Mental Health Navigator

1. Introduction

You’ve been distressed for months. You’re frequently missing work and have lost touch with friends. You’re becoming more withdrawn and skeptical about the future.

You’ve finally worked up the nerve to talk to a professional. You hope they might have a solution. Whether right after the first appointment or months down the road, you’ve realized you’re not only still unwell, but more confused, desperate, and angry. You’ve lost hope that there is a solution and don’t know where to turn.

Far too many people have this experience, particularly those seeking help for mental health problems for the first time. The mental health system makes it difficult for people to get the help they need. It’s hard enough finding the right person willing to spend the time to listen to your problems, let alone someone who is able to help you fix them. You may waste time trying treatments that make you worse instead of better and miss those solutions likely to help.

It doesn’t have to be that way. Part of the problem is that nobody tells you what the process of getting better looks like when you have a mental illness. How long should it take? What do the treatments do? The information that’s out there is often piecemeal and scattered. It rarely reflects the practical realities of finding care. How then can you even tell the difference between good care and bad care?

All you know is you’re not getting better. And you don’t know how to fix it.

Take Control

You may be on a lengthy waiting list to see a professional. You may be going in circles with one or more treatment providers who seem to be fresh out of new ideas. You may feel abandoned and not sure where to turn next. Being on a waiting list isn’t care. Neither is hoping for inspiration to strike. You have an important choice to make.

You can continue passively doing things as you have been. You can periodically raise your mental health concerns with your family doctor or other professional, hoping for a different response. If you’ve been referred to a psychiatrist or mental health clinic, you can sit back and wait until you’re seen there. Your doctors are the experts. If there was something else you should be doing, they would have told you to do it.

Or you can learn and empower yourself. Get the best possible care you can within the system. You can work with your family doctor or another provider to move forward instead of waiting. Sometimes, a gentle nudge in the right direction is all it takes. You can learn to play a more active and productive role in your own care.

In other words, you can help bridge the gap between the sad reality of the mental health system and the comprehensive care you need.

The Sad Reality of Mental Health Care

To improve your care, you need to first understand what isn’t working. People talk about a mental health system. In reality, it’s less a system and more an uncoordinated patchwork of independent entities.

A true system would behave like an organization, with clear roles, responsibilities, processes, and procedures assigned to each part. Most importantly, there would be a map that ties each piece into an integrated whole. Despite the size and bureaucracy of many organizations that provide mental health care, groups inside and outside organizations rarely coordinate smoothly. Patients don’t interact with a unified, coherent system.

Instead, providers move in different directions. Each sees itself in isolation, doing what they think they should be doing. There’s no clear global accountability for results.

How can this affect you? After only a short time, if you’re like most people, you’ll find

  • multiple, confusing entry points to access care;

  • care not provided by the most appropriate providers;

  • treatments often unhelpful or worse;

  • standard of care for treatments often not met;

  • poor communication between providers; and

  • no progress tracking, resulting in being lost or stuck

To put it more simply, no one person is responsible for ensuring you get the care you actually need.

Comprehensive Care

If you want to do things differently, it helps to know what you’re trying to accomplish. Even if you’re taking on some of the work yourself, try to picture what a sensible patient-centred mental health care system would look like:

  1. You’d know where to go to ask for help, and if that wasn’t the right place, you’d quickly find your way to the right place.

  2. You’d be properly diagnosed by a trained professional within a reasonable timeframe (i.e., days or weeks).

  3. You’d know the plan to treat your illness, and you’d regularly check to make sure the plan is working. If not, the plan changes.

  4. You’d involve the right professionals or resources as needed. All members of your care team would communicate with you and one another. Everyone shares the same view of your overall treatment plan, even if each person is responsible for only a particular part.

  5. Nothing would be missed. If you became stuck or lost, you’d get back on track. All treatment would be appropriate to your needs.

We refer to this as comprehensive care, where all the necessary pieces are accounted for as part of a unified whole.

The Plan

What does taking a more active role in your treatment look like? It doesn’t mean you’re going to replace your doctors or other treatment providers—far from it. You’re going to learn to work with them, even to do some things they can’t. Together, as a team, you can get closer to achieving comprehensive mental health care.

To accomplish this, we’ll help you do several things:

  1. Demystify mental illness. A basic understanding of mental illness is the starting point. We’ll try to clear up some common misconceptions and bring to light the most salient aspects of mental illness.

  2. Understand the mental health system. Understanding some of the key pieces, the priorities, and the failures in the system will help you make the most of it and avoid frustration.

  3. Communicate. You’ll learn how to benefit from interviews with mental health providers, ensuring treatment decisions are based on the most accurate, important, and relevant information.

  4. Engage with professionals. You’ll learn how to access and productively work with a variety of treatment providers, not only counsellors, psychologists, and psychiatrists, but especially family doctors.

  5. Understand treatment options. Knowing what different options are available and how they work allows you to suggest alternatives and maximize the effect of recommended treatments.

  6. Manage treatment. Instructions, ideas, and opinions may come at you from many directions. Capturing them, organizing them, and sharing them with everyone involved can help increase collaboration, avoid missing essential steps, track progress, and speed up the entire process. We’ll describe a tool called a living treatment plan that can help you with exactly that.

We didn’t say this would be easy. You will have to learn a few things, but in a very focused and directed way. On the plus side, while mental health professionals have to learn a lot of things to help a lot of people, you will only need to learn enough to help you. And while all this research, communicating, and managing will take a bit of time, you’re only doing it for one person.

Using This Book

This book is divided into three parts:

  1. A Primer on Mental Illness. The first part will quickly run through the basics of mental illness. What is a mental illness? What causes it? How is one person’s mental illness different from someone else’s? How is a mental illness diagnosed? You’ll also get a very high-level picture of the mental health system, the people in it, and some of its challenges. Depending on what you know to start with, you may want to quickly skim through this part.

  2. Navigating Your Care. The second part will help you take a more active role in your own treatment. This is the core of the book. You’ll learn what to expect, the questions to ask, and the many things you can do to make the whole process work to your advantage. You’ll learn to work and communicate effectively with doctors and others, helping them, and helping you. We’ll touch on waiting lists, interviews, finding reliable health information, and keeping track of the big picture in a living treatment plan. This part will teach you what you need to become a full partner in your own treatment.

  3. Treatments. Finally, the last part will introduce you to the wide range of treatments that can help with your mental illness. Yes, we’ll talk about medications and therapy. You’ll learn what antidepressants do and what makes one different from another. You’ll learn about different psychotherapies, what they’re used for, and how to find the right provider. You’ll also learn about many other things that can improve or worsen your mental health: vitamins, supplements, exercise, caffeine, cannabis, and diet, to name just a few. There’s a lot here, so you’ll probably focus on only one or two parts at a time. It’s the place to go when looking for ideas to bring forward or learning about treatments others suggest.

Each chapter is broken up into small sections, which should make it easier to skim over some parts and spend more time on other portions that you feel better suit your needs. To the extent possible, we’ve tried to minimize situations where you need to have a good understanding of the material in an earlier chapter to make sense of later material.

Throughout the book, you’ll find pockets of extra information that go into a bit more detail or help provide a deeper understanding of a topic. You’ll be able to spot them because they’re set off a bit from the rest of the book. This paragraph is an example of how they are formatted. These are optional. You can skip them entirely and you won’t be missing anything critical that you’ll need later.

You’ll also find footnoted material collected at the end of the book. It will often point you to various articles, books, or websites that delve much further into a very specific topic. These include research on the effectiveness of different treatments.

Crucial Warning

We cannot emphasize enough how important it is for you to make changes to your medical or mental health treatment only in conjunction with your family doctor or other mental health professional.

We firmly believe in taking an interest in and accepting responsibility for your own healthcare. But you also should respect that you don’t have the years of education and experience, or the perspective of trained professionals who have devoted their careers to this.

Mental illness can sometimes look simple, but it’s not. For example, there’s a big difference between feeling down and having clinical depression. Your brain is a complicated organ, intimately tied in with other body systems in a complex feedback loop. Making treatment decisions has consequences for your mental and physical health. Your doctor, in particular, has the background and training to anticipate and recognize those consequences.

While you will learn a lot about some of the causes and treatments of mental illness in this book, it only just scratches the surface. It’s not a substitute for the expertise and judgment of professionals. Remember that mental illness can sometimes impair your judgment or cognition. Discuss, debate, challenge, agree, or disagree, but never make actual changes on your own.

The Payoff

All the effort you put into this will pay off. You’ll be able to collaboratively come up with an effective treatment plan for your mental health concerns. You’ll feel better faster. You’ll get your life back more quickly. If you’re on a waiting list to see a psychiatrist, your family doctor would like nothing more than to cancel the referral because it’s no longer needed. The psychiatrist and the other people on their waiting list probably wouldn’t mind either.

Even if you don’t find a perfect solution, you’ll certainly be further ahead than when you started. And knowing what hasn’t worked will be valuable information to help the next professional you see find the right treatment for you. You’ll also be a lot better informed and able to actively collaborate with your treatment providers.

Mental Health 201: Real-World Treatment Essentials

Now Available! A MSP-supported live course for BC residents based on the book. [Mar/2023]

While you can read it for free online, there are conditions on sharing it with others (see below).
You can also still purchase copies in paperback or e-book (PDF, Kindle, Kobo, etc.).

Discover more practical mental health resources:
www.bcpsychiatrist.com
/BCPsychiatrist /BC_Psychiatrist

Mental Health 201: Take Control of Your Mental Health

Now Available! A MSP-supported live course for BC residents based on the book.