Treatments for mental health issues

We all have the right to the best possible clinical care to treat mental illness and its symptoms

Clinical care means the medical treatment provided by a doctor or other professional at a GP’s surgery, community mental health service, hospital or other health facility.

Knowing what services are available, and understanding the roles of the different mental health professionals, helps to make sure you get the best possible service from the health system. The earlier you receive treatment, the easier it is for health professionals to help you to manage symptoms.

These days, clinical care and treatment does not just mean the help you get from a psychiatrist or a medical doctor. This care can involve a whole range of other mental health professionals at a community mental health service such as psychiatric nurses, social workers, occupational therapists and psychologists. Any one of these may be assigned as a case manager to coordinate treatment.

Diagnosis

When you or someone you know starts to feel mentally unwell, the first step in obtaining treatment is to see a doctor or other health professional for a diagnosis, just as with any other medical condition. This will usually be at a GP’s surgery or a community mental health service.

What’s involved in being diagnosed?

A diagnosis simply means the identification of an illness. After a thorough assessment, a doctor will make a diagnosis based on a particular pattern of symptoms. This then helps with the decision on the best treatment for these symptoms and their underlying causes.

Just because someone has a particular diagnosis doesn’t mean they will have all of the symptoms associated with it, of course. It doesn’t mean they will have these symptoms all of the time. And it doesn’t necessarily mean that they will always have this diagnosis.

A diagnosis describes an illness, not the person

Remember, a diagnosis describes an illness it doesn’t describe a person.

Rather than focusing on the diagnosis, it is more useful to identify what the symptoms are, and then what can be done to deal with them – so that you are able to get on with life again.

It is not unusual for a diagnosis to alter. This may be because symptoms have changed, or other information has become known.

It’s important that the diagnosis doesn’t become a label. The focus should be that symptoms are clearly understood by the doctor, so that the most helpful treatment can be selected.

Can someone see a GP on behalf of me?

Sometimes symptoms can be so confusing that it’s difficult to recognise you are ill. If family or friends think this may be the case, they can visit a GP themselves to discuss what can be done to help.

In some circumstances a team from a community mental health service can visit you at home (or other place where you feel comfortable) to make an assessment.

Public health care systems

The public health system includes treatment in public hospitals and community mental health services.

Advantages of using the public health system are that there is no direct charge, and that – at its best – it will provide access to a range of support services in the community such as rehabilitation and supported accommodation.

Public mental health services are also more evenly distributed across the country, although there are still not enough, particularly in rural areas.

Private health care systems

It is possible to visit a psychiatrist working in private practice rather than in the public system. A GP can provide a referral to a psychiatrist as they would to any other specialist. If the psychiatrist doesn’t bulk-bill this would involve paying a fee and then claiming reimbursement from Medicare.

It is also possible to be an in-patient at a private clinic or hospital. This would be expensive, however, unless you are covered by private health insurance.

The role of the general practitioner

A general practitioner (GP) is usually the best person to see when you start to feel unwell.

As well as making an assessment and being able to refer to a psychiatrist, GPs also provide ongoing care to many people who have a mental illness. Training and support are now available to help them in this role.

Some areas operate a shared care system where a GP provides the medical treatment and a case manager provides the ongoing support and coordination of care.

It is important to look after your physical health too, and regular visits to a GP can play an important role in maintaining good general health.

The role of the psychiatrist

Psychiatrists are medically qualified doctors who specialise in the study and treatment of mental illness. Most people diagnosed with a mental illness will have contact with a psychiatrist at some stage, though people more seriously affected will have regular contact.

Other doctors also work at community mental health services and are often responsible for treatment too. It is important to feel comfortable with this treating doctor, and to feel able to communicate with them about all aspects of the illness and treatment.

What to expect from community mental health services

When you have been diagnosed with a mental illness which needs specialist ongoing treatment (such as Bipolar disorder or Schizophrenia, for example), you should be able to receive a range of clinical services from a community mental health service while continuing to live at home.

Mobile Crisis Teams and Support Teams are often based at community mental health services. Some parts of the country have transcultural psychiatric services, with mental health professionals able to provide help in a number of languages. The case manager should be able to tell you if such a service exists in your State or Territory. All community mental health services should also have access to interpreters.

Case managers

If assessed as needing ongoing treatment and support you should be allocated a case manager (or other key contact person in the mental health service). This is a very important role.

Where a service is well run and properly funded, the case manager should be able to provide a range of services, including:

• assessing needs and making sure you are able to access the range of services necessary
• monitoring progress through all the different services, including clinical and non-clinical care
• working with you and others (such as carers) to develop an individual treatment plan, and helping to put this into action
• linking you into community supports such as psychiatric disability rehabilitation programs (see Section 4, Support in the community)
• helping to educate you and your family or other carers about the illness and how to deal with it
• providing individual counselling and therapy
• meeting and supporting your family or other carers
• arranging specialist services (for example, if you have another disability).

Crisis teams

Crisis teams – sometimes called Crisis Assessment and Treatment (CAT) Teams or Psychiatric Emergency Teams (PET) – are groups of mental health professionals who provide assessment and treatment for people seriously affected by mental illness.

In some parts of the country crisis teams are available around the clock, seven days a week (though this is not the case everywhere).

Crisis teams can assess people in their own home and then arrange treatment, including visits from a support team or hospitalisation where necessary. They should also provide information and support to family and any other carers.

Support teams

Support Teams provide intensive, long-term treatment and support to people seriously affected by mental illness (unlike Crisis Teams which focus on crisis situations).

Support Teams have a variety of names in different parts of the country. They may be called Community Rehabilitation Teams (CRT), Continuing Care Teams (CCT) or Mobile Support and Treatment (MST) Teams, for example.

Support Teams try to reduce the number of hospitalisations a person may need and help them maintain a treatment plan and reasonable quality-of-life. They normally provide an extended-hours service, ideally for seven days a week.

Going into hospital

A generation ago, it was common for an episode of mental illness to lead to many months in a psychiatric hospital. Nowadays you are likely to be admitted to hospital only if you are acutely ill and require intensive care for a while.

It is considered better for people’s mental health for them to be treated at home, if at all possible, by a community mental health service.

There is also a trend to treat people in psychiatric wards in general hospitals rather than stand-alone psychiatric hospitals – treating mental illness just like any other medical condition, in fact.

Involuntary treatment

If a psychiatrist or other treating professional recommends that you need psychiatric treatment, and you do not agree, it is possible to be treated involuntarily in certain circumstances. (This is called ‘sectioning’ in some parts of the country.)

The exact circumstances vary between different States and Territories, but in general people receive treatment in this way to ensure their own health or safety, or that of others.

There are legal limits on how long you can be treated involuntarily before a review is held by a Mental Health Review Board or similar body. These facts should be explained to anyone receiving involuntary treatment.

In some States and Territories it is possible to be treated involuntarily either as a hospital in-patient or while living in the community.

If you are treated involuntarily in the community, the treatment team has extra responsibilities and obligations in relation to things such as medication and regular check-up visits. This type of arrangement may be subject to a court order (sometimes called a Community Treatment Order) and is legally binding.

The range of clinical care

The range of treatments provided as part of clinical care can include medication and psychological therapy (covered in the following sections), often in combination.

As well as these, a further form of treatment is electroconvulsive therapy (ECT). This can be highly effective in treating severe Depression, especially when other treatments have not been helpful. It may occasionally be recommended for other forms of mental illness too.

ECT involves giving a general anaesthetic and muscle relaxant, after which an electrical current is passed through the brain. Any side-effects, such as a headache or mild loss of memory are usually temporary and pass after a few hours.

ECT should be administered only after the treatment has been fully explained to you, and any questions have been satisfactorily answered. ECT is usually given only with the consent of the person being treated.

If the psychiatrist does not believe that you are able to give informed consent, then the psychiatrist can consent for you, but only after notifying and discussing the issue with the primary carer. (In some parts of Australia the agreement of two doctors is required.)

Many mental illnesses are associated with changes in the natural chemistry of the brain. Certain medications help the brain to restore its usual chemical balance – reducing symptoms so that the person feels better. These include antidepressants (for Depression), antipsychotic medications (for psychotic illnesses such as Schizophrenia) and mood stabilizers (for Bipolar disorder).

It is usually helpful to combine medication with psychological ‘talking’ therapies, ongoing support in the community, and finding ways for you to help yourself.

How medication is taken

Medications are usually taken as tablets, sometimes by injection, in a syrup or wafer. The size of dose is not necessarily an indication of how severe symptoms are.

Some people have depot injections. This means that the medication releases slowly from a muscle over a period of time, usually between a week and a month. Some people prefer injections because they are not good at remembering to take tablets, or just because it makes life simpler.

What if there are side-effects?

We all react differently to medications, and body mass and rate of metabolism can affect the amounts needed to be helpful. Age, gender, whether we smoke, and other factors may also mean that we react differently to the same dosage. If you have any concerns about the unwanted side-effects of medication, make sure you discuss them with your doctor.

Doctors have a responsibility to prescribe the most effective medication at the lowest effective dose, so that any unwanted side-effects are kept to a minimum. They can only do this, though, if told as clearly as possible how well you feel the current medication is working. This is an important contribution that you and family and other carers can make to the effectiveness of the treatment.

How long does it take for medication to work?

It can be some weeks before the medication starts to take effect and reduce symptoms.

Once the best medication and dosage have been established, a maintenance dose will be determined from then onward, to help avoid a return of symptoms. This may be needed for some months or longer, depending on need.

In some circumstances, you can be legally required to take medication

If a doctor considers that it is absolutely essential for you to take medication – for your own safety or that of others, for example – then you can be legally required to take it. This may mean a support team supervising the medication to help you remember to take it. It may mean asking you to take it as an injection.

Antidepressant medication

The symptoms of Depression are associated with changes in brain chemicals called neurotransmitters. Antidepressant medications assist the brain to restore its usual chemical balance. This helps reduce or get rid of some of the symptoms.

Sixty to seventy percent of people with major Depression respond to initial appropriate antidepressant treatment. Antidepressants may also be helpful (in combination with psychological treatments) in the treatment of anxiety disorders.

What are different types of antidepressant?

There is a range of antidepressants available and it is generally thought that they have similar effectiveness. However antidepressant drugs differ in their likely side-effects and their safety in overdose. These are key considerations for a doctor when deciding which one to prescribe.

In some cases, where the Depression is particularly severe, the newer antidepressants may not be as effective as the older tricyclic and MAOI antidepressants, such as amitriptyline (Endep, Tryptanol) and imipramine (Tofranil), for example.

Side-effects such as dry mouth, blurred vision, constipation, urinary retention, sedation, and weight gain have been associated with the tricyclic antidepressants. Once again, it is important to discuss any side-effects immediately with the doctor.

As there are differences in the way people respond to each antidepressant, the doctor may have to change the medication to find the one that works best for you. It may take between one and four weeks from beginning to take the antidepressant before it starts to have an effect.

What about the newer antidepressants?

Newer antidepressants have fewer side-effects and are safer in overdose than the older antidepressants.

These newer antidepressants are sometimes referred to by the class they fall into: SSRI, SNRI, RIMA, NaSSA and NARI.

They include:

• fluoxetine (Prozac, Lovan, Auscap20, Fluohexal, Fluoxebell, Zactin),
• paroxetine (Aropax, Oxetine, Paxtine)
• sertraline (Zoloft, Xydep, Concorz, Eleva)
• citalopram (Cipramil, Celepram, Ciazil, Talam, Talohexal)
• fluvoxamine (Luvox, Faverin, Mavox, Voxam), venlafaxine (Efexor), mirtazapine (Avanza, Mirtazon, Remeron, Axit-30)-reboxetine (Endronax)
• moclobemide (Aurorix, Arima, Clobemix, Maosig, Mohexal).

Some people may experience side-effects with the newer antidepressants, especially when starting – for example: nausea, reduced sexual function, agitation, diarrhoea, headache, insomnia and in some cases restlessness and agitation. Not everyone will experience these side-effects but if you do, then discuss this with your doctor.

Antipsychotic medication

Antipsychotic medication works to minimise the symptoms of Psychosis – such as thought disturbance, delusions and hallucinations – and to minimise the risk of having another episode.

The first antipsychotic medicine, chlorpromazine, was developed in the 1950s. Others have since been developed, and they have become an important part of treatment for psychotic illnesses.

Before the development of antipsychotic drugs (also known as neuroleptics), there was no effective treatment for psychotic symptoms. This meant that people had to stay for many years (and perhaps indefinitely) in psychiatric hospitals.

Now most people who experience a psychotic illness can live in the community and benefit from other forms of treatment and support offered by a range of mental health professionals, as well as family and other carers.

How does antipsychotic medication help?

Psychotic symptoms are associated with changes in a particular brain chemical called dopamine. Antipsychotic medications assist the brain to restore its usual chemical balance. This helps reduce or get rid of some of the symptoms. It can take some weeks before the medication starts to work.

Antipsychotic medications cannot ‘cure’ mental illnesses for good, but they are effective in eliminating, or at least reducing, psychotic symptoms such as hallucinations, delusions and thought disorder.

Until recently, they have been far less useful in the treatment of so-called ‘negative’ symptoms such as social withdrawal and loss of motivation and emotional expression. Continuing to take a ‘maintenance dose’ of these medications also helps minimise the risk of further episodes.

What are the types of antipsychotic medications?

There are two types of antipsychotic medication: typical (older) and atypical (newer). While both are effective, the atypical ones are considered superior because they generally have fewer side-effects than older medications and may be more effective in treating ‘negative’ symptoms such as lack of motivation. While no single antipsychotic medication is totally effective for everyone, they are improving.

Atypical antipsychotic medications currently available on prescription in Australia include:

• Amilsulpride (Solian) – Tablet or solution. Approved for use by people with Schizophrenia
• Aripriprazole (Abilify) – Tablet. Approved for use by people with Schizophrenia
• Clozapine (Clozaril, Clopine) – Tablet. Approved for use by people with Schizophrenia and who have not been helped by other medications. People taking clozapine have regular blood tests to check for early signs of a very rare but serious blood disorder. These tests ensure serious problems do not develop
• Olanzapine (Zyprexa) – Tablet, quick-dissolving wafer. Approved for use by people with schizophrenia or bipolar disorder. An injectable form (Zyprexa Intramuscular) is also approved for use in people with agitation in Schizophrenia or Bipolar disorder
• Quetiapine (Seroquel) – Tablet. Approved for use in people with Schizophrenia, and for acute mania associated with Bipolar disorder
• Risperidone (Risperdal) – Tablet, quick-dissolving wafer, or solution. Approved for use in people with Schizophrenia and related psychoses, and for acute mania associated with Bipolar disorder. A long-acting injectable form (Risperdal Consta) is also approved for use in people with Schizophrenia and related psychoses.

What happens if someone stops taking medication?

Medical research shows that if someone suddenly stops taking antipsychotic medication against their doctor’s advice, it can lead to a return of psychotic symptoms.

If you are not comfortable about the medication you are taking, it is important to discuss this with the treating doctor so that action can be taken without the risk of symptoms returning.

What are the possible side-effects of antipsychotic medication?

It is important to remember that the same medication can affect people quite differently. In other words, not everyone who takes a particular medication will experience the same unwanted side-effects.

The most common side-effects of antipsychotic medication include drowsiness, weight gain, loss of periods in women, and a fall in blood pressure on standing, which can cause dizziness.

Some people may experience what are called ‘extrapyramidal side-effects’ (EPS). The word ‘extrapyramidal’ simply refers to the muscles which control body posture and muscle tension. Extrapyramidal reactions affect these muscles and cause involuntary movements and abnormal body postures.

These reactions do not occur in all people taking antipsychotics, and they are less likely to occur with atypical antipsychotics than with the older, typical ones.

Examples of extrapyramidal side-effects are:

• Parkinsonism – a stiffening and weakening of muscles, particularly in the face, a shuffling walk, and trembling hand movements. This is more likely to occur on high doses or when a medication is first prescribed
• Akathisia – a severe sense of physical or mental restlessness
• Dystonia – a reaction which causes muscles to go into spasms.

While these unwanted effects show that the medication is starting to take effect, they are understandably worrying. The most important thing to remember about taking medication is to discuss any side-effects immediately with the treating doctor, who can help to minimise these by lowering the dose, changing the medication, prescribing an antiparkinsonian medication, or sometimes simply changing the time of day it is taken.

Clozapine (Clozaril, Clopine)

Clozapine (Clozaril, Clopine) has a rare but potentially fatal side-effect on white blood cells in a small proportion of people. This medication is very helpful for many people, so to make sure this problem does not occur, everyone prescribed clozapine has a regular blood test to ensure that they can be taken off the medication before any harm occurs.

What is tardive dyskinesia?

Tardive dyskinesia refers to certain involuntary movements, which appear in some people who take an antipsychotic medication for a long time. The movements usually involve the mouth and tongue but other parts of the body may also develop movements over which the person has no control.

It is not known how common tardive dyskinesia is among people who have been taking an antipsychotic for a long time, but it is thought that only a minority of people develop the symptoms.

Tardive dyskinesia does not respond to anti-parkinsonian or other treatments, and the best way of dealing with it is prevention, by using the lowest antipsychotic dose possible.

The risk of developing tardive dyskinesia may be reduced in people using the new generation of antipsychotic medications.

Mood-stabilising medication – lithium carbonate

A drug called lithium carbonate (Lithicarb, Quilonum) is helpful for many people who have Bipolar disorder.

People with Bipolar disorder (previously called manic depression) experience extremes of mood, ranging from ‘highs’ of irrational over-excitement to ‘lows’ of depression. Lithium carbonate can help reduce the frequency of the recurrence of major depression and can also reduce the symptoms of manic or ‘high’ episodes.

Possible side-effects of lithium carbonate

A variety of blood and urine tests are taken before beginning lithium, as it can occasionally accumulate in the body and cause unwanted (and potentially harmful) effects. To prevent this, a blood test is repeated regularly during treatment to monitor the lithium concentration and to confirm that the dose is at the right level.

The signs of lithium toxicity are nausea, vomiting and diarrhoea, probably preceded by increasing tiredness, difficulties in concentrating, unsteadiness and increased thirst. If it appears that someone has a toxic reaction, the treating doctor should be consulted immediately. In most cases of toxicity, the lithium will be eliminated from the body within about two days after stopping the treatment.

People taking lithium long term should have thyroid, kidney and central nervous system monitoring. Other possible side-effects of lithium (when taken at recommended levels) are a fine tremor, muscular weakness and cognitive difficulties such as memory problems.

Other mood-stabilizing medications

Sometimes the doctor may decide it is better to prescribe other antimanic drugs instead of lithium, such as carbamazepine (Tegretol, Teril) or sodium valproate (Epilim, Valpro). Blood tests are still required to check that the dose is effective and to monitor for unwanted (and potentially harmful) effects.

Some antipsychotic medications such as olanzapine (Zyprexa), quetiapine (Seroquel) and risperidone (Risperdal) are approved for the treatment of Bipolar disorder.

Helpful tips about taking medication

Here are some helpful tips and things you should be aware of when taking medication.

Dealing with drowsiness

If you find that your medication makes you drowsy, there are things that can be done to help. With tablets, for example, the largest dose of the day can be taken just before bedtime, so the major part of the sedative effect occurs while you are already asleep.

If you receive an injection, the drowsiness will be strongest immediately after receiving it. If possible, the injection should be arranged for a time when the initial drowsiness is least likely to cause inconvenience to you. If these techniques don’t work, ask the doctor about a less sedating medication or the possibility of lowering the dose.

Healthy living

Research shows that people with a mental illness often get more physical illnesses too. This is probably because those affected are far more likely to smoke and less likely to exercise. Smoking can also counteract the helpful effects of medication.

For a number of reasons, then, it is especially important to look after your physical health – by eating healthily, reducing or quitting smoking, and taking regular exercise such as walking or swimming.

For further information, please see Guide to Healthy Living.

Alcohol

Drinking alcohol is strongly discouraged for people who have Depression. Alcohol itself is a depressant. This means that it slows down the normal activity of the body. The body slows down even more when alcohol is taken with the sedating antidepressant or antipsychotic medications. For example, if someone who is taking an antipsychotic drug drinks alcohol, they might feel much more drowsy than either alcohol or the drug alone would make them feel.

In an ideal world people would avoid alcohol whilst on medication, but this is not always realistic. Talk to the treating doctor about how much alcohol can be safely consumed and what the likely effects might be.

Cannabis and other drugs

Cannabis and other recreational drugs can bring on a drug-induced Psychosis (where symptoms are experienced for a relatively short period). They can also induce a psychotic episode in someone who has a vulnerability to an illness such as Schizophrenia, and increase the frequency and severity of episodes.

Use of cannabis is associated, too, with increased depression and suicidal thinking, especially for women.

Use of such drugs is strongly discouraged for anyone affected by, or vulnerable to, a depressive or psychotic illness.

Pregnancy

It is important that anyone who is planning to have a baby or is already pregnant discusses with her doctor the likely effect of medication on the foetus. As some medications can have a harmful effect on the foetus at any stage in development, it is important that this is discussed as early as possible, ideally when the pregnancy is being planned.

If possible, all medications should be avoided in the first twelve weeks of pregnancy when the risks of abnormality are higher. This will not always be possible and in these circumstances, the treating doctor’s advice is especially important.

Neither antipsychotic medications nor antidepressants appear to affect the development of the foetus although some new-born babies have shown symptoms of withdrawal.

The use of mood-stabilising medications when a woman conceives and in the first twelve weeks of pregnancy has been associated with problems in the development of the foetus.

Withdrawal from the medication or prescription of an alternative may be necessary. As high concentrations of lithium pass through breast milk, it is recommended that mothers taking this drug should be cautious and seek advice about any risks of breastfeeding the baby.

Sunlight

The antipsychotic medication chlorpromazine (Largactil) commonly causes people to be extra sensitive to sunlight. People taking this drug should avoid strong sunlight (for example, at the beach or snow), wear suitable clothing including a hat, and wear high factor sunscreen if exposure to the sun is unavoidable. If this is a problem, ask the doctor about changing the medication.

Being ‘sunsmart’ is advisable for people taking any antipsychotic medication, just as it is for everyone.

Driving

A number of medications carry a warning that since they are likely to make people less alert, driving a motor vehicle or operating machinery may be unsafe. This possibility varies from person to person, and may also vary over time. For example, if you take medication by depot injection, it might be best to avoid driving or operating machinery immediately after having the injection.

Think about whether your medication does make it unsafe for you to drive or do other things, and discuss this with your doctor if it is a concern. Some antidepressants can also affect physical coordination, particularly in the first few days of treatment.

Getting the most out of medication

While it isn’t always easy to keep taking medication, this is one of the most important things you can do to reduce the symptoms of mental illness and feel better. Here are some ways to make it easier:

• find out and be involved as much as possible in the treatment process. Ask the doctor to explain clearly what the goals of treatment are, what it is going to be like, and the advantages and disadvantages of different types of treatment. If you would like printed information about the medication, ask your doctor or pharmacist. You can also contact Medicines Line on 1300 888 763 or at www.medimate.org.au
• taking medications at different times of the day can be complicated. If this is so, talk to the doctor about reducing the number of times the medication has to be taken, or about taking it at night so the side-effects interfere less with daily life. Dosage dispensers (available from pharmacies) or calendar reminders can also be useful to ensure medication is taken at the right time
• family or friends can help support the process of taking medication. It is important, therefore, that they understand the medication, how it helps, and any potential side-effects
• let the doctor know any problems that the medication is causing as they may be able to make changes to the prescription or dosage
• store medication in an appropriate place away from heat and damp which can damage them. That is why you shouldn’t store your medication in the bathroom, near a sink or in your car. Medication should not be left within reach of children. It’s important, too, to only take medication that is specifically prescribed for you and only in the prescribed dose.

Many people affected by mental illnesses, especially anxiety disorders and depression, are helped by psychological, ‘talking’ treatments . . .

Psychological treatments help by giving an opportunity to talk about thoughts and feelings with a specially-trained professional in order to understand your symptoms, and to help you cope better with them.

How do psychological treatments work?

Through the process of talking to your therapist, psychological treatment works in a number of ways.

You play a role in the therapy yourself

Psychological treatments help you to understand what might be contributing to feeling the way you do and support you to try strategies for feeling better. This can be challenging but it means you play an important part in your own therapy, and this in itself is empowering.

Real change takes time to happen

Psychological treatments do not work instantly, but over a period of months will help you to learn new ways of thinking, behaving and even feeling. You may notice, for example, that you are better prepared to handle things that used to worry you or get you down.

Eventually you may find the whole way you think of yourself and the way you perceive and respond to the world changes for the better.

Sometimes they work best combined with other treatments

Psychological treatments are often effective on their own for people with Depression and Anxiety disorders. Sometimes it is also useful to combine them with other treatments such as medication. For some people, with psychotic illnesses such as Schizophrenia and Bipolar disorder, for example, ongoing rehabilitation, accommodation and employment support are also needed.

What psychological treatments are there?

There are many types of psychological treatment, which are proven to be effective. These may be provided individually, as part of a group, as a couple or even as a whole family – depending on the nature of the problem. The following are some of the more common types.

Cognitive behaviour therapy (CBT)

In CBT people discover how their thoughts, feelings and behaviour can get stuck in unhelpful patterns, and are supported in trying new, more positive ways of thinking and acting.

The person and therapist form a shared view about the unhelpful patterns and agree on goals. Therapy usually includes tasks and challenges to do outside, as well as within, the sessions.

In addition to treating Depression and Anxiety disorders, CBT may be helpful sometimes to people with psychotic disorders such as Bipolar disorder or Schizophrenia.

Interpersonal psychotherapy (IPT)

IPT is based on the idea that the way people relate to each other affects how they think, feel and act as individuals. It involves looking at the way a person has related to significant people in their life and finding more positive ways of interacting with others.

Difficult relationships are stressful and may contribute to worsening of symptoms for some people with mental illness. Addressing these difficulties therefore may help improve their quality of life.

IPT has been found effective in treating a range of mental illnesses, especially Depression; it is much less commonly used for people with psychotic illnesses.

Dialectical behaviour therapy (DBT)

DBT is a form of treatment specifically for people with Borderline personality disorder (BPD).

DBT is based on the idea that a key problem for people with BPD is an extreme difficulty in handling emotions. DBT helps people learn to handle their emotions better and re-learn the way they typically respond to situations and other people.

DBT generally combines individual and group therapy.

Family interventions

These treatments aim to support families and other carers, and foster calm and constructive family relationships where a member of the family has a Psychotic illness such as Bipolar disorder or Schizophrenia. Highly emotional environments are stressful for people with a mental illness and can lead to relapse.

Family intervention sessions typically focus on education about mental illness, solving of problems encountered as a result of the illness, and improving communication and relationships where these are strained or stressful.

The meetings may include some or all members of one family or, alternatively, the members of a few families may meet together in a ‘multiple family group’.

Psychoeducational family interventions can reduce relapse rates for people with Schizophrenia and Depression, whilst also supporting everyone in the family.

The more severe the effects of a mental illness, the more difficult it can be to engage in a psychological treatment, although the therapy may still be helpful. In these cases, it is likely that medication and practical support will be required in addition to any psychological therapy.

How long do psychological treatments take to work

Psychological treatments vary in the length of time they take to work.

Here’s approximate for the numbers of sessions:

• Cognitive behaviour therapy – 10-15 sessions
• Interpersonal therapy – 20 weekly sessions
• Dialectical behaviour therapy – 8-12 weekly sessions
• Family interventions – 9-12 monthly sessions

The benefits of psychological treatments happen at a different rate for individuals, and these are approximate numbers only.

Psychologists

A clinical psychologist is a health professional trained to provide psychological treatments to people with emotional and mental health problems.

Medicare or the local GP Division may cover all or some of the cost if a referral is made through a GP – ask your doctor about this. Costs may also be covered by private health insurance.

Some psychologists take on clients at a reduced fee, if they are receiving a Disability Support Pension for example. Psychologists accessed through Community Mental Health Services and some Community Health Services do not charge fees, and psychology training clinics run by universities charge a reduced fee.

Psychiatrists

Psychiatrists are medically qualified doctors who specialise in the study and treatment of mental illness. They can therefore prescribe medication as well as provide psychological treatments.

The cost of seeing a psychiatrist can be claimed from Medicare; like GPs, psychiatrists set their own fees and so there is normally an out-of-pocket ‘gap’ payment. Psychiatrists accessed through Community Mental Health Services and public hospitals do not charge fees.

Other mental health professionals

Other mental health professionals in Community Mental Health Services may also be able to provide psychological treatments. These may be social workers, nurses, psychologists or occupational therapists who have done specialised training.

Mental health professionals accessed through Community Mental Health Services and public hospitals do not charge fees.

General practitioners (GPs)

An appointment with your GP is always the best place to start if concerned about your physical or mental health. A GP can make a diagnosis, provide treatment and refer you to a provider of psychological treatments if necessary.

A growing number of GPs are also receiving training in providing psychological treatments themselves. The cost of seeing a GP can be claimed from Medicare, and there is normally an out-of-pocket ‘gap’ payment unless they bulk bill.

How do I find the best help?

The following tips are to help you get the best from psychological treatments:

• word of mouth – as well as your GP, ask other health professionals, local pharmacists or trusted family and friends about providers of psychological treatments they would recommend
• Australian Psychological Society (APS) – the APS has a referral service that gives contact details of privately-practising psychologists in your area who work with particular mental health problems
• ask questions – it’s important for you to be engaged as much as possible in the psychological treatment. When making an appointment, or during an early session, ask the provider what the goals of treatment are and what it will involve
• Speak out – the more you speak out and are frank with yourself as well as with the person providing the treatment, the more successful it is likely to be. If you feel concerned, confused or uncomfortable with the treatment, let the provider know, so they can work with you to address the reasons for these feelings. If you feel that they are not the right person to help you, then explain this and ask for another referral. A good provider of psychological treatment will want what is best for you and will not hesitate to refer you to someone more appropriate.

Psychiatric disability rehabilitation services help you to deal better with the personal and social effects of mental illness

Treatment is not just about medication or clinical care. Mental illness can sometimes affect the way you are able to cope in everyday life too. Community support and rehabilitation try to minimise the effect of any psychiatric disability by helping you rebuild those skills which have been affected. You are encouraged and helped to live as normal a life as possible.

Rehabilitation is also about focusing on the whole person, not just the mental illness, and assisting you to meet personal goals.

Psychiatric disability rehabilitation services are specifically designed to offer support and rehabilitation to people with a psychiatric disability. Some States and Territories offer more of this type of support than others. Metropolitan areas also tend to have more services available than rural areas.

Inquire at the local mental health service or local council about programs offered, and ask others what services they would recommend.

You can also contact the SANE Help Centre for details of services in your area. Call 1800 18 SANE (7263).

Support programs

Support programs offer a welcoming, non-threatening place for people with a psychiatric disability to go and spend time. Providing an informal atmosphere, most have activities centred around outings, short-term groups, music, games such as pool, or simply socialising.

Most support programs are run on the principle that participants should initiate the activities as much as possible, so activities that are offered may change from week to week. It could be an art class one week and an outing to the zoo the next.

The most important thing about support programs is that anyone who attends can take things at their own pace. There is no pressure to attend or participate if someone doesn’t want to.

Support workers at the program are available if someone needs help, or just a chat – but if only a game of pool or a cup of coffee is wanted, that would be alright too.

Structured day programs

Sometimes a structured rehabilitation program is more suitable. In most cases this means that you have a key worker allocated to you at the program, to be your advocate and support person. The key worker will discuss with you what your goals are, and different ways to achieve them. Goals can be anything from learning how to cook to feeling more confident around other people.

Structured day programs can offer skills training in a range of different areas such as woodwork, gardening, computer skills, office procedures and many more. Some of the skills training takes place one-on-one; other activities take place in groups. Group activities can be fun, and you have the opportunity to meet others and learn from each other.

Housing support

A good place to live matters for lots of reasons. It’s the place where we have our things, where we should feel most safe. Sometimes, though, we need extra help at home, and a supported accommodation program can provide this.

In accommodation such as this, workers provide support to people able to live relatively independently in their own homes. This could be in a group-living situation, your own house or unit, family home, or a rooming house. Disability support workers can help with practical matters such as budgeting, or issues such as relationships with other people living in the house.

For others who need more support, a residential rehabilitation living situation will work better. Residential rehabilitation involves disability support workers providing support to people with psychiatric disabilities in a communal environment. This can be individual support or group work with fellow residents.

There are more intensive levels of service and support in residential rehabilitation accommodation. For people who want to move to independent living eventually, residential rehabilitation is a good starting point.

Employment support

There are many specialist employment programs which can help people with a disability get back to work, accessible via Centrelink. Some structured day programs can also help in this way.

Employment programs can help prepare you to start work, and offer vocational counselling, suggest training options and help building up confidence about working again. They may also offer support in preparing resumes and job applications, and training in interview techniques.

Some of these agencies also do what is called job maintenance work. This can happen with the support worker coming along with you to the workplace, meeting up after work to see how you are going, or getting a lift to work for a while if you are anxious, for example.

For further information, please see the Guide to Mental Illness for the Workplace and the Guide to getting back to work.

Respite care

Respite care offers family and other carers time away from the demands of full-time care, and can give you an opportunity for a break too. This can be a vital source of relief for you and a carer. The Carers Association in your State or Territory can provide details of respite services in your area.

Respite care can be for a short time, for example, an afternoon, while a carer goes shopping or has some recreation, or for longer periods.

In some cases, you can take the break away from home and stay in accommodation where support is available. In others, the carer goes away and the support for you is provided at home.

Respite can be planned, which means that everyone knows when the respite care will be provided. There are also some services which provide unplanned respite, for situations in which respite is urgently required.

Recreation

Not only are recreation and leisure activities fun, they also give you the chance to get to know people and have new and challenging experiences. Psychiatric disability rehabilitation services often provide access to recreation and leisure programs for their participants.

Recreational activities can include anything from going away on a canoeing trip to having a tai chi class, for example. Participants are often encouraged to choose and plan their own activities, so the program can offer people the opportunity to do something they have always wanted to do.

Your local council may also offer a range of leisure programs, such as sporting activities; ask them about what is available. For arts and entertainment activities, concession prices are widely available.

See if there are any organisations in your area which help people access the arts. Some are able to provide free or low-cost tickets to performances, or classes in writing or painting, for example.

Peer support and education

Self-help, peer support groups operate on the principle that people whose lives have been affected by mental illness can offer each other a unique source of support and understanding.

Peer support offers an opportunity to talk, to learn from other people’s experiences and expertise, and – importantly – to feel that you are not alone in facing the challenges that mental illness can pose.

Families and other carers of people affected by mental illness have also established their own organisations in every State and Territory. Some of these are self-help groups providing mutual support for families. Others focus on providing direct services such as accommodation or rehabilitation to people affected by mental illness. Sometimes they provide a range of services including counselling services for families. Education and training for family and other carers (for example, in coping skills and stress management) is also important.

Peer support and self-help can be empowering. As well as giving support, people can become advocates for each other too. Rather than just receiving assistance from mental health professionals, self-help and peer support offers people the option of organising themselves, and helping services understand what consumers need.

In some States it is possible to be trained in peer support and counselling, and consumers are employed as consultants by mental health services.

As well as accessing clinical treatment and support programs in the community, there is a lot you can do for yourself to deal positively with the effects of mental illness

Dealing with stress

Stress is an uncomfortable, even painful, mental state accompanied by feelings of great tension, anxiety and fatigue. It results from a sense of being unable to cope with the current demands that life makes. If you experience these feelings, discuss them with your doctor or case manager so that they can suggest ways of dealing with them.

Stress is not only an unpleasant and unwanted experience, it can also contribute to a return of symptoms. By following some simple rules, you can act to help reduce the stress in your life.

Try as much as possible to:

• make time for relaxing and doing things which you enjoy
• talk about your problems regularly with a friend, carer or mental health professional
• deal with one thing at a time to avoid feeling overwhelmed.

When you’re feeling down

Everyone feels a bit down sometimes, but when this persists and interferes with normal enjoyment of life, then it’s time to do something about it.

Depression can be a disabling condition which others may find hard to understand. It often accompanies other illnesses too. It’s important to realise, then, that there are things you can do to lessen and even recover from it. A doctor will be able to help but can only do so, if you tell them about how you feel.

People who have experienced Depression say how important it is to do things to help yourself too, such as doing some physical exercise, giving yourself treats, helping others, keeping a sense of humour and trying to think positively.

For further information, please see the Guide to Depression for tips for what helps.

Being prepared

Sometimes symptoms come back even when you are taking medication.

This may be for no apparent reason, or because something happens which triggers the symptoms, such as getting stressed or taking recreational drugs. This is not to say that they are the cause of mental illness, but they can be a trigger for another episode. Avoiding drugs such as cannabis, speed, LSD and others which have this effect is a good idea. So, too, is using common sense to avoid or modify stressful situations where possible and taking steps to reduce stressful reactions.

Conflict with others, especially people who are close, can increase stress and lead to setbacks. If this is an issue, it is important to resolve any conflicts in a way that everyone accepts is fair. It can be worthwhile involving a third party, such as the case manager, to help sort things out.

Early warning system

An episode of illness is often preceded by signs that you are developing symptoms again, such as changes in behaviour and perception or the sort of thoughts you have.

It’s a good idea to work together with any family, friends, case manager or treating doctor to identify these signs and write them down. This makes it easier to spot if you are becoming unwell and get help sooner if a relapse occurs.

The same goes for suicidal thoughts. It’s important to tell your doctor and others about these, so that something can be done about them.

For further information, please see the Guide to Staying Alive, which has been designed specifically to help with this.

Develop a plan with others

After you have had an episode of illness, you are in a good position to know what support would have assisted in getting help sooner and making the process easier.

Discuss this with the treating mental health professionals and family or friends to help you set up a plan. This means that if you develop symptoms again, things such as who should be telephoned and what needs to be done to get help will be clear for everyone.

A healthy lifestyle

If you are affected by mental illness, it’s even more important to do things which are good for you anyway, such as getting enough sleep, being sociable, eating healthy meals, and avoiding recreational drugs and undue stress. Physical exercise, especially, is known to be helpful for people affected by Depression.

For further information, please see the Guide to Healthy Living for more tips on this topic.

Alternative therapies

Alternative therapies are ways of treating illness which lie outside the mainstream practice of medicine. Examples include homoeopathy, herbal medicine, hypnosis and acupuncture.

Some alternative therapies which have proven to be beneficial in the treatment of illness are becoming more accepted by mainstream medicine. However, it is essential to talk to the treating doctor about the alternative therapy you are considering, to ensure that there will be no harmful effects.

There’s a big difference between alternative therapies which work generally on the body and mind, such as tai chi (which helps relaxation and mental well-being), and those which promise a cure to mental illness.

If you want to use an alternative therapy in addition to the clinical treatment you are receiving, it is very important to make sure that the therapist and therapy are legitimate. Always find out as much as you can about the type of therapy involved. Some alternative therapies are regulated by professional associations, so it can be useful to find out if the therapist is registered to one of these bodies.

Whether you have a mental illness or not, it can be worthwhile and enjoyable to find new ways of being healthier, both mentally and physically. It is equally important to be very careful about who and what we involve in this process.

Be aware of your rights

In every area of our lives we have rights as citizens, as tenants, or as consumers of mental health services for example. We can only exercise these rights, though, if we know what they are.

The right to treatment

Sometimes, simply getting medical treatment can be a challenge. We all have a right to the best treatment possible from mental health services – in terms of the most effective medication, support with rehabilitation and living in the community, and help in dealing with Centrelink benefits and other issues.

Peer support groups and other community agencies can help here, as well as the doctor and case manager who are responsible for treatment.

Citizens’ rights

For general rights as a member of the community, a good place to start is the nearest Citizens’ Advice Bureau (sometimes known as Community Information Services). They are not only an excellent source of information, many also provide free legal advice from a solicitor. If necessary they can refer on to another, more specialised body.

Discrimination rights

It is illegal under Federal legislation to discriminate against someone because of a psychiatric or other disability. If you think this applies to you or someone you know, contact the Human Rights Commission.

The right to safety

Being safe from violence and sexual assault is everyone’s right. If this has happened to you or someone you know, or you fear that it might happen, discuss it with someone you trust and decide on a plan of action. Telephone 1800 RESPECT (1800 737 732) available 24/7. Do not hesitate to contact the police if necessary.

Multicultural rights

We all have the right to enjoy our own cultures. If you feel that you (or someone you know) are being discriminated against because of your cultural background, contact the Human Rights and Equal Opportunity Commission. Each State and Territory also has an Aboriginal Legal Service.

In a crisis

See In a crisis for advice on what can be done to help when someone you know experiences a mental health crisis.