Psychological problems are universally experienced. Some of these can progress into diagnosable Mental illnesses. From one perspective these represent two ends of the same spectrum. Psychological problems & Mental illnesses can take various forms ranging from understandable reactions to day-to-day life to neurotic problems like Depression, Anxiety, various Lifestyle & Addictive disorders & rarely, more serious conditions like psychosis and Schizophrenia. It is estimated that one in 4 people will develop some form of a mental health problem in his/her life. In fact, the contribution of mental illnesses to population disability & the Global Burden of Disease is comparable to physical illnesses like Cancer and Cardiovascular illnesses. These facts notwithstanding, the public perception and priority accorded to mental health in India is disproportionately low. Perhaps lack of awareness and stigma (amongst other social, cultural and political factors) are partly responsible for this state of affairs.The following article is intended to help raise awareness of mental health problems as a small step to address these issues. In particular, the following sections will attempt to outline when and where to seek help, and what to expect from a consultation with a Psychiatrist.
When should I consult a mental health professional?
All of us have good and bad days. It can sometimes be difficult to decide when to seek professional help- this can be particularly challenging with emotional or behavioural experiences as they are often an extension of normal life experiences. However, as a rough guide, if one or more of the following symptoms persist for longer than usual, are pervasive across most domains of life and begin to affect your interpersonal, social, work or family relationships, it is probably time to get help from an expert.
Amongst adults the symptoms may include one or more of the following (though this is not an exhaustive list):
- Persistently high or low or irritable or angry moods
- Suicidal or aggressive thoughts or acts
- Confusion and lack of clarity in thinking
- Excessive worries, fears, anxiety symptoms
- Persistent ruminations/ preoccupations
- Loss of control over thoughts, moods or behaviours
- Social withdrawal, isolativeness
- Lack of interest or pleasure in usually enjoyable activities
- Self-neglect
- Problems with anger control
- Being hypersensitive or suspiciousness
- Odd beliefs and experiences (including hearing voices when no one is around)
- Excessive use of alcohol or smoking or use of the internet or mobile apps- with loss of control over these behaviours.
Who is a mental health professional?
A number of different professionals can help with mental health difficulties.
- A Psychiatrist is a medically trained doctor (MBBS) who has undertaken specialist training in psychiatry (MD or DNB or MRC Psych, etc). S/He is trained to conduct a comprehensive diagnostic assessment of your symptoms and to develop a holistic treatment plan along biological (eg., medications), psychological (eg., counselling, therapies) and social (managing the environment around) lines. She/ He may be a good starting point to access help for any mental health difficulties. A psychiatrist’s expertise lies in the pharmacological management of mental illnesses, but s/he may also be trained to undertake specific therapies like CBT, Dynamic therapy, Family/ couple therapy, etc.
- A Psychologist usually comes from a humanities background and holds a masters and/or a doctoral qualification in Psychology. Clinical and Counselling psychologists are trained to evaluate and help patients with a range of psychological and behavioural problems. They do this by conducting psychometric tests (to facilitate diagnoses), and by undertaking counselling and psychological therapies.
- There are several other mental health professionals too. These include Psychiatric nurses, Psychiatric social workers, Occupational therapists, Support workers and Pharmacists- all of who together constitute a Multidisciplinary team. Although Western experience highlights the importance of a team-based approach to patient care, this model has not been integrated within the Indian healthcare system yet (except perhaps in some group practice settings). Most mental health professionals however, tend to work independently and will cross-refer to other specialists when the need arises.
What mental health services are available to me?
Finding the right service can be a confusing experience, if not a daunting. One can choose from a range of mental health service providers- ranging from Government run mental hospitals to privately run psychiatric or psychological clinics. Recent times have seen the emergence of group practices that provide access to both psychiatrists, psychologists and other professionals under the same roof. These have the advantage of being able to offer a holistic assessment and a multidisciplinary care plan, which may be less available in individual practices.
What can I expect when I see a Psychiatrist?
- Initial psychiatric appointments can range from 45-60 minutes (sometimes even longer if the problems are complex).
- The psychiatrist will interview you (as the index client) and may also want to speak to a close friend or relative for corroboratory information to complete the assessment.
- Your doctor will ask about main concerns to understand how these affect your life. S/He will also ask for any associated symptoms, explore your past, and understand how this could be impacting upon your present. Relevant personal, medical and family details will be explored. The doctor will conduct a detailed mental state examination.
- All these will give a clearer picture of the problems, associated risks and how they have evolved with time.
- Your doctor may also request a psychological evaluation to help with the assessment.
- After assessment, s/he will communicate her/his view about the nature of your difficulties. The doctor will also discuss why you could be suffering from problems at this juncture in your life and what could be making these persist or get worse. At the same time, the consultation will also shed light on your own strengths, resilience and coping skills in dealing with difficulties.
- This will lead on to a management plan addressing each of the elements that is contributing to your problems. This may include medications, counselling & therapies and practical suggestions & advice.
- You should ask about the treatment options and any concerns that you may have.
Remember, mental illnesses like physical illnesses, are common and treatable. The earlier they are recognised and treated, the sooner you get better and get back to living your life.
