January 2017 – Jason Hobbs LCSW, M.Div

The ABCs of Mental Health Treatment

[Note: This is the last in a three-part series of articles written several years ago for a local publication. The purpose was to do some education about mental health, especially for a church audience. I thought it might be good to revisit.]

LMFT. LPC. LCSW. PsyD. MD. M.Div. Ph.D. CAC. RN. CSB. Medicaid. Medicare. MHP. When you dive into the bowl of alphabet soup that is our mental health system, it is confusing mix of letters, providers, payment types, and places to go for services.

How do I access the mental health system?

The first item to know is how to access the system in situations of dire need. In other words if you or a loved one are unable to leave the house because of debilitating depression or anxiety or if you or a loved one is suicidal or homicidal, then you need to call emergency services at 911.

If the need is not an emergency, but is urgent, then it is a good idea to call your regular doctor or pediatrician and discuss the symptoms you are noticing and ask for a referral. Many times the doctor may ask for a blood test to evaluate for other conditions that may look like depression or anxiety. Thyroid problems or diabetes are common conditions that have symptoms that may look like mental health concerns.

Another important consideration in our health care system is how you are going to pay for services. If you are insured, it is best to look at your insurance card for words such as “behavioral health” or “mental health” or “substance abuse” and to call the number on the card to discuss a referral. Many insurances have separate plans for mental health coverage; it is important to understand these rules so that you do not go to a provider that is not “in-network” and then face a large bill.

If you are not insured, or are insured by Medicaid, another avenue for mental health services is your local community service board. These are the state-funded mental health providers such as Oconee Center, Phoenix Center or River Edge Behavioral Health Center. They typically have a variety of services ranging from all-day services for adults, treatment for addiction, counselors and psychiatrists.

Lastly, there is inpatient treatment. While there was a time when inpatient treatment last for weeks and perhaps months, being hospitalized in a psychiatric unit typically lasts for three days to one week. Treatment in this setting is to manage a temporary crisis until a patient can be stabilized and released to outpatient treatment.

What happens at a psychiatric hospital?

Inpatient units are typically in a large hospital or in a separate psychiatric facility. Inpatient treatment is NOT what many of us saw in the film One Flew Over the Cuckoo’s Nest. Typically, there are counselors, nurses, and psychiatrists on staff there who will monitor whether medications are working. There are also groups and classes that patients attend to work on the life circumstances that may have created or may be maintaining some of the problems in their life.

There are also in-between sorts of options for people who need the intensity of everyday treatment, but are not needing to stay in a locked unit. These programs are usually called “intensive outpatient” or “partial hospitalization” programs. These can be wonderful options!

But who are the people who provide these services?

The type of provider you need to see is largely based on what type of need you have. Just as doctors are regulated by a medical board, there are also boards that license and regulate counseling. These boards ensure that providers who hold that license have fulfilled the requirements, both in terms of education and experience, which enable them to competently provide mental health counseling and psychology.

If you are looking for psychological testing, then a psychologist is who you need to call. These tests (which are both paper/pencil and computer-based) can test for everything from mental illnesses, learning disabilities, intelligence, and can also be helpful in assessing career paths and in helping groups of people learn more about each other to help them work better together.

Some psychologists also provide therapy to help with behavioral health issues. These are generally folks with a Psy.D., but may also be people who have a Ph.D.

Other providers typically have a Master’s degree in professional counseling, marriage and family therapy, or social work. Master’s level providers are the bulk of people providing therapy to address behavioral health. The type of license is either a LPC, LMFT or LCSW. Sometimes you will see someone with a LAPC, LAMFT, or LMSW; this means that this person does not yet have their full license, but is working towards the ability to practice independently.

What happens in therapy?

Typical sessions with a therapist or counselor are 50 minutes and cover some of the patterns of behavior, family structures, and ways of thinking that may exacerbate the problem or have led to the problem. The MOST important item in finding this type of provider is that you feel you have a good “fit” with this person. Research has shown that beyond the style/type of counselor, whether you have a good fit with them is one of the strongest predictors that you will get better.

Meds?

Master’s level providers and psychologists do NOT prescribe medications. Psychiatrists are the providers who do treat mental illness with medication and other interventions that require a license to practice medicine.

Another group of providers are certified addiction counselors. These are people that have been through training and supervision in order to specialize in providing services for people struggling with addictions. While this is not regulated by the state of Georgia, there is a state organization that certifies them.

In finding a provider, insurance is definitely a factor, but you should also ask your clergy, your friends, and your family about their experiences with a provider. The “fit” is important, so make sure that you trust and are comfortable with the person.

Mental Illness in the Church

[Note: This is the second in a three-part series of articles written several years ago for a local publication. The purpose was to do some education about mental health, especially for a church audience. I thought it might be good to revisit.]

We bring food. We knit prayer shawls. We call or text or email or even Facebook and tell people that we are thinking about them and praying for them.

These are some ways in which our churches respond to people in need. We signal to the people around us that we care, that we are available, that we hurt with them, and that we want to help if we can.

This is how we respond to deaths in families. It is how we respond to heart attacks, surgeries, and all manner of scary physical illnesses. The tough part is this: for many people, their faith community seems absent when the illness in question is not “physical.”

We understand heart disease. We know lots of people that have had to have their gall bladder removed. And even though many of us are aware that there are people in our churches who suffer from depression, addiction, schizophrenia, bipolar disorder, and anxiety, we do not tend to respond in the same way.

We don’t bring food. We don’t knit prayer shawls.

Sometimes we don’t respond at all.

But we are called as people of faith to do more.

An important aspect of Jesus’s ministry was one of healing and of bringing people back into relationship with God and the people of God. Jesus did this not with a spirit of fear, but a spirit of compassion for those who were hurting and vulnerable.

So when Jesus saw a leper, he reached out to touch them. When Jesus saw someone who could not walk, Jesus healed them. When Jesus saw the children, some of the most vulnerable members of that society, Jesus said, “Let them come to me.” There was not fear in Christ’s response, only compassion.

But sometimes, especially with mental illnesses, there is fear. Most of that fear is our lack of understanding. Most of us have some understanding of illnesses such as depression or anxiety because we may have felt this way at some point. It is more difficult to be unafraid when someone tells us that they or their loved one has schizophrenia or autism.

And then we hear Jesus’s voice saying to us, “Peace. Be still.” And even though we may not understand, we are called to react with compassion and caring. And even though there is a part of us that wonders why such an illness would happen, we are called to be open to where God is working in our life and in the life of this person and family who is hurting.

We should not blame the person or the family.

Jesus tells his disciples as much in John 9 when the disciples ask, “Who sinned?” when confronted with a man who was blind from birth. And Jesus responds, “Neither this man nor his parents.” And then Jesus reorients us to acting with compassion, not judgment.

We should be compassionate to the whole family because like any other illness, a mental illness affects them too. We can bring food (because they may be going back and forth to the hospital and have a tough time attending to household chores). We can bring prayer shawls or flowers to let that person and their family know that we care. We can pray for them, for peace, for comfort, and for healing.

And in our churches, we should be compassionate to folks with mental illnesses just as we would with any other illness.

What does become more difficult is that some illnesses, especially addictions, become very difficult for families to weather. And I would argue that at times, family members must set strong boundaries with other family members about their need to be in treatment in order to protect themselves and their families.

Remember, mental illnesses express themselves in thoughts and behavior. The ill person themselves may not be thinking clearly and may behave in ways that are uncharacteristic for them. Many older adults with diseases like dementia have personality changes.

This does become an area where as supportive friends and church family, we must be careful with our own limits and boundaries. For example, it is fine to express our care and love and God’s care and love for the person who is ill and for the struggle of their family. But we need to be discerning about how or even if we need to intervene in some way.

Just because we believe that we may know the right action to take in a situation, does not mean that we do. There are times when those of us on the outside may even disagree with a family’s decision, but disagreeing does not mean not showing care and concern.

Oftentimes without being inside of that family, we will not know the day-to-day struggles. We will not know what has been tried and what would not suit this particular family. But we can show God’s love for people who are hurting.

And finally, as leaders within the community of faith, whether clergy or lay leaders, we should have an idea of the local resources available to people with mental illnesses and addictive diseases and their families. These referrals will ideally be people who are trusted and will provide good care to the people in our congregations.

Am I crazy or what?!?

[Note: This is the first in three-part series of articles written several years ago for a local publication. The purpose was to do some education about mental health, especially for a church audience. I thought it might be good to revisit.]

CRAZY! Lunatic. Maniac. Nuts.

These words are easy for most of us to say. We use them all the time to describe something that doesn’t “make sense”. Or someone who is doing something that we don’t understand or with which we disagree.

What gets tougher is when we use the words “mental illness.” And trying to tease out what we mean by those words, especially as people of faith, is a harder task.

Depression and Anxiety are not moral problems.

Maybe it is tough for us as Christians, because for a long time we have looked at illnesses such as depression or anxiety as moral problems. We don’t look at the biochemical reasons why someone might be “down” or “worried.” Sometimes we think or even say, “Well, they just don’t have enough faith.”

The tough part of that response is that is misses Jesus’s compassion for ALL people who are hurting and vulnerable. And someone who cannot leave their home because of crippling panic attacks or someone who thinks about their own death nearly every hour of every day is hurting and vulnerable.

There are certainly times when we need to be reminded of God’s hope for all of us and times when we should remember that we have been asked by Jesus to “be anxious for nothing.” Those times may reflect a struggle in our life, but that is different from a mental illness.

What is a mental illness?

Mental illnesses go by names like Panic Disorder, Schizophrenia, Major Depressive Disorder, and Bipolar Disorder. And the line that gets crossed from “struggle” to illness is a line where the illness is causing serious problems in your life.

For example, someone who overeats may be having a struggle and may be experiencing some negative effects that come with being overweight, but that is very different from another person who begins to have diabetes or cardiovascular effects from the excess weight. At some point, what may have started as a “condition” is now out of control and dramatically affecting that person’s life.

Many people experience a panic attack at some point in their life. Panic attacks usually involve your heart racing, shallow breathing, feeling VERY scared, muscle tightness, shakiness, narrowing of vision, and quite often happen in a situation where you may be safe, but your body and your brain are giving off major danger signals. Many people experience this!

But then what fewer people experience is when they begin to fear having the panic attack again. This leads people to avoid situations where the attacks have occurred. Then you begin to avoid activities that might lead to an attack. And then you are afraid to even leave the house because home seems the only place that is safe. That is Panic Disorder.

Illnesses needs treatment.

And when a condition rises to the level of an illness, most of us seek treatment by someone who specializes in that illness. If you begin to have frequent urination, dry mouth, have extreme hunger, fatigue, irritability, frequent infections, blurred vision, and other symptoms, you would talk with your doctor about the possibility of diabetes.

It is not much different if for over two weeks you have difficulty making decisions, feel fatigued, guilty, hopeless. If you have a change in your sleeping, either sleeping way too much or insomnia. If you felt your appetite change and began to lose interest in activities that used to be fun. And if you began having thoughts about your death or even suicide, then you would want to talk with someone who could help with your Depression.

And even though sometimes we may feel “crazy” when we our emotions and thinking are like these examples, we are not. We have an illness. And God’s response to people who are hurting and vulnerable is compassion. And sometimes we need to have compassion on ourselves too and make effort to get the treatment that we need.

That doesn’t make you crazy. It makes you smart.