Twenty percent of adult Americans – or one in five – will have a mental illness during their lifetime that is severe enough to require treatment, and many more have problems that prevent them from enjoying their lives. Often these people suffer in silence, rather than admit they need help. Asking for help is not an easy thing for many people to do, but it is a wise move when a person feels that something is wrong. This page is a guide to locating mental health services. Many individuals who are looking for help for themselves or a loved one ask the same questions. Following are some of the most commonly asked questions and their answers.

When I need help, where can I go?

For information about resources available in your community, contact your local mental health center or one of the local affiliates of national self-help organizations. These agencies can provide you with information on services designed to meet the needs of those suffering from mental disorders such as depression, schizophrenia, panic disorder, and other anxiety conditions. In addition, they will have information regarding services designed for specific cultural groups, children, the elderly, HIV-infected individuals, and refugees.

I don't have adequate personal finances, medical insurance, or hospitalization coverage – where would I get the money to pay for the service I may need?

In publicly funded mental health centers, such as those funded by state, city or county governments, the cost of many services is calculated according to what you can afford to pay. So, if you have no money, or very little, services are still provided. This is called a sliding-scale or sliding-fee basis of payment. Many employers make assistance programs available to their employees, often without charge. These programs – usually called Employee Assistance Programs – are designed to provide mental health services, including individual psychotherapy, family counseling, and assistance with problems of drug and alcohol abuse.

Are there other places to go for help?

Yes, there are alternatives. Many mental health programs operate independently. These include local clinics, family service agencies, mental health self-help groups, private psychiatric hospitals, private clinics, and private practitioners. If you go to a private clinic or practitioner, you will pay the full cost of the services, less the amount paid by your insurer or some other payment source. There are also many self-help organizations that operate drop-in centers and sponsor gatherings for group discussions to deal with problems associated with bereavement, suicide, depression, anxiety, phobias, panic disorder, obsessive-compulsive disorder, schizophrenia, drugs, alcohol, eating disorders (bulimia, anorexia nervosa, obesity), spouse and child abuse, sexual abuse, rape, and coping with the problems of aging parents – to name a few. In addition, there are private practitioners who specialize in treating one or more of these problems. You may contact local chapters of self-help organizations to learn about various services available in your community.

I don't like to bother other people with my problems. Wouldn't it be better just to wait and work things out by myself?

That's like having a toothache and not going to the dentist. The results are the same – you keep on hurting and the problem will probably get worse.

Suppose I decide to go ahead and visit a mental health center. What goes on in one of those places?

A specially trained staff member will talk with you about the things that are worrying you.

Talk? I can talk to a friend for free – why pay someone?

You're quite right. If you have a wise and understanding friend who is willing to listen to your problems, you may not need professional help at all. But often that's not enough. You may need a professionally trained person to help you uncover what's really bothering you. Your friend probably does not have the skills to do this.

How can just talking make problems disappear?

When you're talking to someone who has professional training and has helped many others with problems similar to yours, that person is able to see the patterns in your life that have led to your unhappiness. In therapy, the job is to help you recognize those patterns – and you may try to change them. There may be times, however, when you will need a combination of "talk" therapy and medication.

Are psychiatrists the only ones who can help?

No. A therapist does not have to be a psychiatrist. A number of psychologists, social workers, nurses, mental health counselors, and others have been specially trained and licensed to work effectively with people's mental and emotional difficulties. However, only a psychiatrist is a medical doctor and therefore qualified to prescribe medication.

Since I work all day, it would be hard to go to a center during regular working hours. Are centers open at night or on weekends?

Often centers offer night or weekend appointments. Just contact the center for an appointment, which may be set up for a time that is convenient for both you and the center.

And how about doctors in private practice – do they sometimes see their patients after working hours?

Many doctors have evening hours to accommodate their patients. Some even see patients very early in the morning before they go to work.

I feel that I would be helped by going to a mental health center. Actually, I think my spouse could be helped too. But the idea of going to a "mental health center" would seem threatening to my spouse. Could I just pretend that it's something else?

No indeed. It's better to talk your spouse into it than to lie. Don't jeopardize trust by being deceptive. However, you may want to discuss it first with the center. Marital or family therapy is available when a problem exists that involves more than one family member.

If I go to a mental health center, what kind of treatment will I get?

There are many kinds of treatment. A professional at the center will work with you in determining the best form for your needs. Depending on the nature of the illness being treated, psychotherapy and/or treatment with medication may be recommended. Sometimes, joining a group of people who have similar problems is best; at other times, talking individually to a therapist is the answer.

Does taking therapy for mental and emotional problems always work?

Sometimes it does, and sometimes it doesn't. It primarily depends on you and the therapist. It is important to share your concerns in a serious, sincere, and open manner. Only if you are completely honest and open can you expect to receive the best support and advice.

What if I really try, but I still can't feel comfortable with the therapist?

There should be a "fit" between your personality and that of the therapist. Someone else – or some other method – may be more suitable for you. You can ask your therapist for a referral to another mental health professional, or, if you prefer, you can call one of the mental health associations for the names of other therapists in your area.

What if I am receiving medication and don't think it is helping?

If there is little or no change in your symptoms after five to six weeks, a different medication may be tried. Some people respond better to one medication than another. Some people also are helped by combining treatment with medications and another form of therapy.

Does a mental health center provide services for children?

Yes. Children's services are an important part of any center's program. Children usually respond very well to short-term help if they are not suffering from a severe disorder. Families often are asked to participate and are consulted if the child is found to have a serious disorder – such as autism, childhood depression, obsessive-compulsive disorder, attention deficit hyperactivity disorder, or anorexia nervosa or bulimia – and long-term treatment is needed.

I have an elderly parent who has trouble remembering even close members of the family. He is physically still quite active and has wandered off a number of times. Could someone help with this?

A staff person at a center can advise you about ways you can best care for your parent. You may be referred to a special agency or organization that provides services designed especially to meet the needs of elderly people. The department of public welfare in your county can give you addresses and telephone numbers for both your county and state agencies on aging. These agencies provide information on services and programs for the elderly.

I have a friend who says she could use some professional help, but she is worried about keeping it confidential.

She needn't worry. Confidentiality is basic to therapy, and the patient has the right to control access to information about her treatment. Professional association guidelines plus federal and state laws underscore the importance of confidentiality in therapist-client relationships and govern the release of records. Some insurance companies require certain information from the therapist as a condition for payment, but that information can be released only if the patient gives written permission. If your friend wants to know exactly who gets information and what kind of information is released, she should ask her insurance provider and discuss it in detail with the therapist.

I have a relative with a severe mental problem. Should I urge this person to go to the hospital?

A person who is mentally ill should be in a hospital only if it is absolutely necessary. In general, most mental health professionals believe that persons with mental illness should live in the community and be treated there. That's why mental health centers and community support and rehabilitation programs stress the importance of having many different services available: day, night, and weekend care, and outpatient treatment through regular visits to an office or clinic.

Do emergency cases wind up as long-term patients in mental hospitals?

Generally no. Mental hospitals are used today for short-term crisis intervention when there are no other community services available or when a person needs extra care to stabilize a drug treatment regimen. Also they serve the small percentage of patients who need long-term, structured, supervised care and treatment in a protective setting.

I have heard people use the term "involuntary commitment." What does this mean?

In an emergency (for example, where a person is considered a danger to self or others), it is possible for someone to be admitted to a hospital for a short period against his or her will. The exact procedures that must be followed vary from one area to another, according to state and local laws. At the end of the emergency commitment period, the state must either release the individual, obtain his or her voluntary consent to extend commitment, or file with the court an extended commitment petition to continue to detain the person involuntarily. Most states require an emergency commitment hearing to be held within two to four days after hospital admission to justify continued involuntary confinement.

Whom can I call if I feel that my rights have been violated or if I want to report suspected violation of rights, abuse, or neglect?

Federal law provides that each state have a Protection and Advocacy (P&A) System. These agencies, partially funded by the Center for Mental Health Services, investigate reports of abuse and neglect in public or private mental health or treatment facilities for current residents or those admitted or discharged during the past 90 days. For the name of the P&A agency in your state, contact the National Association of Protection and Advocacy Systems.

Mental Treatment and Therapy Guide

Warning Signals

Many people are not sure how to judge when professional help for mental problems may be needed. There are some behaviors that may be signs of trouble:

1. Is the person acting differently than usual? Could this change be linked to something that has happened recently? Any event, such as the death of a close relative, loss of a job, marital break-up, or even something positive – like a job promotion – can trigger a troublesome emotional reaction.

2. Does the person complain of episodes of extreme, almost uncontrollable, anxiety or "nervousness"? One sign of an emotional problem is "free floating" anxiety that is unrelated to a normal concern, such as a child's illness or a backlog of bills.

3. Does the person become aggressive, rude, and abusive over minor incidents or talk about groups or individuals "out to get me"? If such remarks are made in all seriousness, and if violent behavior occurs, it is likely that help is needed and should be sought.

Any of these symptoms, if they persist or become severe, may suggest a need for professional help. Fortunately, early identification and treatment of the problems causing this behavior often can make these symptoms disappear.

What to Do in Emergency Situations

If a person becomes violent, gets completely out of control, or tries to commit suicide, there are several things you can do:

1. In a dangerous or violent crisis, call the police. Often the police are the best equipped, most available resource, especially when violence has occurred or when there is a strong possibility that the person may do physical injury to self or others. Once the emergency situation has been brought under control, if the troubled individual is already in treatment, call his or her therapist.

2. In a nonviolent crisis, contacting other resources may be the best choice. For example, if an individual hasn't eaten for a substantial period of time and has become weak and dehydrated, call his or her physician or therapist. If the person doesn't have one, get him or her to a hospital emergency room where there are doctors on duty – even if you have to call an ambulance to get there. Look in the Yellow Pages under "Ambulance," or call the fire department or rescue squad. Look under the list of emergency numbers in the front of your phone book or call the operator if you can't find a number in a hurry.

Emergency room doctors will treat injuries resulting from violence, a suicide attempt, or a drug or alcohol overdose. They may also be able to provide temporary help for an emotional problem, even if they are not mental health specialists. In addition, they will be able to tell you where and how to get further help.

If the person in crisis is a member of a church, synagogue, or temple, you may choose to call the minister, priest, or rabbi. Many members of the clergy are trained to deal with emergencies, or they can refer you to other sources of help.

You may choose to call a mental health or crisis hotline, drug hotline, suicide prevention center, "free clinic," or Alcoholics Anonymous chapter, if your area has such services. Their telephones are often staffed around the clock. Look for a number in the list of emergency or community service numbers in the front of your phone book, or you can find a listing in the white-pages section of the Yellow Pages under "Suicide," "Mental Health" or "Alcoholics Anonymous," or ask the operator for help.

Another option would be to call the nearest mental health center. If it is not listed that way in the phone book, look under "Hospital," "Mental Health," or "Physicians" in the Yellow Pages. Mental health centers generally provide a wide range of services. Included in these are:

1. 24-hour emergency service – day or night service available at hospitals or other mental health clinics.

2. Outpatient care – a person goes into the center's clinic for treatment that has been set up on a regular appointment basis.

3. Inpatient service – a person stays at the hospital where care is provided.

4. Partial hospitalization – a person might spend occasional days, nights, or weekends at the center, living at home and going to work as much as possible.

5. Consultation, education, and prevention services – assist schools, community organizations, institutions, and businesses in dealing with mentally ill persons and in developing programs that help in the understanding and prevention of emotional disorders.

Treatment Methods

The goals of treatment are to reduce symptoms of emotional disorders; improve personal and social functioning; develop and strengthen coping skills; and promote behaviors that make a person's life better. Biomedical therapy, psychotherapy, and behavioral therapy are basic approaches to treatment that may help a person overcome problems. There are many specific types of therapies that may be used alone or in various combinations.

Biomedical Therapies

Treatment with medications has benefited many patients with emotional, behavioral, and mental disorders and is often combined with other therapy. The medication that a psychiatrist or other physician prescribes depends on the nature of the illness being treated as well as on an assessment of the patient's general medical condition. During the past 35 years, many psychotherapeutic medications have been developed and have made dramatic changes in the treatment of mental disorders. Today there are specific medications to alleviate the symptoms of such mental disorders as schizophrenia, bipolar disorder, major depression, anxiety, panic disorder, and obsessive-compulsive disorder.

Psychotherapy

Psychotherapy is accomplished through a series of face-to-face discussions in which a therapist helps a person to talk about, define, and resolve personal problems that are troubling. Psychotherapies generally appear to be more effective and appropriate than medications or ECT for less severe forms of emotional distress.

Short-term psychotherapy, lasting for several weeks or months, is used when the problem seems to result from a stressful life event such as a death in the family, divorce, or physical illness. The goal of the therapist is to help the patient resolve the problem as quickly as possible. Often this takes only a few visits. Long-term psychotherapy, lasting from several months to several years, emphasizes the study of underlying problems that started in childhood.

The following is a list of a few types of psychotherapy:

Psychodynamic psychotherapy, which may be either long- or short-term, examines important relationships and experiences from early childhood to the present in an effort to analyze and change unsettling or destructive behaviors and to resolve emotional problems. One form of psychodynamic psychotherapy is psychoanalysis, a long-term, intensive therapy that emphasizes how the patient's unconscious motivations and early patterns of resolving issues are important influences in his or her present actions and feelings.

Interpersonal therapy focuses on the patient's current life and relationships within the family, social, and work environments.

Family therapy involves discussions and problem-solving sessions with every member of a family – sometimes with the entire group, sometimes with individuals.

Couple therapy aims to develop a more rewarding relationship and minimize problems through understanding how individual conflicts get expressed in the couple's interactions.

Group therapy involves a small group of people with similar problems who, with the guidance of a therapist, discuss individual issues and help each other with problems.

Play therapy is a technique used for establishing communication and resolving problems with young children.

Cognitive therapy aims to identify and correct distorted thinking patterns that can lead to troublesome feelings and behaviors. Cognitive therapy is often combined effectively with behavioral therapy.

Behavioral therapy uses learning principles to change troublesome thinking patterns and behaviors systematically. The individual can learn specific skills to obtain rewards and satisfaction. Such an approach may involve the cooperation of important persons in the individual's life to give praise and attention to desirable changes. Behavioral therapy includes an array of methods such as stress management, biofeedback, and relaxation training.

Other Treatments

Some treatments, called "adjunctive," are used in combination with other therapies, and sometimes they are used alone. They include occupational, recreational, or creative therapies, as well as some that focus on special education. A mental health professional can help a client find the kind of therapy, or combination of therapies, that is best suited to his or her situation.

Rehabilitation Services – Community Support Programs

Many individuals with severe mental illness find it difficult to work, learn, socialize, and live independently outside a controlled setting. To help in these matters, community support programs offer rehabilitation services, either through freestanding programs that are similar to clubs, or through mental health centers. These agencies offer a variety of activities to assist clients in learning skills that will help them to live and work independently and productively in the community. For information on community support programs, contact your local or state mental health agency.

The Helping Professionals

Helping professionals work in a variety of settings, such as mental health centers, outpatient clinics, private and group practice, general hospitals, psychiatric hospitals, nursing homes, jails, and prisons. They also work in residential treatment centers, partial care organizations, family or social service agencies, and the psychiatric departments of university medical centers or teaching hospitals.

Who They Are – What They Do

Psychiatrists

A psychiatrist is a medical doctor who specializes in mental disorders, is licensed to practice medicine, and has completed a year of internship and three years of specialty training. A board-certified psychiatrist has, in addition, practiced for at least two years and passed the written and oral examinations of the American Board of Psychiatry and Neurology. Psychiatrists can evaluate and diagnose all types of mental disorders, carry out biomedical treatments and psychotherapy, and work with psychological problems associated with medical disorders. Of the mental health professionals, only psychiatrists can prescribe medications. Child psychiatrists specialize in working with children; geriatric psychiatrists concentrate on helping the aged.

Psychologists

Psychologists who conduct psychotherapy and work with individuals, groups, or families to resolve problems generally are called clinical psychologists, counseling psychologists, or school psychologists. They work in many settings – for example, mental health centers, hospitals and clinics, schools, employee assistance programs, and private practice. In most states, a licensed clinical psychologist has completed a doctoral degree from a university program with specialized training and experience requirements and has successfully completed a professional licensure examination.

The field of psychology also includes those who specialize in such areas as testing, community organization, industrial relations, and laboratory research.

Psychiatric Nurses

Psychiatric nursing is a specialized area of professional nursing practice that is concerned with prevention, treatment, and rehabilitation of mental-health-related problems. These nurses are registered professional nurses who have advanced academic degrees at the master's degree level or above. They conduct individual, family and group therapy and also work in mental health consultation, education and administration.

Social Workers

Psychiatric (or clinical) social workers have master's or doctor's degrees in social work, have completed a field supervision program, and are licensed/certified. In addition to individual, family, and group counseling and psychotherapy, they are trained in client-centered advocacy. This includes information, referral, direct intervention with governmental and civic agencies, and expansion of community resources.

Mental Health Counselors

A clinical mental health counselor provides professional counseling services that involve psychotherapy, human development, learning theory, and group dynamics to help individuals, couples, and families. The promotion and enhancement of healthy, satisfying lifestyles are the goals of mental health counselors, whether the services are rendered in a mental health center, business, private practice, or other community agency. Clinical mental health counselors have earned at least a master's degree, had supervised experience, and passed a national examination before they can be certified by the National Board for Certified Counselors, Inc. (NBCC).

Case Managers and Outreach Workers

These individuals assist persons with severe mental illness, including some who may be homeless, to obtain the services they need to live in the community. Most persons with severe mental illness need medical care, social services, and assistance from a variety of agencies, including those dealing with housing, Social Security, vocational rehabilitation, and mental health. Because such services are uncoordinated in many areas, case managers provide a critical function to monitor a person's needs and assure that appropriate agencies get involved. In many instances they also act as advocates for the client. Case managers can be nurses, social workers, or mental health workers and can be associated with mental health centers, psychosocial rehabilitation programs, or other agencies. Case management and outreach services are frequently provided by teams that may include people who are recovering from a mental illness who function as peer counselors, case management aides, or outreach workers.

Mental Health Research and Services

The core mission of the National Institute of Mental Health is to understand, treat and prevent mental illness. Research into the kinds of mental health services that will support this mission plays an important role. The Center for Mental Health Services provides national leadership in mental health care delivery and policy development to facilitate accessible, comprehensive and quality mental health and support services. The institute and the center, in cooperation with consumer and family groups, professional organizations and other federal and state agencies, work to advance the application of scientific findings and practice-based knowledge to improve the range of effective prevention and treatment services.

This information is provided by the National Institute of Mental Health (NIMH)

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