Challenges & Choices: Finding mental health services in Ontario
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You may decide to talk to a co-worker, friend or a spiritual adviser about a mental health difficulty, without formally using the mental health system. But if you do decide you want to use the services available, you will likely need to have an assessment. This evaluation will help identify the types of difficulties you are having. It will also help determine the kind of services you think would be helpful.
General practitioners, psychiatrists and psychologists are the only health care providers who can give an official diagnosis. These professionals should explain the diagnosis, the kind of treatment being suggested and the reasons for this type of treatment. (If they don't explain, make sure you ask them their opinion before you leave the office.)
Other health care professionals, such as nurses or social workers, can assess your situation but can't make a diagnosis.
Question: Do I need a diagnosis to get treatment?
Answer: You don't necessarily need a diagnosis to get treatment. However, it may be helpful to get a thorough assessment and diagnosis to help direct your treatment. If you have information about your condition, you'll have a better idea, for instance, if you need medication, or if there is a certain kind of therapy that would be most helpful.
But even if you get a diagnosis, it may change or be interpreted differently, depending on the doctor who is assessing you. Some conditions are difficult to diagnose, and sometimes the only way to figure out what you are dealing with is to see how the condition develops over time.
Assessments usually involve a conversation with your health care provider. Sometimes you'll need to fill out a questionnaire.
During an assessment, you will likely discuss things such as:
- why you have come for help, what kind of help you are looking for and what has helped in the past
- what condition you are in physically
- what problems you have been having, and how long they have lasted
- if you've experienced or seen violence (e.g., physical or sexual assault, war), even if it occurred years before
- if there is a history of mental health problems in your family
- what your life is like: how you feel, what you think, how you sleep, if you exercise and socialize, how you do at school or work, how your relationships with friends and family are
- if you've come to Canada in the last few years, and/or if you've come from a war-torn country
- what, if any, medications you are taking and
- any other topics you would like to discuss.
Assessments can go many ways. You may decide you simply need more support during stressful times. You may need to find affordable housing. You may need to find meaningful work and adequate pay. Or the person giving the assessment may recommend that you see a therapist or that you start taking medication. He or she could also encourage you to seek other types of services.
Family doctors, or general practitioners (GPs), are often the first professionals that people talk to about a mental health problem. In fact, family doctors spend up to half their time identifying and treating mental health problems. Doctors are able to examine your physical health and rule out problems that could be adding to or affecting changes in your mood, thinking or behaviour. They may ask some questions about your symptoms and what kind of stress you are coping with.
Sometimes doctors can do a full psychiatric assessment, particularly for the more common conditions, such as depression or anxiety. Other times, doctors will suggest that you see a psychiatrist, because psychiatrists have specialized training in identifying and treating mental health problems.
Community agencies can also offer assessments. The type of assessment will depend on the health care provider available. Sometimes this may be a doctor, psychologist, social worker or nurse. But in smaller cities and rural areas, you are more likely to be seen by a community mental health worker. This person will match your needs with the services available at the agency.
Social workers and community mental health workers tend to focus on the social situation that may be affecting your mental health (e.g., poverty, family situation, work, support systems, if you have violence in your life). They also examine what supports you need to cope or manage better in the community. If you have a serious mental health problem, you will likely also need to see someone who is medically trained, such as a family doctor or preferably a psychiatrist. This doctor will assess your need for medication or other medical help.
Even if you believe you've identified your problem after reading or hearing a description of it, it's a good idea to get an assessment from a psychiatrist. Family doctors often have a list of psychiatrists they can refer you to. (Psychiatrists almost always need a referral from a doctor before they can see you.) After you book an appointment, you may have to wait about two to three months to see a psychiatrist.
Question: My psychiatrist said that I have X diagnosis, but I don't agree. What should I do?
Answer: If you don't agree with your diagnosis, you should ask your family doctor to refer you to another psychiatrist for a second opinion. People often don't ask for a second opinion because they don't want to offend their doctor. But in reality, most doctors are open to their clients seeking another perspective and may even suggest it themselves.
Remember, it's your health, and you have the right to get another opinion.
For more information on specific types of disorders, contact the Canadian Mental Health Association (CMHA), Ontario Division. Descriptions of these disorders can be downloaded from their Web site at www.ontario.cmha.ca
If you are in a crisis or can't wait for an appointment, go to the emergency department of a nearby hospital. But be prepared for a long wait! You may want to bring someone to keep you company who can help look out for your best interests.
You will first be seen by a nurse. If the nurse determines that there is concern for your safety, you will then be seen by the emergency room doctor. Based on his or her assessment, the doctor has three options, to:
1. release you
2. refer you to a mental health professional or
3. admit you to the hospital.
If the situation does not require immediate medical care, the next step may be for you to get a more in-depth assessment from a crisis worker. This person is often a nurse or social worker. If the worker thinks that you will be able to manage safely out of hospital, he or she may direct you to outpatient or crisis services. The crisis worker may set up an appointment with you for a couple of days later to see how you're doing.
Challenge: There are few, if any, mental health services in my community.
Suggestions: In areas that don't have many services, you will probably be referred by your family doctor to a local hospital or health centre. If there are no psychiatrists on staff at the hospital or centre, you may be seen by a visiting psychiatrist.
Videoconferencing is another way to get an assessment. It allows you to benefit from the expertise of a professional not in your area, without either of you having to travel.
If you don't have a family doctor, you can go to the emergency department of the nearest hospital.
Challenges & Choices: Finding Mental Health Services in Ontario