Mental illness: available treatments

Treatment for mental illness often involves a combination of approaches, which may be offered by different healthcare professionals in Australia. A team approach often works best, especially for people with more severe illnesses.

The main treatments for mental health problems include self-help measures, medicines and psychological (talking) therapies. Treatment will vary depending on your diagnosis.

Medicines for mental illness

Although medicines are not a cure for mental illness, they can relieve or improve symptoms in most people with mental illness. If the first medicine your doctor prescribes is not helpful, there are usually several other options that may work better for you.

For some people, medication is only needed for a short time. Others may need ongoing, long-term treatment with medicines to help them live with their illness.

Medicines available for mental illness include:

When prescribing medicines for mental illness, your doctor will take the possible side effects into account. Your doctor will aim to prescribe the most effective medicine with the fewest side effects.

Psychological treatments

'Talking' treatments, or psychological therapies, are effective for a range of mental health problems, and can be combined with other treatments.

There are many different psychological treatments available, and some are more well-known and widely used than others. Some of the many available therapies include the following.

Cognitive-behavioural therapy (CBT)

CBT is based on the idea that the way that we feel and behave depends on how we think about and interpret experiences. CBT can help you discover how thoughts, feelings and behaviour can get stuck in unhelpful patterns.

During CBT you work with your therapist to identify negative thinking patterns and develop alternative ways of thinking and acting. This can help reduce stress, as well as improve your coping abilities and self-esteem.

CBT is not a passive experience. At times your sessions may make you feel uncomfortable and you will likely be asked to do ‘homework’. To get maximal benefit from counselling you will need to commit to the process.

CBT is often used in the treatment of depression and anxiety.

Counselling

Supportive counselling is appropriate for treating milder forms of mental illness, such as grief reactions. It involves talking about your difficulties on a one-to-one basis with a a counsellor, who will listen and give you support. The counsellor may also offer you advice on how to deal with problems in a practical way.

Problem solving, where people learn better ways of dealing with seemingly intractable situations, is a very useful form of counselling. Activity scheduling, involving the time-tabling of exercise, pleasant and purposeful activities, is another commonly used technique.

Interpersonal psychotherapy

Interpersonal psychotherapy examines how you relate to other people, and how this affects the way you think, feel and act. You work with a therapist to develop more positive ways of interacting, and by strengthening communication skills and self-esteem, this form of therapy can help improve interpersonal relationships.

Psychoanalysis

Psychoanalysis is somewhat similar to counselling in that it involves one-to-one communication with a professional, but it is much more intensive. A psychoanalyst will encourage you to explore your feelings in depth, particularly in relation to how these feelings relate to experiences you have had early in your life. Psychoanalysis is very often a long-term treatment.

Group therapy

Sometimes people who share a common problem, for example, substance abuse or social anxiety disorder, may benefit from working together in small groups to resolve their difficulties in a supportive environment under the guidance of a professional.

Online treatments

There are several online treatment programmes available in Australia that can be helpful to people with mild-to-moderate depression or anxiety. These programmes are especially useful for people with limited access to psychological services. Examples of online treatments include counselling or psychological therapy, support services and group chats and information sessions.

Self-help for mental illness

We all know that a healthy lifestyle helps improve our physical health. But did you know that lifestyle adjustments such as eating a healthy diet and getting enough physical activity and adequate sleep can help your mental health too?

It’s also important to avoid alcohol and drugs, which can make symptoms worse when you have a mental illness. If you need help with this, talk to your doctor.

Stay connected with your friends and family - having a close support network is important for maintaining mental health. You may also want to consider joining a support group. Talk to your doctor or search the internet for a local support group, or join an online group. Talking to people with similar mental health problems can make a big difference to how you feel.

Once you are feeling well again, it can sometimes be tempting to stop medicines or skip appointments. But keeping to your treatment plan is important to stay feeling healthy. You can always talk to your doctor, nurse or therapist about your treatments and whether a change or break is recommended.

Who should I turn to for treatment of mental illness?

If you’re experiencing a problem that may be related to mental health, your general practitioner (GP) is usually the best person to turn to for help. Your GP can help work out whether your symptoms are part of a mental illness, or whether they are caused by something else (such as an underlying physical illness, a medication side effect or a normal reaction to current life circumstances).

If you or someone you know is very distressed or you think they may be a threat to themselves or to others, the best place to go is the local hospital emergency department. You can call 000 for an ambulance. You can also call Lifeline or other support lines - see the table below.

National Helplines
Lifeline (24 hours)13 11 14
Kids Helpline (24 hours)1800 55 1800
MensLine Australia (24 hours)1300 78 99 78
SANE Helpline - mental illness information, support and referral1800 18 SANE (7263)

 

Mental health specialists

Many people with mental health problems are treated primarily by their GP. Some GPs with a special interest in counselling can provide psychological treatment. Alternatively, your GP may refer you to a psychologist or psychiatrist for additional treatment.

Psychiatrists are fully qualified medical doctors with specialist training in how to diagnose and treat mental illness. Psychiatrists work in hospitals, community mental health centres, and also in private practice. Psychiatrists are able to prescribe and monitor medicines, and can also offer psychological therapy. You need a referral from your GP to see a psychiatrist.

Psychologists and counsellors are professionals who specialise in counselling and interpersonal therapies. Some psychologists undertake extra training to become specialist clinical psychologists. Some psychologists hold PhDs and are thus called doctor, but they are not medical doctors, so they do not prescribe medicines. Psychologists work in both community health centres and in private practice.

Many other professionals such as social workers, mental health nurses and occupational therapists may hold counselling qualifications and often play an important role in treating mental illness.

Community support is an important aspect of treatment for mental illness, and ongoing support and treatment can be provided by a community mental health service clinic.

Choosing a therapist

The most important question you should ask yourself if you decide to see a psychological therapist is whether you will be able to develop a good relationship with them. If you establish rapport with the therapist and have a positive attitude towards the treatment, the treatment will be more likely to benefit you.

You should also ask about the therapist's training, experience and the treatment approaches they use. A referral from your doctor will help ensure that you see a therapist with appropriate expertise.

Medicare rebates for psychological therapy

You don’t need a referral to see a psychologist, but you do need one if you want a Medicare rebate for least some of the cost of your sessions. Medicare-funded psychological services, provided by registered psychologists, are available under the Australian Government’s Better Access to Mental Health Care initiative. This programme allows you to claim up to 10 individual and 10 group therapy sessions each calendar year.

You need to be referred by a general practitioner (GP), psychiatrist or paediatrician. Your GP will need to complete a detailed Mental Health Treatment Plan before referring you to a psychologist.

Hospital treatment for mental illness

Most treatment for people with a mental illness will be carried out in the community. Treatment in hospital is usually only required when a person is very ill and needs intensive treatment and/or supervision. In the majority of cases, treatment in hospital is only required for a few weeks.

One treatment that can be given in hospital is electroconvulsive therapy (ECT). This treatment is usually reserved for people with very severe depression that is resistant to other treatments, especially where doctors believe someone may be at risk of suicide. It can also be used to treat bipolar disorder and schizophrenia.

ECT involves giving a person a general anaesthetic and muscle relaxant, and passing a small dose of electric current through the brain. It can be highly effective for people who have not been helped by other treatments. ECT is painless, and can only be given if the person consents to having the treatment.

Talk to your doctor about the various treatments available for mental illness. Working together with your doctor and other health professionals is the best way to get on the path to recovery.

References

1. Royal Australian and New Zealand College of Psychiatrists. Psychiatrists and psychologists: what’s the difference? (updated Jun 2016). https://www.yourhealthinmind.org/psychiatry-explained/psychiatrists-and-psychologists (accessed Oct 2018).
2. Royal Australian and New Zealand College of Psychiatrists. Psychological treatments (updated Jun 2016). https://www.yourhealthinmind.org/treatments-medication/psychological-treatments (accessed Oct 2018).
3. Australian Psychological Society. Better Access to Mental Health Care: Medicare funded services. https://www.psychology.org.au/for-the-public/Medicare-rebates-psychological-services/Medicare-FAQs-for-the-public (accessed Oct 2018).
4. Royal Australian College of General Practitioners (RACGP). e-Mental health: a guide for GPs. https://www.racgp.org.au/your-practice/guidelines/e-mental-health/ (accessed Oct 2018).
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