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Mental Health

Working with your Doctor When You Have a Mental Illness

 

Author: Canadian Mental Health Association, BC Division

 

photo of a woman talking to a doctor online

Talking to a doctor or your health professional about a mental illness is a very important first step. It's the beginning of your journey to wellness. Once you've received a diagnosis, you and your health professional will need to build a treatment plan that works for you. This is vital—if your treatment plan doesn't address your own needs and concerns, you may not see the benefits in areas of your life that are most important to you.

What mental health professionals might I see?

You will likely encounter different mental health professionals on your recovery journey. They have different kinds of training and offer different services and supports. Here are the professionals you might see:

  • Family doctors or general practitioners (also called GPs) are medical doctors. Family doctors are the people you'd see first for most health concerns. You may already have a family doctor, but you can also talk to a family doctor at a walk-in clinic. They are also your first step in navigating the mental health system. Family doctors can diagnose mental illnesses, prescribe medication and refer you to specialized services. Nurse practitioners (NPs) can do much of what family doctors can do and often work alongside one in a family practice.

  • Psychiatrists are also medical doctors who specialize in mental health. They can diagnose mental illnesses, prescribe medication and provide different psychotherapies. Many psychiatrists work at hospitals or mental health centres. Your family doctor can refer you to a psychiatrist.

  • Registered psychologists can give a diagnosis and provide different psychotherapies, but they don't prescribe medication.

  • Counsellors (such as Registered Clinical Counsellors or Canadian Certified Counsellors) provide a clinical assessment and psychotherapies.

  •  

If you have a mental health team or use services at a mental health centre, professionals like social workers, registered nurses, occupational therapists, and vocational rehabilitation therapists may help you learn new skills and achieve your goals.

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How do I work with these health professionals?

The most effective way to take charge of your health is through shared decision-making, which means you and your doctor (or other health care professional) work together to make a treatment plan that works for you.

Some people prefer to be very involved in their care while others prefer less direct involvement. And your role may vary depending on the stage of your illness you're at, such as when you've been recently diagnosed or when have a lot of experience with your illness. Regardless of your preferred level of involvement, you do need to be involved in some way.

A mental illness can affect how you interact with your health professional. It can affect your memory and concentration. It's helpful to look for ways to keep track of everything so you have the information when you need it. You could use apps on your phone to take daily notes, track changes in your mood, write down questions you'd like to ask at your next appointment, and set reminders so you don't forget appointments. Some people carry a notebook with them. Online screening self-tests are another great tool: you can print out your screening results to bring to appointments. (This can be a great strategy if you have a hard time talking about your symptoms or experiences.) Some people also find it helpful to bring trusted family members or friends to appointments.

Shared decision-making is a series of steps that lead to an effective treatment plan for you. These steps are:

  • Defining the problem. Your role is explaining the problem in your own terms.

  • Setting goals. Deciding what the goals of treatment will be, or deciding what will happen as a result of treatment.

  • Making decisions. Developing and deciding on treatment strategies. You’ll want to balance the advice of the mental health professional with your own expectations and priorities for treatment.

  • Monitoring results. Evaluating whether strategies are working, and re-assessing the treatment plan as needed.

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Step one: Defining the problem

When you go to see a mental health professional, they will talk with you to assess your problem. Your job is to give as much information as you can in your own words to give the doctor the full picture of what's going on. Your doctor will also need to know what you’ve experienced in the past and what treatments you've tried in the past.

It's also important to talk about how your mental health is affecting different areas of your life, such as your job, your home life and your relationships. For example, do you have a hard time concentrating at work? Do you spend less time with family and friends? Do you feel like you don't have the energy for social events? Are you less certain that life is still worth living? This information will help health professionals understand your experiences.

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Step two: Setting goals and making decisions

Before you decide on a treatment strategy, you need to think about what you want to change. Your eventual satisfaction with your treatment plan will depend on whether it helps you deal with the way a mental illness impacts your life.

Your job is to explain what you hope to achieve as wells as what doesn't work for you. For example, if you feel best when you can work, you may not be satisfied with a medication that makes it hard to get up in the morning. However, if your doctor understands your priorities, they can recommend a better option.

You'll need to be open to advice from your health professional. Ideally, you can communicate your own concerns, listen to new information and perspectives, and then come together to find a treatment strategy.

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Step three: Making decisions

Now that you've decided what you want to change, the next step is figuring out how you're going to change it. Deciding on a treatment plan that you can live with involves different parts:

  • Considering the evidence

  • Considering your own preferences and values

  • Considering other people’s experiences

Considering the evidence

When you consider an option for treatment, you need to know some basic facts about the treatment. You need to find out how the approach works, how long it will take to work, what the potential risks and benefits may be, and whether it's an appropriate choice for you. Here are some questions to keep in mind when you consider the evidence, whether it came from your doctor, another health professional, or you came across it on your own:

  • What are the potential risks or benefits? How probable are the benefits? How probable are the risks?

  • What might happen if you do nothing?

  • How do the benefits and harm weigh up to you? What risks are you willing to take to achieve your goals?

  • Do I have enough information to make an informed choice? Are there any options or perspectives you haven't considered?

If you're considering information you heard from a friend or information from the media, online, or a book, check out our info sheet Evaluating Mental Health and Substance Use Information at www.heretohelp.bc.ca.

Considering your own preferences and values

You will need to consider all the things that influence your thinking, including your personal values, culture and background, emotions, and attitudes about your illness and potential treatments. For example, some people have concerns about medications, like concerns about becoming too reliant on medication or fear of side effects. Talking about your preferences and concerns help your health care professionals understand your perspectives and help you look at your concerns more realistically.

Considering other people's experiences

Other people's experiences can provide a lot of valuable information, and can often provide reassurance. It's best to talk to several people, not just one or two, to get a variety of perspectives. Everyone's situation is unique, but there are often things in common. Support groups are a good place to learn from others. You can also find stories of other people's experiences in books and online.

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Step four: Monitoring results

Once you've developed your treatment strategy, your next role is to help monitor the results. For this, you'll need to know when and how to measure success. For example, you'll need to know how long it may take for the medication to start working or how long it may take to see results from psychotherapy. You also need a clear idea of how a treat may impact your daily life.

Once you start a particular treatment, you need to be able to tell your doctor or mental health care professional what has been happening between visits, such as side effects from treatments and changes in symptoms. It's also important to see if treatment is meeting your goals. There are many tools to help you track your progress, such as apps, journals, and charts. We've included one here, but you can use others you like better. Then when you meet with your health care team, you'll have the information you need to assess your current treatment and look into other options, if needed.

In the early stages of developing a treatment strategy, you should meet fairly regularly with your care team to monitor your progress and make adjustments to your treatment plan when they're needed.

It can be very disheartening when a treatment doesn't work as well as you hoped. It's impossible to predict exactly how a treatment will work until you try it, and that means a treatment might seem perfect on paper but fail to help once you start. It's common for people to try multiple treatment options before they discover what works best for them. It's important to maintain hope and keep trying. If you and your health care team take a systematic approach and work through options, the odds that you'll find a treatment that works are high.

If nothing seems to work, it may be a sign that you need another assessment. There may be another health problem involved or the diagnosis may be incorrect. If you feel like your health care professional is unwilling to listen to you or consider different options, it's a good idea to seek a second opinion from someone who may be able to help you better.

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Sticking with your treatment plan

Once you've arrived at a treatment plan that works, it's important to stick with it. For many treatments, this means continuing treatment even when you start to feel better.

Suddenly stopping a medication like an antidepressant or antipsychotic can cause uncomfortable side effects. If you want to stop taking the medication, your doctor can help you taper your doses slowly to make sure you continue to feel well.

If your treatment plan isn't working for you for whatever reason, have an honest discussion with your care team. Your doctor can help you re-evaluate your treatment plan and move to a different strategy safely.

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Tips for talking with your health professionals

Talking to health professionals may be intimidating, but you and your health care professional do need to work together. Your doctor can't provide the best information if they don't know what the problem is, and they can't offer the best-suited treatment options if they don't know your goals or concerns. Here is a checklist to help keep you on track during your appointments.

Before the appointment
  • Plan—Think of what you want to tell your doctor or what you want to learn from your health care professional at this appointment. Decide what is the most important to you. You can write down a list of symptoms you're experiencing and questions to bring to the appointment. If you take medications, including over-the-counter medication, plan to bring them with you or write down the medication name and dose.

During the appointment
  • Report—Tell your doctor what you want to talk about during this appointment.

  • Exchange information—Tell the doctor what’s wrong and listen to your doctor's advice.

  • Participate—Talk with your doctor about the different ways to handle your health problem. Make sure you understand the positive and negative aspects of your choices. Ask as many questions as you need.

  • Agree—You and your doctor agree on a treatment plan that you can live with.

  • Repeat—Tell your doctor what you think you will need to take care of the problem.

Adapted from the Institute for Healthcare Communication's PREPARE program at www.healthcarecomm.org

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Activity: Tracking your progress

Keeping track of symptoms as well as factors that seem to affect your symptoms is a good way to look for trends over time. This can help you see your progress, see what helps you make good progress, track your response to different treatments, and narrow down factors that make symptoms worse. It's a great tool to bring to health care appointments because it's easy to see how your treatment is working and how you feel between appointments—and you don't have to try to remember everything.

An easy system in a simple chart that tracks daily factors like symptoms, sleep, exercise, and treatments. Make it relevant to your experience—if you experience changes in symptoms around your menstrual cycle or mood changes related to the seasons, for example, make sure you include those factors in your chart.

There are also free and paid mood journal apps, such as Daylio and Mood Tracker.

Here is an example of a tracker for someone who experiences depression:

Mood influences
Mon
Tues
Wed
Thurs
Fri
Sat
Sun
Medication (dose)

Effexor 150mg

Effexor 150mg

Effexor 150mg

Effexor 150mg

Effexor 150mg

Effexor 150mg

Effexor 150mg

Counselling

none

none

1 hr appt

none

none

none

none

Skills I practiced today

10 min mindfullness meditation

thinking traps worksheet

10 min mindfulness meditation

none

10 min mindfulness meditation

none

10 min mindfulness meditation

Sleep

6.5 hrs

6 hrs

7 hrs

7 hrs

7.5 hrs

8 hrs

8 hrs

Exercise

30 mins

30 mins

none

30 mins

none

1 hr

none

Overall stress level

2

2

3

3

2

1

1

Alcohol

none

none

1 drink

none

2 drinks

2 drinks

none

Work time

5 hrs

5 hrs

6 hrs

5 hrs

5 hrs

none

none

Overall mood

3

3

2

2

3

4

3

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Where do I go from here?

Your doctor or mental health professional can recommend resources in your community. In addition to professional resources, you may find non-professional support helpful.

BC Partners for Mental Health Substance Use Information

Visit www.heretohelp.bc.ca for more info sheets on depression and mood disorders, self-tests and personal stories. visions journal, our magazine, brings together mental health professionals, people managing mental illnesses, family members, and communities. You can also find the info sheets When You're Diagnosed with a Mental Illness and Preventing Relapse of a Mental Illness.

Support groups

Support groups are an important way to find support and information. They may help you feel less alone and more connected, even if you haven't told many others about your diagnosis. You can find support groups in your community through mental health organizations listed below.

Anxiety Canada: Visit www.anxietycanada.com or call 604-620-0744. Anxiety Canada increases awareness about anxiety disorders, provides education and increases access to evidence-based resources and treatments.

BC Schizophrenia Society: Visit www.bcss.org or call 1-888-888-0029 (toll-free in BC) or 604-270-7841 (in Greater Vancouver). BCSS provides support to people with serious mental illness (not just schizophrenia) and their families,public education, advocacy and research. They have support groups for individuals and family around the province.

Canadian Mental Health Association's BC Division: Visit www.cmha.bc.ca or call 1-800-555-8222 (toll-free in BC) or 604-688-3234 (in Greater Vancouver). CMHA promotes the mental health of all British Columbians through education, advocacy, research and direct services.

Canadian Institute for Substance Use Researchh: Visit www.cisur.ca. CISUR is dedicated to research and knowledge related to substance use, mental health and well-being. For referrals to service providers, contact the Alcohol and Drug Referral Service at 1-800-663-1441 (toll-free in BC) or 604-660-9382 (in Greater Vancouver).

FamilySmart: Visit www.familysmart.ca. Call 1-855-887 8004 (toll-free) or 604-878-3400 (in Greater Vancouver). FamilySmart supports families of young people who experience a mental illness.

Jessie's Legacy eating disorders prevention and awareness: Visit jessieslegacy.com. Call 604-988-5281. Jessie's Legacy offers resources to help prevent eat disorders and support to people who experience an eating disorder.

Mood Disorders Association of BC, a branch of Lookout Housing + Health Society: Visit www.mdabc.net or call 604-873-0103. The Mood Disorders Association provides health and wellness services and maintains a network of support groups around the province.

Understanding psychiatric medications

Find information on different psychiatric medications from the Centre for Addiction and Mental Health in Ontario at www.camh.ca.

Reclaiming Your Power During Medication Appointments

Visit www.power2u.org for the article Reclaiming Your Power During Medication Appointments from the National Empowerment Center. It describes how to think about medication and work with health professionals as you work towards your treatment goals.

This is the third module in a three-part series. The other two modules are When You're Diagnosed with a Mental Illness and Preventing Relapse of a Mental Illness.

 
About the author

cmha bc logo

The Canadian Mental Health Association promotes the mental health of all and supports the resilience and recovery of people experiencing a mental illness through public education, community-based research, advocacy, and direct services. Visit www.cmha.bc.ca.

 

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