Treatment

The Oxford Dictionary defines treatment as "something done in order to relieve or cure an illness or abnormality". The term 'treatment' is very broad and means different things to different people. For some, treatment automatically equates with medications. However, whilst medications can play an important role, it is only one part of the armory in the battle to regain mental health.

Treatment in the mental health field is known as the bio-psycho-social approach and consists of three dimensions:

1. physical treatments;
2. psychological treatments; and
3. social interventions.

Just as there are options for treatment, there are many factors involved in the development of mental illness. These factors are often interrelated and they also affect the rate of recovery.

• Biological factors, e.g. imbalances in the levels of brain chemicals.
• Psychological factors, i.e. negative ways of thinking, or not having good ways of handling stress.
• Social factors, e.g. the role of poverty and low socio-economic status; unemployment, or jobs that are not satisfying or too demanding; war; gender; education; marital status; and the absence of supportive relationships.

There are various treatment options available to individuals with mental illness and because individuals are different, individualized approaches are required. One of the most important aspects of treating mental illness is targeting all of the factors that have contributed to the problem in a combined treatment approach. This means that the treatment of a mental illness or disorder needs to incorporate strategies that address biological, psychological, and social factors and is often referred to as a bio-psycho-social approach.

For example, in the treatment of depression, studies have found that the use of antidepressants together with Cognitive Behavioral Therapy (CBT) brings about a better response rate than results from either of the two treatments being used alone. In the treatment of schizophrenia, for example, it has been recognized that the timing of the onset of the illness, the level of disability, and the associated disruption to normal development and family life, means that the treatment approach needs to involve the patient and family members. Taking this individualized approach may involve working on strategies to improve self-confidence, increasing daily activities, learning about social and living skills and looking at vocational training. It will often involve providing family support and education, and require liaison with many different types of services in the community.

The treatment plan is usually formulated by a medical practitioner or mental health professional after a detailed assessment. For the treatment to be successful, it is essential that the patient is involved as an active participant, that is, supportive, co-operative and committed. Involving families or caregivers in this process is also recognized as being very important, and their opinions will be sought during this process, particularly if the nature of the illness has affected a person's capacity to take an active role in his/her treatment planning.

The treatment team

General practitioner (GP)

Your GP or doctor is the most skilled professional to provide initial help. GP's have the skills to look at the problems that a person is experiencing and can start to make a full assessment. It can take some time to sort through problems so it is important to seek a long initial appointment with your GP. It may be necessary to return to him/her on more than one occasion in order to fully explore all the factors that may be involved. It is often very useful to get a member of your family, or a friend, to go to the first appointment. The doctor may want to also gain an idea from others as to the nature of the problem because others are often in a good position to see things that the patient might not be able to recognize. Family and friends can also give support at, what can seem to be, a frightening time.

It is important that physical or biological causes of symptoms are first identified, therefore, a full physical examination is important. A doctor will often do some routine tests to help exclude any medical problem that may be contributing to the individual's symptoms. These tests may include blood and urine tests and certain imaging tests, such as a cranial CT scan (x-ray of the brain).

At this point, your GP may have a clear picture of what the problem is and will discuss treatment options with you (which may involve medication). If you are experiencing a number of relationship or social difficulties that contribute to your symptoms, your GP may suggest you undertake counseling. A referral to a professional more experienced in treating mental health problems may be made.

Psychiatrist

A psychiatrist is a medical specialist working predominantly in the area of mental health. Psychiatrists have a medical background that consists of a medical degree, followed by at least five years of postgraduate specialization in psychiatry. Psychiatrists are specifically trained within a biological framework that is governed by: a deep understanding of how the body and mind work together, and how medication; and other medical methods of treatment can assist in treating the symptoms of mental illness and psychological difficulties. Psychiatrists also have a strong grounding in psychological models of mental illness and can apply this knowledge in treatment settings. Unlike psychologists, they can prescribe medication.

The main roles of a psychiatrist are listed below.

Psychiatric diagnosis

Psychiatrists are specifically trained in making diagnoses and an assessment of an individual's mental health problems. When doing this the psychiatrist also takes account of medical issues and ensures that mental symptoms are not being caused by illnesses and diseases that are better handled by other professionals, e.g. physicians or surgeons. Treatments applied by psychiatrists are based on the individual's symptoms and an understanding of the context in which they are occurring (the bio-psycho-social approach).

Biological treatment

Psychiatrists are able to prescribe medication for patients with mental health problems. They will also instigate methods to alleviate other symptoms, e.g. an elderly patient suffering dehydration, vitamin deficiency and malnutrition may require hospitalization. The psychiatrist also decides about, provides or supervises other treatments.

Psychological treatment

A psychiatrist makes use of a variety of psychological techniques.

Social treatment reflects the need for social intervention, and usually psychiatrists refer on to other appropriate mental health care professionals for this to be implemented.

Clinical psychologist

Clinical psychologists are health professionals who work predominantly in the area of mental health. Clinical psychologists have a minimum university training of six years, followed by two years of supervision in the professional setting. Their university degree involves rigorous training in scientific research methods. This strong foundation in scientific research provides a very distinctive framework within which the clinical psychologist works. The main roles of a clinical psychologist are listed below.

Psychological assessment is a structured process which makes use of assessment tools shown, through research, to be reliable and valid in identifying and measuring psychological attributes, normal or abnormal, and psychosocial problems in general. Some clinical psychologists specialize in tests of brain functioning which assist in the detection of specific organic pathologies affecting the brain. Psychological assessment of an individual may enable comparisons to be made with patterns in the community, leading to a greater understanding of an individual's special situation. Examples of tests used by a clinical psychologist include intelligence, diagnostic, neuropsychological and personality tests.

Psychological treatment includes a variety of techniques, all of which utilize psychological principles and methods in order to assist individuals with their difficulties. The goal of psychological treatment is always to: reduce individuals' current difficulties and symptoms; help them feel better about themselves; and minimize the problems from interfering with day-to-day activities.

Psychological evaluation is the continued evaluation of the effectiveness of the psychological treatment undertaken. It assesses whether the treatment administered was appropriate and effective, and if the treatment is not effective, the clinical psychologist reformulates the individual's problem and redesigns the treatment offered.

Counsellor

Counsellors are mental health workers who may have formal qualifications in counselling, or may be trained in nursing, social work or psychology. Some counselors have been trained in particular areas of expertise, for example, inter-personal relationships, grief counseling, or sexual assault counseling. When choosing a counselor, it is important to ensure that he/she is accredited by an official counseling body or organisation. Doctors have a list of counselors that they regard as appropriately trained and competent. If you have been referred to a counsellor, simply ask them about his/her training.

At some point in a person's life he/she will experience challenging times and the person may feel unable to move on in life. Although he/she is not necessarily experiencing mental illness, the person can feel great psychological distress as a result. At times like these, being able to talk through such issues or problems with a good friend or a close member of the family is often all that is needed to be able to resolve the problem or to make a decision.

There are times, however, when the issues may be too difficult to discuss with friends or family. Spending time with a trained counselor can help in these situations. Many people have been to talk with a counselor at some point in their lives and often friends and family are able to make a recommendation. Try to avoid working with the same counselor as a close friend or partner because this can make it difficult for the counselor to keep issues separate.

Occupational therapist (OT)

Occupational therapists are professionals who have undertaken tertiary education and have specialized in the assessment of functioning of an individual in physical, social, and vocational areas. They aim to assess a person in these areas and to help them achieve and maintain his/her highest potential in terms of independence. They may also have particular skills in certain treatments, such as relaxation training, and may work either with individuals or with groups. In the inpatient setting, an OT can help to: explore creative and leisure needs; assist in dealing with stress; improve skills needed for daily living, e.g. budgeting and cooking; and facilitate a comprehensive and effective discharge plan.

Mental health nurse

Mental health nurses are qualified to provide nursing care to people with mental health problems. This includes: assisting providing for physical needs; assessing on-going symptoms in the hospital or day-hospital situation; discussing with patients their general health needs and, in particular, eliciting information about the development, assessment and monitoring of symptoms; dispensing and supervising the taking of prescribed medication; assisting with other treatment programs including psychological treatments; and providing education and support to patients and their families.

Social worker

A social worker has undertaken tertiary training in social work and social administration and they aim to improve a person's well being through the promotion of social justice and social change. They liaise with many services including public housing, rehabilitation services, and appropriate government agencies, e.g. disability services. They have particular skills in the assessment of families and the social and living circumstances of an individual. They have therapeutic skills in individual counseling and family work and can also be involved in group-work (education, therapy and support). They play an important role in planning for patient discharge and also work with outpatients.