Sunday, July 15, 2018
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What you need to know when choosing a mental health professional

Nearly half of us will experience a mental illness at some point in our lives.

And all of us will go through periods of stress, sadness, grief and conflict.

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We're better able to navigate these periods when we are able to access the right support, medication or services. Sometimes the right treatment is lifesaving.

There are a range of people who can help with mental health issues. But it can be hard to know who is best to turn to, as practitioners vary widely in their training, experience, and expertise.

Some are trained to offer support for psychological issues, like grief and stress, others specialise in more serious mental illnesses such as depression, bipolar disorder or schizophrenia.

So where do you begin when you're looking for a mental health professional?

Your GP

If you're feeling stressed, anxious, depressed, or having difficulty coping, your GP can be a good first port of call.

Figures suggest Australians see their GPs for mental health issues more than any other health concern.

"It is not musculoskeletal problems patients are presenting with most often, or cardiovascular disease — the stock standard medical presentations we always hear about," Dr Bastian Seidel, the president of the Royal Australian College of General Practitioners, said.

"It is psychological issues GPs are dealing with most of the time."

All GPs have mental health training, and for most of us they are the health professional we know best and the one we see most often.

If you know you're going to see your GP about a mental health issue, it can help to plan ahead and book a double appointment. It will give you a bit more time to talk about what's going on, and what might be the best treatment options for you.

Depending on your situation they may refer you to a psychologist, psychiatrist, counsellor, or other mental health practitioner. They may also put you on a GP Mental Health Treatment Plan, which gives you access to subsidised care.

If your GP doesn't refer you to a mental health professional, you can go directly to a psychologist or counsellor yourself.

Psychiatrists

Psychiatrists are medical doctors who specialise in diagnosing and treating mental illness.

They tend to treat complex and serious mental illness, and have a deep understanding of physical and mental health, and how they affect each other.

"Psychiatrists have a broad knowledge of biological factors as well as psychological and psychiatric issues," says Dr Gordon Parker, professor of psychiatry at the University of New South Wales and founder of the Black Dog Institute.

Psychiatrists typically work with people with conditions such as schizophrenia, bipolar disorder, severe depression, eating disorders and addiction.

Psychiatrists are the only mental health practitioners able to prescribe medication, which they commonly do (if appropriate) alongside their use of psychological treatment (also known as psychotherapy), and brain stimulation therapies.

"If somebody walks in with a biological problem — they've got schizophrenia or bipolar disorder — a broad-based psychiatrist is likely to prioritise medication as part of their treatment.

"But if somebody walked in with an existential midlife crisis, a psychiatrist wouldn't prescribe a medication, but would counsel, and give psychotherapy advice," Professor Parker says.

Psychiatrists work in public and private hospitals, community mental health services and private consulting rooms. You'll need a referral from your GP or another medical doctor to see a psychiatrist.

What's their training? In total, at least 11 years.

Psychiatrists train as doctors: they spend four to six years at medical school, followed by a one-year internship at a hospital, then a speciality training registrar program. Then it's post-graduate psychiatry training: they work as registrars in hospitals and clinics for another five years under supervision of the Royal Australian and New Zealand College of Psychiatrists (RANZCP).

Are they regulated? All psychiatrists must be accredited by RANZCP before they can practise, and be registered with the Australian Health Practitioner Regulation Agency.

How much do they cost? Costs vary. If you see psychiatrist in a public hospital or community health service, you generally don't pay. If you see a psychiatrist privately, there will likely be an out-of-pocket cost. Medicare rebates may be available — see details below.

Psychologists

Psychologists are experts in human behaviour. They use scientific methods to study the factors that influence the way we think, feel, learn and behave.

Psychologists work in a variety of settings with a vast range of people: they deal with everything from depression, anxiety and eating disorders to relationship problems and personal growth.

That's because psychologists don't just provide counselling and therapy to people with diagnosed mental disorders; they also work with mentally healthy people to help them function better.

They can provide guidance and support, give perspective, and teach coping strategies to people experiencing things like significant change, stress, illness, grief, learning difficulties, behavioural problems, substance abuse, relationship breakdowns, and so on.

Psychologists use different types of psychological treatment (or talking therapies) to help people explore and challenge their behaviour and thought processes.

"Cognitive behavioural therapy is central to that, because over the last two decades or so, it has been the most evidenced-based treatment for a wide range of mental health problems," says Alice Shires, director of the Psychology Clinic at the University of Technology Sydney.

When it comes to dealing with more acute mental health concerns, clinical psychologists (and other specialised psychologists) are best placed to assist: they have additional training in assessing and treating severe mental illness.

"If you're a clinical psychologist, you need to be able to respond a whole range of problems — from fairly mild to really complex — across the lifespan," Ms Shires says.

Under the Australian Psychology Society's (APS) Code of Ethics, psychologists must provide services only in their areas of competence.

Because it's unlikely any psychologist will have expertise in all areas of mental health, it's important when approaching a psychologist to check that they work in the area in which you need assistance.

The APS's Find a Psychologist service is a good place to start.

What's their training? At a minimum, psychologists complete a four-year degree, followed by two years of supervised postgraduate training — although many hold masters or doctoral degrees. Some psychologists have an endorsed area of practice, meaning they have completed additional training and supervised practice in that particular area (e.g. clinical psychology, neuropsychology, forensic psychology).

Are they regulated? To use the professional title 'psychologist', practitioners must meet the requirements of the Psychology Board of Australia, and be registered with the Australian Health Practitioner Regulation Agency.

How much do they cost? The APS recommends fees of $133 for up to half an hour or $241 for up to an hour, although it's up to the individual practitioner. If you have been referred, Medicare rebates may be available — see details below.

Counsellors

Counsellors use talk-based therapy to help people to develop self-understanding and make changes in their lives.

A counsellor will allow you to talk through your personal concerns, gain perspective, develop coping strategies, and increase self-awareness.

If you're feeling stressed, worrying about the future, having relationship problems or just need someone to talk to, an appropriately trained counsellor may be a good option.

Counsellors can also take on a case-management role.

"This means they look at a whole support plan — including talking to other services, making referrals for support around housing or support around something else," Jayne Ferguson, counsellor and senior clinician at Relationships Australia Victoria, said.

Unlike psychiatry and psychology, counselling as a profession is not formally regulated. This means anyone can call themselves a counsellor — whether they've done a short online course that teaches the basics, or six years of university training.

"While a high percentage of counsellors would have some formalised education and training in counselling, a significant percentage do not," Professor Parker says.

But counsellors can still play a really important and very valuable role — especially those who have many years of experience in talk therapy.

"Everybody has a different personality, everybody has a different style, so it's about finding someone who you feel comfortable with," Ms Ferguson said.

What is a life coach?

What is a life coach?

  • A life coach is employed to help people attain their goals in life.
  • They might help you to get motivated, set goals, and hold you to account.
  • Life coaching is not regulated, so anyone can call themselves a life or personal coach.

If you're looking for a counsellor check out the Australian Counselling Association (ACA) or the Psychotherapists and Counsellors Federation of Australia (PACFA).

What's their training? In Australia, there is no mandated minimum training or qualification framework for counsellors. However, both ACA and PACFA have a national voluntary register of counsellors who meet minimum training and ethical standards.

How much do they cost? According to PACFA, the cost of one session can range from $60 to $150, though some practitioners charge outside this range. You may also be able to negotiate a fee based on your capacity to pay. Medicare rebates are not available for counselling.

Medicare rebates

If you've been diagnosed with a mental health issue, you're entitled to subsidised mental health care through the Better Access to Mental Health Care scheme.

Under the scheme, Medicare rebates are available for up to 10 individual and 10 group sessions per calendar year with a psychologist, occupational therapist or social worker.

To be eligible, you must visit your GP who will assess whether a GP Mental Health Treatment Plan is appropriate, or refer you to a psychiatrist who may prepare a psychiatrist assessment and management plan. Psychiatrists and paediatricians are also able to directly refer patients for Medicare rebate-able mental health services.

If you live in a remote area and find it hard to see a psychologist near you, seven (out of a possible 10) sessions can be done via video conferencing, although one of the first four sessions must be face-to-face.

For more information, check out the Better Access fact sheet for patients.

If you or someone you know needs help, support is available from Lifeline on 13 11 14.

Original Article

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