Finding the right mental health service for YOUR needs

Choosing a mental health practitioner can be a headwreck. Here's a guide to your options, writes FIONA REDDAN

MENTAL HEALTH has never been far from the headlines over the past few years, but at a personal level, seeking help for mental health issues can be overwhelming, and knowing where to turn can often be problematic.

Should you see a counsellor, for example, or would a hypnotherapist be a better option?

Many of us are confused when it comes to understanding the roles of various mental health professionals, particularly as some of these professions and the therapy they offer are not regulated in Ireland.

While psychiatrists are governed by the Medical Council, the same is not true for most other professions.

“It’s a landscape that’s rife for mis-use and for taking advantage of people for those who are of a mind to do so,” says Rosaleen McElvaney, a consultant clinical psychologist and a lecturer in the Dublin Institute of Technology.

Indeed at present, someone with the most basic of qualifications – or even none at all – can refer to themselves as a counsellor or psychologist.

This is set to change next year when Coru, the Health Social Care Professionals Council, start to regulate psychologists, but in the meantime, McElvaney recommends that when seeing someone, patients should first ask about the professional’s qualifications, and whether or not they are a member of a professional body.

This should ensure that they have signed up to a code of ethics, and will give the patient the reassurance that there is some accountability for the services they are receiving.

GENERAL PRACTITIONER

When seeking out professional help, the GP should be your first port of call.

“When people encounter mental health difficulties, ideally a person should speak to a loved one initially. If needs be, the GP is then normally the first port of call if a person needs to interact with medical services,” advises Brian Howard, chief executive of Mental Health Ireland.

And for those concerned about how the GP might judge them, Howard urges people to remember that mental health issues are very common.

“A significant portion of people who enter a surgery have an underlying mental health problem. It is very commonplace. I would make the argument that people should feel in no way inhibited to talk about this.”

If necessary, a GP can prescribe medication such as anti-anxiety or anti-depressant tablets, and can also refer you to receive specialised care.

“There is a greater danger of leaving a particular issue. Bottling it up and not going to a GP, in general terms is not to be recommended. People should be encouraged, as they are with any other physical ailment, to go to a GP.”

According to Howard, the normal course of advice from a GP is that they would ask for an appointment with a community health facility if they felt their patient needed additional care.

Fees: €45-€60 a visit.

PSYCHOLOGIST

Psychologists have an extensive educational background, and are trained to treat clinical and mental health difficulties such as anxiety, depression and personality disorders.

They are also typically trained in Cognitive Behavioural Therapy (CBT). At present, psychologists are self-regulated through the Psychological Society of Ireland (PSI) but, as mentioned previously, this is due to change.

At present, accessing a psychologist in the public health sector can be problematic, with McElvaney pointing out that you could have to wait for up to a year to get an appointment. This is obviously not very helpful for those who are having problems.

“All the research tells us that in order to help people with mental health difficulties, you need to get in early and help at the early stage. It’s much more effective,” says McElvaney.

According to McElvaney, someone will typically see a psychologist for at least six to eight sessions, with most people availing of treatment for somewhere between six and 18 months. As such, it can prove very costly for those who decide to opt for expediency by seeing a psychologist privately, with private fees starting at about €80 a session.

And health insurance cover can be limited. Under the VHI’s Family Plan Plus Level 2, for example, you can get €35 back per visit to a clinical psychologist, but only seven visits a year are covered.

As an alternative, online counselling is also becoming increasingly popular. This enables you to discuss your issues with a trained professional through a secure online chat facility. For some people, this can be easier, or more convenient – and cheaper – than seeing someone in person.

Fees: €80-€150; €45 for 50 minutes of online counselling with a counselling psychologist at turn2me.org.

PSYCHIATRIST

For a serious mental health problem, a person would be referred to a community team led by a consultant psychiatrist.

Typically a psychiatrist works in a psychiatric hospital or unit, or as part of a community care team. These multi-disciplinary teams include mental health nurses, psychologists, social workers and occupational therapists. You can also visit a psychiatrist privately.

A psychiatrist is a trained medical doctor and a specialist in the diagnosis, treatment and prevention of mental illness and emotional problems.

To qualify as a psychiatrist in Ireland takes at least seven years in post-graduate specialist training.

“It’s their speciality, just like a cardiologist,” says Howard.

As well as assessing the patient, a psychiatrist can also prescribe medication. An initial assessment may take one to two hours, and sometimes it is suggested that a family member accompanies the patient.

On occasion, a psychiatrist might recommend admission to hospital if the person’s difficulties are severe.

Fees: €100-€150.

HYPNOTHERAPIST

Hypnotherapy is the use of hypnosis, and the mind’s own natural abilities, to resolve issues, relieve emotional burdens and achieve personal goals. It can be used to treat mental health issues such as anxiety, eating disorders and depression.

However, it is seen as an alternative therapy and the advice of your GP can prove worthwhile.

“You need to be absolutely careful that the person you are going to see is sufficiently qualified and has the authority to make clinical interventions,” warns Howard.

There are a number of hypnotherapy associations in Ireland, including the Irish Hypnotherapy Association and the Institute of Clinical Hypnotherapy Psychotherapy.

Fees: €80-€200 per one-hour session.

COUNSELLOR/PSYCHOTHERAPIST

Some counsellors are qualified psychologists, but many are not. Those who are not may have a basic degree or training in other areas and/or relevant work experience (eg teaching, nursing, and so on) plus a counselling qualification.

There are many forms of counselling available for a wide range of problems, and many counsellors specialise in particular areas such as addiction, bereavement, etc. As self-referral is a common route to counselling, getting some professional advice first is recommended.

“Counsellors are many and varied and some are more qualified than others – approach with caution. Your GP would be best to recommend a good counsellor with sufficient skills,” advises Howard, adding, “There is possibly a danger of going to see someone, and you may not know if they are sufficiently qualified to counsel in a particular area.”

Counsellors or psychotherapists typically recommend that a person is treated over the course of eight weeks.

Fees: About €60-€70 for a 50-minute session. (The Tivoli Institute in Dublin and Galway offers low-cost psychotherapy sessions for €20 an hour with a senior trainee from the institute’s training programme).