Now, I must stress before I write any further that these are my assumptions and observances from my own personal experiences. I have come to these conclusions through many years of being in the mental health care system. There are of course many different opinions and life experiences in the big world out there that may differ from my own, and I respect every one of them. I also might add that every practitioner is different and conducts themselves in their own manner as they see fit. So, please, use the information I have compiled here as merely a guide or stepping stone for you to use in your own personal journey into the confusing maze of health care providers.
I am going to discuss the mental health care practitioners listed below from the most prominent and influential to those who wield the least actual significance in your care.
1. Your Psychiatrist:
My experience with psychiatrists is they are at the top of the health care ladder when it comes to your emotional well-being. They make the difficult decisions concerning your medications, as well as, assess your state of mental health from appointment to appointment. Psychiatrists are also the ones who will diagnose your mental illness and grant you a diagnosis of your disorder. A diagnosis is intrinsic to your emotional health, without it you will not receive proper psychiatric and therapeutic care. Depending upon your emotional stability, you will be meeting them in their offices frequently. You may visit your psychiatrist weekly, bi-weekly or monthly. You may even receive visits from your psychiatrist when you are in hospital; however, this all depends on his personal policies pertaining to his patients.
Here are some things you should be aware of and look for in a psychiatrist:
Please don’t confuse these health care professionals with the ones often portrayed in movies and television. In my experience, and from what I have been told numerous times, they are not really there to listen to your phobias, issues, or neuroses. Many times I have been politely reminded that they are only there to prescribe medications, assess your present state of mental health while on the medications, and diagnose any disorders that may present themselves.
It is important to be aware of whether your psychiatrist admits to a local hospital’s psyche ward. If he does not admit to any hospital, it may be his policy not too; you may be looking at an emergency room admittance should you experience a time of mental health crisis. This admittance procedure can be quite stressful and may not guarantee you a hospital bed. Psychiatrists who admit their patients to a local hospital’s psyche ward usually make prior arrangements for their patients. Everything can run more smoothly with your psychiatrist’s involvement in your admittance to hospital.
Some psychiatrists will not visit their patients if they are in hospital. Some will. It all depends on his personal policies and practices. If he does not visit patients on the ward this could mean you will have to deal with the psychiatrist assigned to the hospital ward. For those who find it difficult to adjust to a new psychiatrist the change may make them ill at ease.
*It should not reflect badly on the psychiatrist who does not admit or visit his patients in hospital. These are policies that have been set in place for valid reasons. It is very important to know these policies and what practices your psychiatrist follows in order to be prepared in case of a mental health crisis. You should be aware of how you will be admitted to hospital and whom you will be dealing with on the psyche ward.
Does your psychiatrist express genuine concern for your health and welfare? Do you feel your psychiatrist is watching out for you both emotionally and physically? A psychiatrist should not only concern himself with your mental health but also have an interest in how your medications affect your body as well as your mind. He should regularly test your blood to monitor the levels of your medications in your system. Too much of that or too little of this may cause you to have difficulties with internal organs, perhaps a bad reaction to the drug, or worse. With lithium for example, levels must always be tested every six months to alleviate the risk of your body becoming toxic, as well as, to make sure your lithium level is not too low, thus ineffective. These blood tests must be done to protect the patient from possible kidney or liver damage. It is crucial that your psychiatrist keep track of your medication levels with regular blood tests. Make sure he tests for liver, kidney and thyroid functions.
Your psychiatrist will ask you varied questions about your emotional state of mind, whether you feel more intensely an emotion or not, appetite, libido, etc. He does this to assess your emotional state of mind in order to properly medicate you. If he feels you are stabilizing he may reduce your medication levels. If it seems you are not doing well he may raise your medication levels. It is so very important that you are open and completely honest in your interview with your psychiatrist. Answer the questions to the best of your ability. If you should mislead your psychiatrist he may prescribe improper medication levels and this will not help you stay stable or healthy.
*Your care not only depends on your psychiatrist, but on yourself as well. You must also want to work towards a healthy mental state, together with your doctors.
It is important that you feel comfortable and well taken care of by your mental health care providers. You should feel that your concerns are being looked into so you can work on the every day trials of being bi-polar.
Your psychiatrist is the most powerful participant in your mental health care. And, rightly so, they are the regulators of medications, diagnoses and mental health resources.
It is important to understand that most decisions about your mental health come from the treatments your psychiatrist prescribes for you. All other caregivers involved in your mental health care will follow the guidelines your psychiatrist sets for your care.
* This section only pertains to you if you are in hospital.
2. Hospital Nurse:
Your hospital psyche nurse is second in the chain of command when it comes to your mental health care only when you are in hospital. The psyche nurse is one of your principal caregivers until you are discharged from the ward. When you arrive you are immediately allotted to a specific nurse to oversee and plan for your care for the time you will be on the ward. Other psyche nurses will attend to you; however, they receive their instructions and the plan of your care from your assigned nurse. Your nurse will handle such things as: medications (recommendations on their levels to psychiatrist), daily assessment of your condition and progress while in their care, meetings with psychiatrist, arrangements for group therapy and activities, meetings with family members (both with the patient and without) and patient discharge. Your nurse will be the main go between for you and your psychiatrist. It is very important for you to establish a positive working relationship with your assigned psyche nurse.
These nurses are specially trained to work with mentally ill patients; they are not regular nurses, and they are quite specialized to deal with all psychiatric conditions. Most psyche nurses have seen their patients in varying degrees of emotional distress; for the most part they have seen it all. It is good to know this because you can use their experience to help you deal with your illness. Often they have good advice from tending to many other patients with similar conditions to your own.
It is good to remember there is nothing new under the sun for these nurses, because you too will have your ugly moments. You can feel reassured that they won’t hold anything against you personally if you are not always sunshine and tulips. They know it is usually your illness talking in those moments of nastiness, and they probably know how best to deal with you at that particular moment. At a time when your self-image is at an all time low it is soothing to know you are not extensively judged for your misappropriate behavior. It is, mind you, recorded in your medical chart. As a matter of fact most of your activities, emotional turmoil’s, and behavior during the day, are recorded as a daily record of your mental health. It is part of your nurse’s job to chart your progress from one day to the next. All this may make you a tad paranoid, try not to let it get to you, it’s just part of their job.
You must remember you are going to be with these nurses 24 hours a day, you may dislike them or feel negative feelings towards them, this is normal. If you do feel resentment or ill will towards your nurse talk about it with them or your psychiatrist. Let it out. You don’t have to love them in order for them to take care of you. There will be hospital staff that you just don’t care for, but then you are not guaranteed to like everyone in this world.
These nurses also have their limits and there are times when even their professional façade will crack, but for the most part they try to be neutral to their patients. Remember they are human too. They are not there to work through your life story or all your complicated issues that may have put you in hospital in the first place. They will listen to you and talk with you, but their main goal is to maintain a stable medication level and prepare you to deal with your problems in the outside world when you are discharged. They focus on whether or not you are still in a state of instability and a danger to yourself, or others. They will also decide if they feel you are emotionally ready to go home.
The psyche nurse usually is the one that has to deal with the hostility of their patients and on occasion they are forced to call in help to put an end to a physical engagement. This is obviously not their favorite part of the job. They also aim to deter patients from attempting to harm themselves while on the ward. Most nurses see these behaviors as unpleasant and not appropriate. If they should encounter such incidents they may transfer you to a more appropriate facility if the behavior is extreme. They do not handle physically dangerous patients (to others or oneself) in the average psyche ward.
Sadly, many nurses are forced to deal with their patients on a somewhat shallow basis. They may seem quite glib or unsympathetic at times in their daily dealings with you, but they must tend to many patients in the space of time it would take to properly listen to half the patients they would like too. They don’t have the time they may want to properly tend to all your needs and many times I’m sure they wish that wasn’t so. They are there to help you get better in any way they can.
3. Therapist, Counselor, Psychologist:
In describing this section I will use the word therapist for the most part to explain this link in the chain of your mental health care. Your therapist is the one you can tell your life story too. They are the ones who delve deeply into your snake pit of phobias and traumas that have birthed the issues that may haunt you today. The way a therapist works is that you usually see them on a regular basis (the frequency usually depends on your mental stability). They usually see you in their office (my therapist always tried to make her office conducive to a comfy calming atmosphere). They will try to hash out ways for you to deal with your past issues and present troubles. Sometimes they will do a series of psychological tests on you to assess your mental state. They may give you homework like: different questionnaires to fill out, charting your mood swings, writing your feelings down on paper, reading assigned books, developing new thought processes (positive thoughts or mantras in your head) and sending you to support groups. Your therapist is your guide to the local mental health resources in your area. If there is a group or program for you, they will know about it.
They are more like the psychiatrist you always see portrayed in theatre or movies. These are the people who have the comfy chairs. They can’t, however, prescribe medications or treatments, and can only recommend hospitalization when it is needed. They must follow the medication levels and mental health care plan of your psychiatrist. Sometimes they have a partnership like relationship with your psychiatrist; other times they are a “free agent”. They do not have the power to make you do anything you don’t want to do pertaining to your mental health care. A psychiatrist, on the other hand, can commit you to a hospital, or prolong your stay, without your consent if they have the medical proof you may be a danger to society or yourself.
These are the people you will come to realize know you the best out of all your mental health care providers. This is because they are the only members of your care that actually know you as a person and all your complexities. You will probably develop the closest and most likely the most intimate relationship with your therapist. Your therapist is usually the person you call in a state of crisis for emotional aid and to talk you down. My therapist just passed away a little over a year ago. She was one of my closest confidants and I felt truly understood around her. She created an atmosphere of safety and trust in her tiny little office, it felt like an oasis of tranquility in a desert of troubles. I knew I could reveal anything about myself and be given amnesty from all the dark twists and turns in my soul. She let me know it wasn’t just her job that got her up every morning, but her love of her clients. I miss Clara. I haven’t found a new therapist, as of yet; I can’t seem to find someone I can trust like Clara.
It is important to find a therapist with whom you can establish a good one on one relationship. You should be able to feel that they are someone you can trust and rely on to help you through the many twists and turns of your emotional therapy. They should be able to know when to give advice or when to just listen, in other words, be able to read your situation with the know how to properly respond with the appropriate reactions. Now, all of this of course, takes time to establish. You will not have an instant connection with any therapist you do not have an established history with. It takes time and a lot of work on both parts to reach a point where you know each other with the intimate bonds of a client/therapist relationship.
4. General Practitioner:
Your general practitioner, or family doctor, can play a varied role in your mental health care. I know of several people who are treated for their mental illness purely by their family doctor and are never referred to a psychiatrist. Then, there are some, like me who need a more extensive treatment than a general practitioner can provide. You see, a general practitioner is exactly what the name states, a health care provider who has a general knowledge of most human ailments. They do not necessarily specialize in anything in particular meaning they may not have the medical know how to properly deal with a more in-depth mental illness. These practitioners are important, however, because they are the ones who refer patients on to specialists, like psychiatrists.
It is vital to keep regular check ups with your family doctor to make sure he is up-to-date with your physical health; because it is crucial you stay in good shape. We tend to let our physical health go to pot when we suffer from emotional difficulties and this does not do any favors for our self-esteem or over-all general health. A healthy body can do wonders for a broken spirit.
5. Proctor or Home Care Nurse:
A proctor or home care nurse is someone who has been assigned to you if you need extra care outside of the hospital in your own home. They typically will drop in to your home two or three times a week and monitor your emotional well being. They assist with things like tracking your medications and making sure you are taking them. My proctor was a lady who came to visit me in my home twice a week. Most of the time she would allow me to vent my pent up emotions, she acted like a friend I could talk to when I wasn’t visiting my therapist. I have difficultly with public places and people in general. My proctor would take me out for coffee, or errands I had to run, to get me out of the house once in a while. She would report back to my therapist on my progress during the week.
Some people my proctor attended too were severely mentally ill and she would do odd chores for them like dishes or teach them how to cook for themselves. She would bring them to their appointments with the varied mental health care providers they needed to see and help them deal with social aspects of their life. I only saw her six hours a week, but I know there were other clients who needed her more often and for longer stints of time. Her obligations concerning her clients depended mainly on their state of emotional health and their physical needs at the time.
6. Self-Help Groups or Therapy Groups:
These groups are great if you are in need of social interaction and commiseration with others. Usually these groups meet once a week and last for two or three hours a night. They are led by one form of health care professional or another; some are run by psychologists, some by therapists or counselors. There are some I have heard of that are run by a “mental illness mentor”, someone who suffers from a mental illness who has been through many years of therapy and self-discovery. These people have set up their own groups in an attempt to help others by using their own experiences and knowledge of the disease in question. These groups are fine, but they lack professional input. It is always a good idea for the most part to base your mental health care on professionals.
Group therapy can be highly significant to your mental health because you can go to a safe place, vent your emotional dilemmas, and receive advice from people who suffer from the same illness you do. You won’t feel like a fish out of water and may learn things about your illness you didn’t know before. Usually the members of the group are asked to keep what ever is shared in group to themselves for the sake of privacy. Some things shared in group can be very personal and should not find its way out of the session. The atmosphere of the group is typically kept at a fairly supportive and positive level; you should feel at home with the people who attend with you. The leader or facilitator of the group will try to guide the group towards the culmination of issues brought up in the sessions and steer you gently towards positive and constructive ways to bring closure to problems you may face.
A group setting can be very therapeutic if you are experiencing a personal crisis or dilemma. There will be some people involved in the group who will probably have experienced a similar problem at some point in their lives and will be able to support you in your time of need. It can be a powerful and poignant form of therapy if you are willing to open your life up to a room full of people.
This should not be your only form of therapy. It is usually used in combination with regular sessions with your psychiatrist and those of your therapist as well. Sessions with your psychiatrist and therapist should rank higher in the mental health care ladder due to the fact that they are a more formal controlled treatment for your illness. You will not receive a diagnosis from group therapy nor will you be prescribed medications from attending these sessions. These groups cannot really help you stabilize your mental health if you are experiencing a manic high or a depressive low. They can help you see the signs of one of these crises coming and bring your attention to the warning signs, but that is all.
7. Crisis Phone Lines and Crisis Teams:
Crisis phone lines are put in place for one purpose, to give a person experiencing emotional meltdown or crisis a way to call for help. It is like the 911 of the mental health world. You can call these lines and speak to a person who is typically trained to deal with psychological breakdowns. They will listen to your dilemma and either talk you down or endeavor to put you in touch with people who can intervene to help get you through your crisis.
In my town the crisis phone line is directly linked to the local crisis team. These are people who actually come out to your home and depending on the situation, will take you to a place of “safety”, until you are stable enough to go home. These crisis teams are made up of trained health care professionals, some may be nurses, others may be counselors, psyche aids, etc. They can be the thin thread of hope that might keep a person alive long enough for someone to get to them and to take them into some form of protective custody. It is a very good idea to enquire as to whether your community has a crisis phone line or crisis team. Have their number displayed on your fridge or bulletin board just in case you may need them.
Crisis phone lines and crisis teams are incredibly vital to the mental health care system. They are able to step in immediately when the situation calls for emergency intervention. And, for some people that is everything. They are not, however, put in place for long-term care and treatment of your illness. They rank so low on the health care ladder because they are good for you to know they are there, but they do not impact your long- term care to any large degree. You may even completely circumvent their step on mental health care ladder. They are there purely for emergencies. These are the people you contact when you have run out of options.
You may think putting your pharmacist on the list of mental health care providers is a bit strange, but it really isn’t. Your pharmacist can actually give you a lot of information about your illness. They can gauge how well you are doing just by your medication levels. They play a long-term roll in your care if you return to the same pharmacist each time you fill a prescription. My pharmacist will often update me with new information about my medications or suggest generic brands that may save some money. They also can best tell you what medications you shouldn’t combine, how you should take your medications and what they will do to you. They basically know everything you could possibly want to know about your medications and how they will affect you. That is good to know.
They also have on permanent record personal information like allergies and other conditions you may suffer from. If there is a medication that could pose a threat to my physical health, my pharmacist will catch these potential health risks early and bring it to my attention. Apparently there is a well-known acne medication that if taken can magnify a depressive low and should not be taken by people suffering from mental illness. I learnt this information from my pharmacist.
8. Informational Books and Reading Matter:
It is an excellent idea to keep abreast of new information on your illness. It is also informative to read books written about Manic/Depression by health care professionals or other sufferers of the disease. You can glean a lot of helpful information about Manic/Depression from these materials. Often you can find out about new medications or research your own treatments, how they affect people and whether or not they are successful through these books. They are also a good way to learn how other people have dealt with their illness and how it affects them. You can receive a lot of comfort when you find a person who suffers similar difficulties that you do.