers are the largest group of mental health providers. They work with children, families and institutions on the treatment of a range of issues including addictions, depression, eating disorders, schizophrenia, bipolar disorder, suicide prevention, and obsessions and compulsions.
Psychiatrists can prescribe medications, and will often work in tandem with other mental health providers. For example, a psychiatrist will meet briefly with a patient and prescribe any needed medications or adjust their medication, while the actual behavioral therapy is provided by a LCSW or psychologist.
In Anne Arundel County, the Department of Health’s Adolescent and Family Services offer outpatient mental health and addiction services to children aged 5 to 18 and their families. Services are provided by psychiatrists, LCSWs, LCPCs, and psychologists. This is a public agency serving low-income and Medicaid-eligible families. However, they can give referrals to private care providers for families who don’t qualify for their services, or who are covered by insurance.
“What we do is twofold. Every child has an intake with a clinician,” said Sandy O’Neill, spokesperson for the Anne Arundel County’s Department of Health’s Adolescent and Family Services. The clinician chosen depends on the specific problem presented. “All children get a psychiatric evaluation to see if medication is necessary.”
How do you know if you need to get professional help? According to Ms. O’Neill, families should call for professional help whenever their problem is interfering with daily life – whether the problem is bedwetting, depression, fear of leaving their house, or fear of going to school. Many of the agency’s patients are referred by their school or pediatrician, but some parents call them directly. “People come into treatment when it’s too painful not to,” she said.
Just the simple of act of reaching out seems to help. “From the time they make that first phone call until their first visit, people typically start to feel better,” says Ms. O’Neill.
Finding a professional
Start with your health care provider; ask your family doctor or pediatrician for a referral. If the issue involves a child, call their school and see if they can offer names for referral. Call the local chapters of any of the national mental health organizations. You can find contact information online for the state chapters of the American Psychological Association, NASW, or the American Psychiatric Association, call and ask for referrals. The Web site of the Maryland Department of Health and Mental Hygiene is also a great place to start, and it offers a directory of core service agencies for each county, in addition to excellent educational information.
Go online. Do your homework. Start making calls. Ask for help. Unlike getting treated for heart disease or diabetes, there is still a secrecy and stigma attached to mental illness that is unfortunate, and can be crippling. Seek out support groups whenever possible. Isolation can unnecessarily exacerbate a problem.
By Deeanna Franklin Campbell