Between the GP and the emergency department, there are many different mental health care options but it’s not always clear which will best suit any person’s individual needs.
As the majority of respondents to Guardian Australia’s reader callout told us about their interactions with the mental health system, the system is very complex and hard to navigate, with confusing options for different types of care. Trying to find the appropriate care was often trial and error and time-consuming.
Pro Liz Scott, a principal research fellow at the University of Sydney’s Brain and Mind Centre, says the best chance of finding a mental health practitioner who’s the right fit starts with being informed about the treatments that are on offer. Scott says places like the Brain and Mind Centre’s clinics and research, as well as online assessment tools like those provided by Mindspot and the Black Dog Institute aim to educate people about what services they should get for the issues they have, so that they can go equipped with that knowledge to a GP or mental health professional asking: “These are the treatments I understand are out there, how do I get that?”
Annie Wylie, senior manager of digital content at ReachOut, says one of the ways to put yourself in the best position when seeking out a mental health professional is to ask yourself some questions before you go looking, such as, do you want them to have a similar life experience to you – for example a similar cultural background or experience in sexuality and gender? Wylie recommends emailing or calling to ask the practitioner: “These are the sorts of things I’m looking for, do you have experience with them?”
“It’s all about plucking up the courage to ask, everyone should be helpful pointing you in the right direction as long as you’ve thought about what that direction should be,” Wylie says. She also recommends giving feedback to the professional if it hasn’t gone the way you wanted and seeing if that professional can recommend someone else with the right experience.
Scott also encourages people to reach out to their family and social network. “Mental health problems are common. We don’t often talk about them but when it’s raised as an issue, people are often willing to share their experience.” Scott says using our extended social and family network, as well as services around us like psychology services at work, can help make us better informed and allow us to find out faster what does and doesn’t work.
Scott also advises anyone dealing with the health system to take an advocate with them “because you might not be in a place yourself to ask what help is out there” and get into the next stage of care.
Here’s a guide to the different types of mental health care generally available, what qualifications they have, and what you can expect at that level of care.
Qualification: “All psychologists go through at least six years of study, training and supervised practice before they can receive their registration and be given the title of ‘psychologist’,” says Tamara Cavenett, president of the Australian Psychological Society. Completion of a professional master’s or professional doctorate allows psychologists to gain an Area of Practice endorsement, the most common being the clinical psychology endorsement. Other areas also include clinical neuropsychology, counselling psychology, sport and exercise psychology, and educational and developmental psychology.
What care can you expect? “Psychologists help people with all sorts of issues. It could be that you want to give up smoking, or overcome a phobia. Or you may have a more complex mental health issue like depression or anxiety, which is affecting everything in your life,” Cavenett says. “A psychologist will meet with you, either face-to-face, or via telehealth which is on the computer or phone. They will talk to you about your issues, work out a plan for how often to meet, and develop strategies to help you overcome these problems.”
Where can you find them? GPs can recommend a psychologist and provide a Mental Health Care plan, which allows Australians to receive up to 20 Medicare subsidised sessions in a year. Individuals can also reach out directly to a psychologist without a referral, or research different psychologists. The Australian Psychological Society’s Find a Psychologist online tool lists thousands of psychologists around the country, which you can search by location and issue, for example depression, eating disorders or grief and loss.
“There’s a lot of trust in a relationship that you build with a psychologist, so it’s important to have rapport. Finding someone that you feel comfortable with is key. Some psychologists are happy to speak to you over the phone before you book your first appointment,” Cavenett says.
Qualification: Psychiatrists are specialist medical doctors who are experts in mental health. They complete a medical degree, do on-the-job training in a hospital for at least 12 months, and then enrol and complete training in the medical specialty of psychiatry with the Royal Australian and New Zealand College of Psychiatrists (RANZCP), which takes approximately 5 years and consists of supervised on-the-job training as well as a series of examinations both written and practical. Psychiatrists can also specialise in certain disciplines like addiction by completing an Advanced Training Certificate.
What care can you expect? Psychiatrists can prevent, diagnose and treat mental health conditions, in addition to listening to and providing expert care for vulnerable people and their families, RANZCP President, Associate Prof John Allan says.
“The range of mental illnesses that psychiatrists can treat is very broad and can include, but not limited to ADHD, anxiety, autism, bipolar disorder, borderline personality disorder, dementia, depression, eating disorders, OCD, PTSD and schizophrenia,” Allan says.
They are able to provide a broad range of treatments, including:
Psychological treatments (psychotherapy or talking therapy)
Brain stimulation therapies such as electroconvulsive therapy (ECT)
General medical care, checking physical health and the effects of medication.
Where can you find them? Find a Psychiatrist is a free online directory of psychiatrists in Australia. Produced and managed by the RANZCP, it provides up-to-date information on Australian psychiatrists who you can see outside the hospital system. Using the search fields you can look for a psychiatrist who:
Is close to where you live.
Treats people with your condition.
Speaks a language other than English.
Has particular skills or experience.
Offers a particular treatment.
What’s the difference between a psychologist and psychiatrist? “Both psychiatrists and psychologists understand how the brain works, our emotions, feelings and thoughts. Both can treat mental illness with psychological treatments (talking therapies). However, psychiatrists attend medical school and become medical doctors before doing specialist training in mental health. Because they are doctors, psychiatrists understand the links between mental and physical problems. They can also prescribe medications,” Allan says.
Mental health nurse
Qualification: A Bachelor of Nursing Degree in addition to graduate qualifications in mental health nursing.
What care can you expect? “In nursing we’re able to shift slightly to match the client we’re in front of, working autonomously and within a team,” says James Southan, a mental health nurse for Primary Integrated Care Supports (PICS) in Sydney. “Our model with nursing is a bio-psycho-social model [that] encompasses the importance of treating someone holistically. We deal with dual diagnosis and complexity, which means someone with a mental illness who also has psycho-social difficulty – people who can’t keep jobs, have difficulty maintaining relationships and/or complex physical health history,” Southan says.
Nurses are able to:
Provide a comprehensive mental health review.
Provide medications review and monitoring.
Provide a physical health review.
Provide advocacy working with different services – for example supporting applications for housing for homeless patients.
Formulate care plans.
Work in the therapeutic manner providing evidence-based treatments for people with mental illness such as psychological therapies, brief focus therapies and for many nurses training in dialectical behavioural therapy.
Where can you find them? Southan says that mental health nurses (outside hospital) can be found in community mental health centres, and through referral to the PICS program via primary health networks which can be completed by your GP, psychiatrist or allied health professionals.
Qualification: Lived experience with mental health issues in addition to a Certificate IV in Mental Health Peer Work.
What care can you expect? Peer workers are a growing and evidence-based form of mental health support. “There is nothing more reassuring than when you can talk to somebody who has walked in your shoes,” says Claire Smith, a peer worker for NSW Health. “When you go and see a doctor and they give you a clinical picture of what’s going on. A peer worker can tell you ‘I get it, I know what’s happening, you’re not alone … things can get better’.”
“My role is to step back and listen and validate what someone is saying and there’s something incredibly powerful about that,” Smith says. She also elaborates on the role of the peer worker who can share what’s been helpful in their own recovery, run support groups, and work collaboratively with a clinical team.
Where can you find them? Peer workers are employed by many different types of mental health services, including inpatient and outpatient mental health facilities. A clinician may recommend you talk to a peer worker but you can also request to speak with one. Non-government organisations such as Mission Australia and One Door are increasingly offering the services of peer workers. ReachOut also provides online peer support aimed at young people and parents, which is professionally monitored and users don’t need to necessarily chat, they can also just read conversations which have already happened.
Qualification: Studied a certificate or diploma in Youth Work at Tafe.
What care can you expect? Youth workers “take on a coaching kind of role in a young person’s life”, says Annie Wylie from ReachOut. They are able to talk to young people about practical issues they face in areas such as school and education, sexual health, accommodation, drug and alcohol use, as well as becoming a young parent. “Any of those issues a youth worker will be able to talk about with and refer them on to other services.”
Where can you find them? Community centres, not-for-profit organisations such as YMCA, schools and youth refuges.
Qualification: Four-year bachelor degree in social work or a two-year qualifying master’s degree, with at least two years’ post-qualifying experience in supervised mental health practice in order to receive accredited mental health social work status.
What care can you expect? The Australian Association of Social Workers (AASW) says mental health social workers “recognise the broader implications of an individual having a mental illness and the impact on friends, family, work and education” and provide a “holistic approach to working with a person”. A mental health social worker can help resolve psychological problems like depression, anxiety and personality disorders, as well as associated social and other environmental problems, like relationship problems and family conflicts. The AASW says that mental health social workers use a range of strategies including:
Cognitive behavioural therapy.
Psycho-education (including motivational interviewing).
Where can you find them? Using the search function on the AASW website. Mental health social workers are also commonly found in hospitals where they meet patients before they are discharged, as well as in community and outreach centres, and not-for-profit organisations.
Lifeline Crisis Supporter
Qualification: Lifeline have an in-house training program that all counsellors take to become a qualified crisis supporter. “This is an extensive skills and attitudes based training that provides core counselling and relationship building skills, safety assessment skills including discussing and managing suicide, mental health and suicide awareness and intervention,” says Rachel Bowes, head of crisis services and quality at Lifeline Australia.
What care can you expect? “Lifeline offers 24/7 crisis support and suicide prevention to all Australians. Calls are free and confidential, those seeking help can do so anonymously and there is no requirement to provide any personal or identifying details … The service is offered though phone, text and webchat channels,” Bowes says.
Liz Scott says crisis lines “can help direct people into care but do not provide care themselves”.
Additionally, the Lifeline website has a range of resources, toolkits and service information on all matters relating to mental health, suicide prevention and emotional wellbeing. Locally based Lifeline centres across Australia provide a range of face-to-face counselling and group programs addressing a range of mental health and wellbeing issues.
Where can you find them? Call Lifeline on 13 11 14 or go to www.lifeline.org.au
Qualification: Counsellors all have training but the levels of qualification vary, with Institutions such as the Australian College of Applied Psychology, Tafe and the University of Western Sydney all offering various levels of counselling accreditation.
What care can you expect? Wylie calls counsellors “good advice all rounders. You can talk to a counsellor about anything going on in your life, you might not have a diagnosed mental illness. Many find counsellors a great option for talking therapy and looking at ways they might be able to feel a bit better.”
Where can you find them? You can find a counsellor in your local area through searching Find a Counsellor on the Australian Counselling Association’s website as well as via the Psychotherapy and Counselling Federation of Australia website. Counsellors are often also available through community centres, charities, and in schools.
Intermediary online resources
Scott says online cognitive behavioural therapy services such as Mindspot and This Way Up “can be helpful while someone’s on a waiting list or struggling to find time for an appointment with a professional”.
Mindspot provide assessments. This Way Up have coaching and run targeted programs for depression, anxiety, PTSD, sleeping difficulties, mindfulness meditation.
Scott says “we know these programs work better if they’re integrated into health care, either prescribed by a GP or psychiatrist” and also recommends often doing the programs with someone trusted as they are often “quite hard for people to do them on their own”.
ReachOut also provides online resources for young people (targeted for ages 14-25) and their parents. ReachOut provides self-help content, with an early intervention approach, peer support forums, as well as a one-on-one coaching program for parents. ReachOut also offers ‘Next Step,’ which takes people through a survey to personalise the care they may need.
Annie Wylie says it will give you different options around self help, for example suggesting an article to read, a particular service for example the Butterfly Foundation for eating disorders, and if necessary, direct people towards urgent help.