Mental illness: available treatments
There are various different treatments available for mental illness, and treatment often involves a combination of approaches, which may be offered by different professionals. Depending on your problem, you may receive help from a doctor or another health professional such as a psychologist or mental health nurse. Optimal treatment commonly involves a team approach.
Who should I turn to for treatment of mental illness?
If you or someone you are close to is experiencing a problem which may be related to mental health, the first place you should look for help should be your doctor or community mental health centre. Community support is an important aspect of treatment for mental illness, and ongoing support and treatment can be provided by a community health service clinic.
Some of the professionals involved in the treatment of mental health problems include the following.
You should see your general practitioner (GP) if you are experiencing problems such as depression or anxiety. A GP can help determine whether your symptoms are part of a mental illness, or whether they are the result of an underlying physical illness, a side effect of a medicine you have been taking, or a normal reaction to current life circumstances. If your symptoms are in fact caused by a mental illness, your GP might prescribe a course of medication, provide counselling (some GPs have a special interest in counselling), or refer you to someone who has expertise in your particular problem. GPs have a special role in ensuring that a person with a mental illness maintains good physical health, even if the mental illness is being treated elsewhere.
Psychiatrists are fully qualified medical doctors with specialist training in how to diagnose and treat mental illness. Psychiatrists work in hospitals, community mental health centres, and also in private practice. Psychiatrists are able to prescribe and monitor medicines, and can also offer psychological therapy.
Psychologists and other therapists
Psychologists and counsellors are professionals who specialise in counselling and interpersonal therapies. Some psychologists undertake extra training to become specialist clinical psychologists. Some psychologists hold PhDs and are thus called doctor, but they are not medical doctors, so they do not prescribe medicines. Psychologists work in both community health centres and in private practice.
Many other professionals such as social workers, mental health nurses and occupational therapists may hold counselling qualifications and often play an important role in treating mental illness.
Treatments for mental illness
Medication is usually indicated for people with serious, ongoing mental health problems. Although medication is not a cure for mental illness, it can allow many people to have a greatly improved quality of life. For some people, medication is a short-term solution, used to help them over an immediate crisis. Others may need ongoing, long-term treatment with medication to help them live with their illness.
Medicines for mental illness include:
- antipsychotics, which are used to treat illnesses such as schizophrenia;
- antidepressants, which are used to treat depression and some anxiety disorders;
- mood stabilizers, which can be taken to treat bipolar disorder (manic depression); and
- anti-anxiety medications, which can be used on a short-term basis for acute attacks of anxiety.
‘Talking’ treatments, or psychological therapies, try to help people understand the basis of their problem, and how they can overcome it. Psychotherapy is effective for a range of mental health problems, and can be combined with other forms of therapy, such as medication.
There are many different psychological treatments available, and some are more well-known and widely used than others. Some of the many available therapies include the following.
Cognitive-behavioural therapy (CBT)
This treatment is based on the idea that the way that we feel and behave depends on how we think about and interpret experiences. CBT can help you discover how thoughts, feelings and behaviour can get stuck in unhelpful patterns.
Identifying and challenging negative thinking patterns, and developing alternative ways of thinking and acting, can reduce stress and improve your coping abilities and self-esteem. A range of illnesses, including depression, anxiety disorders and schizophrenia, can be effectively treated with this type of therapy.
In counselling, you will talk about your difficulties on a one-to-one basis with a professional (a counsellor). The counsellor will listen and give you support, and may also offer you advice on how to deal with your problems in a practical way.
Supportive counselling is appropriate for treating milder forms of mental illness, such as grief reactions. Problem solving, where people learn better ways of dealing with seemingly intractable situations, is a very useful form of counselling. Activity scheduling, involving the time-tabling of exercise, pleasant and purposeful activities, is another commonly used technique.
This type of treatment has been found to effectively treat a range of mental illnesses, including mild to moderate depression, but it is not commonly used to treat more serious illnesses, such as schizophrenia.
It examines how you relate to other people, and how this affects the way you think, feel and act. You work with the therapist to develop more positive ways of interacting, and by strengthening communication skills and self-esteem, this form of therapy can help improve interpersonal relationships.
This is somewhat similar to counselling in that it involves one-to-one communication with a professional, but it is much more intensive. A psychoanalyst will encourage you to explore your feelings in depth, particularly in relation to how these feelings relate to experiences you have had early in your life. Psychoanalysis is very often a long-term treatment.
Sometimes people who share a common problem, for example, self-harm, substance abuse or social anxiety disorder (excessive shyness), may benefit from working together in small groups, to resolve their difficulties in a supportive environment under the guidance of a professional.
The most important question you should ask yourself if you decide to see a psychological therapist is whether you will be able to develop a good relationship with them. If you establish rapport with the therapist and have a positive attitude towards the treatment, the treatment will be more likely to benefit you. You should also ask about the therapist's training, experience and the treatment approach they prefer.
It is important to understand that counselling is not a passive experience. Apart from brief supportive therapy, the counsellor is not there simply to listen and make you feel better by empathising with you. At times your sessions may make you feel uncomfortable or even angry. With CBT in particular, you will be asked to do ‘homework’. To get maximal benefit from counselling you will need to commit to the process.
If your doctor recommends counselling or psychological therapy, you should always ask if there will be any costs involved and what these will be. Visits to psychologists and clinical psychologists may attract a Medicare rebate if you have been referred to them by a general practitioner (GP), psychiatrist or paediatrician. Your GP will need to complete a detailed Mental Health Care Plan before referring you to a psychologist.
Other treatments for mental illness
Electroconvulsive therapy (ECT) is also used in the treatment of certain mental illnesses. This treatment is usually reserved for people with very severe depression that is resistant to other treatments, especially where doctors believe someone may be at risk of suicide. It involves giving a person a general anaesthetic and muscle relaxant, and passing a dose of electric current through their brain. Although it is used less often than it was in the past, it can be highly effective for people who have not been helped by other treatments. ECT can only be given if the person consents to having the treatment.
Most treatment for people with a mental illness will be carried out in the community. Treatment in hospital is usually only required when a person is very ill and needs intensive treatment and/or supervision. In the majority of cases, treatment in hospital is only required for a few weeks.
Which treatment is right for me?
Because the range of options for treating mental health problems can appear confusing, you should always ask your doctor for guidance as a first step. The most important thing is that your doctor understands your symptoms so that he or she can advise on the treatment that is likely to be of most help.
Your treatment will often involve a range of approaches – lifestyle, counselling and perhaps medication, and may well involve more than one health care professional.
2. MayoClinic.com. Mental illness (updated 15 Sep 2012). http://www.mayoclinic.com/health/mental-illness/DS01104/DSECTION=treatments-and-drugs (accessed Nov 2012).