Help Getting Help (for mental health)

On a regular basis, I have friends approach me in private and say something like “I don’t know what to do. My mental health is not good and I don’t know where to go or who to call.”

A few months ago when the world lost one of the greatest comedians of all time to suicide, my social media feeds lit up with admonitions to “get help” and “take mental health seriously” or to “call a suicide prevention hotline.” I agree with all of those and I also know that there is so much secrecy and shame around mental health struggles and treatment that many people don’t know how to get help. I think it is because of a rampant lie that tending to emotional and mental wellbeing is shameful or suggests a moral or spiritual failure. But that is what it is, a lie. The truth is, it takes extraordinary hope, faith, courage, strength, and patience to get help for mental health issues (click to tweet). Neglecting or denying problems does not work for an ear infection, and it doesn’t work for mental health problems.

I can relate to that moment when the only thing you can think to do is type “HELP” into Google. Do I call my doctor? A psychologist? A therapist? A psychiatrist? The national suicide prevention hotline? My mom? What’s this going to cost me? Will they treat me like a crazy person? Will it be as awkward as it is on TV?

A good first step is to take a deep breath.lifesaver

Then ask yourself what kind of help you want to pursue? There are three basic options: medication, talking to someone (therapy/counseling), or both. I will tell you a little about some options, in order from the most medical to the most relational.

Call 911 if you are unable to wait for help. Please.

Call your physician if you just want to try medication for something like anxiety or depression. You will likely get be able to get in and out fast. Keep in mind that the doctor is likely not going to take a lot of time to unearth the source of your problems or get to know all the contributing factors of your personality, experience and relationships. Not because they are bad, it’s just not a major part of their training. It’s like asking your dentist to look at your sore throat. This will cost what your doctor’s visits always costs which you probably already know because there isn’t a stigma attached to seeing a physician.

Call a psychiatrist if you want to try medication but you know your situation is a little more complicated that the average due to allergies, rare diagnosis, side effects to common medications, meds with high potential for abuse, etc. The drawback is it will probably take longer to get into see a psychiatrist, but they have at least a million years of school know a lot about mental health medications. You can expect short appointments (maybe 15 min) to check side effects and adjust dosages if needed. Keep in mind; psychiatrists are highly trained in psychopharmacology, not in creating a healing therapeutic connection. Beware that this avenue may require more patience and money. You can plan on waiting a month or two to get into a psychiatrist and an initial visit is going to cost around $350 without insurance. Insurance should cover it similar to a regular doctor visit.

Call a psychologist if you want a correct diagnosis, a thorough assessment and to talk about your symptoms and your life. Psychologists are typically more focused on the individual’s brain, behavior, and diagnosis and not relationships, strengths, and social influences. Psychologists cannot prescribe medications (nor can any others on this list from here down). Without insurance, this will probably cost around $200 per hour. With insurance, it will cost the same co-pay as your regular office visits.

Call a Licensed Therapist: such as: LPCC (Licensed Professional Clinical Counselor), LMHC (Licensed Mental Health Counselor), LADC (Licensed Alcohol and Drug Counselor), or LICSW (Licensed Independent Clinical Social worker) if you are interested in at least a master’s level professional counselor. As opposed to psychologists, master’s level therapists’ education was more focused on the actual practice of counseling and not research or assessment. They tend toward a strengths based philosophy and might see diagnoses as a necessary evil for insurance purposes. This is the person to go to if you need fresh perspectives, new coping strategies, chances to share your hurts and dreams, and pursue your version of a life worth living. Without insurance, many sliding fee scales go down to around $30 per hour and full price is usual between $100 and $175/per hour depending on specialty, experience, and education of the therapist. With insurance, you pay your regular co-pay or co-insurance.

I could lump Marriage and Family Therapists in with the previous group, but since this is my biased blog, I will give them their own category. Licensed Marriage and Family Therapists (LMFT) are trained in family systems. Simply put, people affect and are affected by others. MFT’s observe rules, roles, and patterns in relationships and help people make changes not just to the individual, but to the system. Yes, MFT’s see people individually, but they will likely view you in the context of your relationships. While an individual psychologist might diagnose depression, and look at the brain chemicals, an LMFT might focus more on the dynamics in the family origin, current relationships, and larger systems in play like the dynamics of power, gender or race. This is the best option if you want to bring family members, roommates or significant others into the therapy room because so much of their training is geared toward helping people heal their relationships.

After you decide what treatment approach(es) you want to pursue, call the number on the back of your insurance card and ask who is covered in your network.

If you can’t afford these options and your health insurance isn’t helpful, find a provider ask them about a sliding fee scale or pro-bono options. There might be a graduate intern or pre-licensed professional who is willing to work for free or a reduced rate to get the experience. Most therapists I know won’t turn you away for lack of funds. They will be willing to help you figure something out. In Minnesota if you have medical assistance insurance, your visits are usually 100% covered with an in-network provider.

There is a really good therapist finder on PsychologyToday.com where you can search by provider type, specialty, insurance network, zip code etc.

The American Association of Marriage and Family Therapy has a therapist locator as well. This is a great tool if you want to be sure to find an LMFT.

There are so many people who spent years learning and preparing to help you. I know that they would love nothing more than a chance to meet you and hear your story.

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