*If you feel you need immediate help TODAY, call the Samaritans FREE on 116123. A trained helpline operator will be available round the clock, 24 hours a day, 365 days a year. You do not need to be suicidal to call. They are they to talk about whatever you are struggling with*
WHERE TO BEGIN? THE SIX KEY STEPS
There is a lot of great work going on in Ireland right now to combat the stigma and silence around mental health. However, there’s so much information out there that sometimes we don’t know where to begin. So I’ve put together some straightforward and detailed options on how to take your first step in seeking help.
- Talk to your doctor. If you don’t have a GP that you find warm and welcoming, get another one. Get online. You can put a shout out on your social media for recommendations of GPs that are good with mental health issues or you can privately look around instead. Boards.ie may be helpful, and Girlcrew can hopefully put out the feelers for you if you are female. If you don’t feel comfortable doing so, you can private message me on twitter and I will gladly put a confidential shout out for you.
The medical card covers GP visits and medication. Anti-depressants and other mental health medications used as directed and under medical supervision can be your friend. It is NOT weak to take a tablet if you are suffering. If you had asthma you would use an inhaler and not berate yourself for doing so. These medications are for your BRAIN, not your MIND; you cannot control the chemicals in your brain any more than you can control any other ailments. Got diabetes? You can’t THINK your way out of it! Take your insulin!
GPs are able to prescribe many mental health medications. Some are excellent with mental health, some aren’t. Some may feel comfortable and be BRILLIANT at understanding and handling mental health conditions. Some may prefer to refer you to a psychiatrist. This does not mean your issue is severe or unusual, it simply means that this particular doctor doesn’t work much in mental health and prefers to leave it to the specialists. That’s totally OK and it’s common. You can try another GP instead if you don’t want to wait for a psychiatric appointment through the HSE.
- Psychiatric appointments referred from your GP are FREE through the HSE if you are going public. Irrespective of whether you want or need medication, getting a referral to a psychiatrist or registrar in your area is worthwhile. Ask your doctor for a referral letter. Once you are in the system with the local HSE psychiatrist, they are able to then refer you to psychologists, short-term counselling (circa 6 sessions) and also CBT. All of these costs are covered by the HSE, although it may take a few months to get an appointment. So ask for a referral. By the time the appointment comes around you may not even need or want it, so you can simply cancel. But there are only positives from trying. If you feel it’s urgent and you can afford to go private, then do so. Your health is too important to postpone taking care of. If private is not an option and you feel you need urgent help, you can present at emergency A&E, day or night.
Medication can help depression and anxiety. So can therapy. But the highest success rates come from a combination of the two, according to the plethora of psychological and medical research on the issue. CBT is great but from my own professional point of view it’s important to also get to root causes of our issues to prevent them manifesting in different ways. I’m potentially biased based on it being my area of study, but the data supports this. However, CBT has a VERY good success rate when it comes to phobic or avoidant behaviour. Where CBT helps provide coping mechanisms for negative thoughts and behaviours, talk therapy deals with what causes these thoughts and behaviours for you in the first place. There is plenty of room for all of it and many therapists practice a combination of techniques. Find what suits you. Research away. Psychcentral.com is a great resource, but try not to get too bogged down. Go at your own pace.
- If you are out of work apply for a medical card immediately. If you feel you cannot work as you are too low, talk to a GP about applying for a medical card. Here’s a link to the application form: http://www.hse.ie/eng/services/list/1/schemes/mc/forms/Medical_Card_GP_Visit_Card_Application_Form.pdf
This may be a bit of a pain, the system is messy and people aren’t going to get back to you as quickly or as fake-smiley as a private business who have to prioritise good customer service. The public sector is overstretched, under-resourced and bureaucratic. There are still good people there. People just like you and me who are worn down from being caught in the middle of dealing with lack of resources from their bosses and taking calls from frustrated people they can’t help. Some are definitely rude from being battered down but many just have had to become quite detached to cope. It’s not easy feeling helpless when it’s your job to help. HOWEVER, that doesn’t mean they can’t crack out of that mindframe if you remain polite and appreciative for anything they can do to help or direct you. It’s the luck of the draw who you get on the phone. Keep trying. If it’s too overwhelming, see can someone help you make these calls. If you don’t have friends or family to ask, try the citizen’s information centre. Tell them you’ve not been well and you’re finding it very difficult and if they can help you make some calls.
NOTE: OF COURSE I’m not referring to all public service employees! I bring this up as when we DO come across somebody like that (and they are in every industry, including mine), when we are feeling fragile and looking for help, it can stop us dead in our tracks and prevent us from persisting and succeeding.
- Every town has a community welfare officer. Find yours here: http://www.hse.ie/eng/services/list/1/schemes/cwo/ As above, they are often overworked and under-supported. Try not to take bluntness or coldness personally. They’re trying to cope in a messy system and this, for most, is the only way to cope under the pressure. If you feel rushed, take a deep breath and acknowledge it. Slow down and ask them to do so too. They get a lot more negative than positive feedback, so showing compassion and kindness when people are usually annoyed with them could be the key to making them go above and beyond or think outside the box, which in turn can make things much easier and speed things up. Take as much time as you need with them. It’s *your* social welfare system. They’re not doing you a favour.
I know it shouldn’t have to be this way. On either side. But this is the reality of our system at the moment. There are hurdles. Being aware that you may not receive the most helpful or warm welcome and preparing for potential difficulties allows you to take care through the process and be mindful that you do not become overwhelmed. But you will get there. The resources are there, they just aren’t necessarily made easy to find. Take a family member, a friend, whoever you have that can help you through it. Let them know to be patient too! If they are getting irate with the speed or efficiency you do not need that kind of companionship right now. Let them know that in advance. Tell them you need them to be calm and patient if they are to be supportive.
5. FIND what is out there. There are mindfulness and meditation centres that are cheap and/or free, asking only for a donation if you have it.
If you are in college, see if you have free consellors on campus and get your name down. If your work was a therapist, speak to HR and get an appointment.
Google group therapy sessions and/or support groups. It can be incredibly powerful knowing there are other people feeling just like you, and meeting with them weekly or whenever you are capable, can allow for a sense of community that is extremely supportive and reassuring.
Remember – if you are on disability allowance, which absolutely covers mental health issues including depression and anxiety, you are also entitled to a free travel pass. So if public transport isn’t difficult for you then you have scope to access numerous groups and services further afield than may be available in your area. Here is the link to that application form:
- Talk therapy
For those of us struggling financially, there are numerous trainees that can offer cheap services in centres around the country. Some trainees are just as good to talk to as therapists with 10 years’ experience, dependent on the person. They are mid training so very focused on each session and are attending weekly supervision to discuss how best to help their clients. It really is all about feeling comfortable with the therapist and having a safe place to speak and be heard. But if they don’t seem very good and you really don’t find it helpful, try elsewhere. There are sub-par therapists just as with every profession. Don’t give up on therapy based on the experience of a bad therapist, or a lack of comfortable connection with a therapist.
Therapist/client relationships are like any other – you need to feel a safe, positive connection in order to open up.
If the therapist doesn’t seem like the one for you – ask yourself why? Remember – Everyone experiences resistance to certain elements of therapy – a lot of the best work is discovering why we feel resistant. If you feel like you can, tell the therapist you’re feeling that way. If there is still little comfort with them and you don’t think it is resistance, try someone else. Always remember, YOU are the expert of you. Your mind is a big black hole to therapists at the beginning. Good ones will make connections and start to help you make sense of your thoughts and feelings. But that does not mean they know you better than you do yourself or will get it right every time. Nobody can get it right every time! So don’t be afraid to talk back. Trust your instincts and tell your therapist if you feel what they’re saying doesn’t resonate or ring true for you. No GP, psychiatrist or therapist is an authority on YOUR life experience. They are simply trained in the workings of the body and/or the mind; they are there to facilitate you discovering what helps, and what doesn’t. Believe in yourself . Therapists are trained to help you find answers, but they don’t automatically have them. You must work together. You are unique and so is your story, therefore nobody’s emotional response to the world is the same as someone elses.
NOTE: The same applies to medication. Everyone is unique, so a medication that worked wonderfully for one person, may not work for you. Just like with any medication, you may need to try a few before you find the right fit. Don’t give up hope. Stay in touch with your doctor and let them know how you are getting on with the medication. A good doctor will make sure that they are checking in while you are changing, or beginning, medication.
NEVER stop a medication cold turkey. It’s unsafe and could make things worse. If you want to come off, wean off based on your doctor’s advice. And just like with a therapist, if you don’t like your doctor, try for a new one or utilise that psych referral. Second opinions are just as important with mental health as with physical. No matter what the qualification, mental health professionals are human, and nobody has ALL he answers ALL the times. Allow for that.
If you can afford therapy, shop around for who feels right for you. The average therapist costs between €50 – €100. That doesn’t mean you can’t ask if their fees are negotiable based on your budget. For example, my session rates are €60, but €40 for those who are students or unwaged. Don’t be afraid to ask. It’s completely common and in no way frowned upon. The usual unspoken response from any decent practitioner will be “fair play to them investing in therapy when money is tight – that’s some emotionally mature behaviour right there!”.
If you find someone online you are interested in, check out their accreditations and what type of therapy they practice. E.G., a psychologist or psychiatrist may not have talk therapy training despite being PhD’s. A counsellor or psychoanalyst with 20 years’ experience may have never studied psychology outside of a talk therapy setting. (If this sounds a bit overwhelming, DM me and I can help direct you). The right fit also applies to recommendations. Just because your friend loves her/his therapist doesn’t mean their style suits YOU.
REMEMBER: If you are completely broke, do not fit criteria for any benefits or medical card, there are still plenty of options for free services. While it may take time to get into the system for free psychiatric care or CBT, there are free counselling services, helplines, organisations and support groups. Google is your friend. Mental healthcare is not a luxury. It is a necessity. Find the resources wherever you can. Reach out.
There’s a lot more to cover so if you have any questions please feel free to message me and I’ll do my best to direct you. I’m not working in the public sector so my advice is based on own experience of the system and working with clients in private practice, directing them as to how to get medical help or alternative therapies within their price range. Personally I’ve tried numerous therapies myself, and this has helped me realise, more than ANY of my training over 7 years, that possibly the most important factor in your healthcare is that you feel safe and supported by the people you are turning to, irrespective of their area of expertise.
I know there’s a lot of info here and it can be overwhelming. So for now, just start at step one. Reach out. ONE STEP AT A TIME!
Good luck. You’ve got this. And if you need help or feel fearful of getting the ball rolling, give me a shout on twitter @bebhinnfarrell1 . I can offer limited time off the clock, but I’ll do what I can and will ALWAYS reply to an email.
If you would like to book an appointment email bebhinnfarrelltherapy@gmail.com
Bébhinn Farrell Psychotherapy 