What are the different options?
Great advances have been made in understanding mental illness and sufferers today are much more fortunate than they would have been only a few decades back. Today a range of treatment options are available and they have proven to be useful in treating even the most severe of conditions. It is important to realise that different combinations of treatment work for different sufferers. Hence, it may be necessary to try out different treatments and see what works best for you.
Mental health services have also evolved in their approach. Research now shows that prolonged admission of sufferers, as was previously done in asylums, isn’t as effective as community-based care which involves offering treatment while keeping sufferers in their home environment. This enables sufferers to develop coping skills as treatment continues, without isolation and worrying about how to reintegrate into society. However, sufferers may have to be hospitalized in some cases in order to help recovery.
Treatment options can be divided into six main categories:
- Talking therapy
- Electroconvulsive therapy (ECT)
- Rehabilitation centres
- Alternative therapies
- Peer support therapy
Medications (psychopharmacology) are prescribed by psychiatrists. They help in cases when the symptoms of mental illness have become so severe that they are causing significant distress to the sufferer. However, unlike medications for physical illnesses, psychiatric medications are not a cure but are useful in controlling and managing the symptoms of the mental illness. They should be used in combination with other forms of treatment in order for the sufferer to undergo a complete recovery. In addition, there is no set regimen for a particular condition. Some medications may work well with one sufferer but have no benefit for another, even if they are diagnosed with the same condition. Usually psychiatrists experiment with different medications in order to figure out which ones work best for their patients. This procedure is normal and, despite the inconvenience, the compliance of the sufferer is crucial.
Psychiatric medications are of several types, the most common of which are:
- Antidepressants: Used for dealing with the symptoms of depression.
- Anxiolytics: Help to ease the symptoms of anxiety.
- Mood stabilizers: Serve to control the symptoms of mania in bipolar disorder.
- Antipsychotics: Used to control the symptoms of psychosis.
Despite their different categorisations, different medications can be alternated in order to deal with different conditions. For example, some antipsychotics can help with mania and depression, whereas some mood stabilizers are also used to treat depression.
Another fact to come to terms with is that mental illness may be a chronic illness and therefore require long-term medical care, similar to diabetes and hypertension. If you stop your medication for hypertension, your blood pressure can increase, leading to the onset of a stroke. Similarly, if sufferers stop taking the antidepressants prescribed to them, no matter how well they are feeling, it can lead to a relapse. With some mental health problems, like depressive and anxiety disorders, it is possible to be slowly weaned off medications after a relatively long period of stability. However, this needs to be done under the guidance of and after consultation with a psychiatrist. Therefore, compliance with medications is important, even if you feel that you have recovered.
It is a well-known fact that psychiatric medications have certain side effects that may cause great distress. This fact greatly discourages sufferers from taking medications and is also used by other people to discourage sufferers from continuing with the medications. It is true that psychiatric medications have side-effects, but so do medications for other illnesses. It is important to see whether the improvement of a patient’s mental health outweighs the side-effects caused by the medications. If this is the case, it is advisable to continue the medications. If not, the sufferer can inform their psychiatrist who can change the medication to one which has fewer side effects.
Talking therapy (psychotherapy) is usually conducted by therapists (psychologists and counsellors), although some psychiatrists are also trained to conduct therapy. Since mental health problems are often caused by neurochemical changes in the brain, it may seem strange how merely talking about our problems can help alleviate them.
If we go back to the section on the nature of the brain and its inherent neuroplasticity, we will recall how our experiences cause changes in the chemical structure of the brain. This is how prolonged periods of unhappiness can turn into mental illnesses. However, it is this very nature of the brain that enables it to heal again through experiences which have a positive effect on it. One such positive experience is talking therapy. Research has shown that a series of therapy sessions with a trained therapist can heal the brain by causing changes in its chemical structure.
Talking therapy helps us deal with our problems by accessing the emotional traumas that are present in our subconscious. As discussed in the emotional health section, the subconscious part of our consciousness consists of all those thoughts, memories and feelings that we are not aware of and often repress because they are too traumatic to deal with. However, these unpleasant subconscious processes exert an influence on the conscious part of our consciousness. This eventually causes us to think and act in a way which may cause distress to us and the people around us. Therapy helps us to bring these traumas from the subconscious to the conscious, to come to terms with them and eventually stop them from having a negative influence on our conscious and, subsequently, our life.
Therapy is of various types (cognitive behavioural therapy, supportive therapy, psychodynamic therapy) and the type is chosen at the discretion of the therapist and depends on the requirements of the sufferer. Although often therapy alone can bring great benefit to the sufferer, in cases of more severe conditions it needs to be used in conjunction with medications.
Electroconvulsive therapy (ECT) is generally misunderstood by the laymen, partly due to its scary depiction in the film industry. In the past, ECT may have seemed a bit brutal with patients thrashing about after being electrocuted. However, modern ECT is very safe and involves the use of anaesthesia and muscle relaxants to minimise risks and discomfort.
ECT is used when the patient is severely depressed, suicidal or manic and when medications and other forms of treatment have failed. It involves the placement of electrodes on the scalp and the passage of small electric shocks through the brain in order to induce a mini seizure, causing immediate changes in brain chemistry which temporarily alleviate the symptoms of the mental illness.
ECT is usually administered in the form of a set number of cycles as per discretion of the mental health professional. It is associated with side effects such as memory loss. However, side effects can be more severe if it is not conducted appropriately. Therefore, care must be taken to go to a qualified and competent mental health professional.
Rehabilitation centres involve admission of sufferers in specialized mental health care centres which offer certain services that aren’t available in a community setting. Rehabilitation centres should not be confused with asylums. Asylums resemble jails and their goal is to isolate sufferers from society, not treat them. This kind of institutionalization is extremely harmful and results in sufferers living in very bad conditions under the constant threat of abuse.
Rehabilitation centres, in contrast, are designed to help sufferers by providing them with an environment conducive to recovery. They are greatly beneficial for those sufferers who don’t have a support system at home or for whom a change in environment is essential for recovery such as those suffering from addiction.
Rehabilitation centres offer various benefits such as:
- Professional mental health care (psychiatrists, therapists, nursing staff)
- Helping to establish proper routine (sleep/wake cycle) and providing a healthy diet
- Establishing goals and helping clients to achieve them, using various evidence based tools
- Ensuring compliance with medications
- Helping with cessation of harmful habits like drugs, smoking etc.
- Encouraging group activities, causing relationships to develop between peers
- Other productive activities such as cooking, gardening, art, music etc.
Rehabilitation services are continously improving with psychiatric rehabilitation professionals forming a separate category of mental health professionals.
Research has shown that aside from conventional professional mental health services, a range of alternative forms of treatment may also greatly benefit the sufferer.
Some types of alternative therapies are:
- Art therapy utilizes the creative process to help suffers explore and come to terms with their emotional traumas, develop self-awareness, alleviate anxiety and increase self-esteem. Art therapy is particularly useful in cases of severe trauma, as it provides patients with a ‘visual language’ to use if they lack the words to express their feelings.
- Dance/movement therapy includes the therapeutic use of movement to access creativity and help ease tension throughout the body. Based on the interconnection between body, mind, and spirit, the therapy encourages self-exploration through expressive movement.
- Hypnotherapy involves sufferers being guided into a focused state of deep relaxation. The intention is to quiet the conscious so that the subconscious can awaken. The therapist suggests ideas (such as ‘heights are nothing to be afraid of’) or lifestyle changes (‘start exercising’) to the client, which ideally manifest themselves in the person’s consciousness.
- Music therapy is based on the belief that there are lots of health benefits to music, including lowered stress and increased pain thresholds. In a music therapy session, credentialed therapists use music interventions (listening to music, making music, writing lyrics) to help clients access their creativity and emotions. Through this, client’s individualized goals, such as managing stress, alleviating pain, expressing emotions, improving memory and communication, can be targeted.
- Yoga has been shown to have great benefits in helping with stress relief. It is a spiritual practice designed to promote a calm mind and an increase in self-awareness. It is particularly helpful to free sufferers from harmful behavioural patterns. The exercises can lead to greater physical and mental freedom as well as to greater control over the body and thought processes.
- Meditation involves different techniques and schools of meditation, based within different philosophies. However, all aim to quieten your mind and put you into a state of calm and stillness.
Other forms of alternative therapies that may prove to be useful are acupuncture, aromatherapy, light therapy, laughter therapy, nutritional therapy, wilderness therapy, herbal therapy etc.
Peer Support Therapy
Peer support therapy is conducted by peer specialists who are survivors with lived experience of mental illness. Peer specialists assist sufferers with mental health problems. Because of their life experience, such persons have an expertise which professional training cannot replicate. The word ‘peer’ literally means ‘friend’, which means that the relationship between a peer specialist and a sufferer is more informal and friendly as compared to one between a sufferer and other mental health professionals.
Peer specialists engage in many tasks that may include:
- Assisting their peers in articulating their goals for recovery
- Learning and practicing new skills
- Helping them monitor their progress
- Assisting them in their treatment
- Modelling effective coping techniques and self-help strategies based on the specialist’s own recovery experience
- Supporting them in advocating for themselves to obtain effective services.
Peer specialists also serve as role models for sufferers and have been shown to greatly help in their recovery. It is a new form of professional mental health service available in Western countries. Taskeen itself is a peer led mental health initiative and we aim to introduce these services in Pakistan, offering formal training and certification in the future.