It is often difficult to admit that we are feeling down and anxious and to acknowledge that we may have a depressive or anxiety illness. No one likes to see themselves as being unwell. It’s sometimes easier to try to keep going in the hope that the symptoms will pass with time. It can be difficult to admit that we are struggling. Instead, we may prefer to put it all down to “working too hard”, “feeling tired”, or to blame “a bug”.

If a friend mentions to us that we are not managing or not looking well, we may take offence at this and decide that it is they who have the problem. It can be tempting to ignore the fact that we are becoming unwell, however if we do the symptoms are unlikely to go away and the danger is that they may get worse. Ignoring the fact that we may be ill isn’t a good idea.

Our belief is that the best approach to pastoral care for people with depression and anxiety or other psychiatric conditions is to see it in the same way as any physical illness. Depression and anxiety are not due to a lack of faith or a mistrust of God – they are illnesses and should be treated as such.

Example: Sometimes when a person feels depressed or anxious, they may say “I want to get better on my own”. But if the same person broke their leg, they wouldn’t be saying that they want to get better on their own, instead they would want to go to hospital to have the bone set, have a ‘pot’ put on it and take antibiotics to ward off the risk of infection. Probably when a person makes that comment when depressed, it’s because they have problems accepting that depression can be a serious condition.

Most people have an idea about treatments for physical illnesses: antibiotics for infection, insulin for diabetes or a plaster cast for a broken leg. Generally individuals are not so well informed about the treatments that are available for depression and anxiety. Along with the stigma of mental illness, there are often preconceived ideas about mental health treatments with stereotyped fears that are inaccurate - tablets which make you feel like a ‘zombie’ or which are addictive, men in white coats forcing you into hospital against your will, and the use of hypnosis are all common stereotypes. The rest of this short article will help you to find out more about the range of treatment options that are available.

Receiving help from the professionals.

Imagine you live in a house that has a smoke detector. One day you hear it beeping while you are watching television. What do you do? Do you ignore it and keep watching the television as if there was no problem – or do you get up, find out if there is a problem and try to deal with it? If you are in a car and the low petrol warning light comes on, you know that if you ignore it you will run out of petrol. No matter how busy you are, you will stop and put petrol in the car. In the same way, if you notice any of the warning signs that depression or anxiety are starting to cause you problems, you need to do something to prevent the problem worsening.

If the problems begin to worsen in spite of your efforts to improve things, it is time to go to the professionals. If a fire is beginning to get out of control at home in spite of your attempts to tackle it, you would call the fire department for professional help. If you ran out of petrol you would call a garage or rescue service. In the same way, if you feel worse in spite of your attempts to overcome your difficulties, get in touch with your own health care practitioner or your doctor. They are there to help you and to advise you as to whether other additional approaches such as the use of medication may be helpful.

You are best advised to talk to your doctor when you recognise that you have symptoms of anxiety or depression. Don’t wait for the symptoms to reach severe levels. In particular you should always see you doctor if:

• You are feeling persistently low, or you have lost your ability to experience pleasure in things for a period of two weeks or more.

• You notice many negative thoughts about how you see yourself, your current situation or the future.

• You have started to significantly alter what you do because of how you feel – so that you have stopped doing many routine things, or are starting to do things that are unhelpful and are adding to your problems such as drinking far more than normal or to excess.

• Important note: if you find that you are thinking a lot about suicide, or are beginning to make plans to harm or kill yourself or others, always see your doctor. Make this a priority.

Your General Practitioner/Primary Care Physician.

Everyone has access to a community doctor such as general practitioner. If you aren’t feeling well this is the best person to see first. Make an appointment and be prepared to be as honest as you can about how you feel. Pray and ask God for his help. Before your appointment you may wish to spend a few minutes thinking and/or writing down the things you want to mention. You might want to include:

• What you see as the main problems.

• How long you have felt like this.

• Your symptoms (for example your emotions, physical changes, and your extreme thinking).

• Any practical or relationship difficulties that are part of the problem.

• What you have stopped doing as a result of how you feel.

• Any unhelpful behaviours such as drinking, which you have started doing to cope with how you feel.

Take your notes along to the appointment. Don’t be afraid to look at them during your appointment – they can give you confidence that you have covered all the main areas. If the initial appointment isn’t long enough to do this, ask if you can come again for a longer appointment to talk through your concerns, or leave a copy of your list with your doctor for him or her to look at in their own time.

If you are anxious about the appointment, you may find it helpful to ask a friend to go with you. If you do this, decide before hand if you wish your friend to go into the appointment with you, to sit in the waiting area with you or to wait outside for you. Be clear with your friend about what you would prefer.

Your doctor will no doubt ask a number of different questions as part of his or her assessment. These might include questions about how you feel and about your activities as well as your present circumstances and relationships. They may ask you specific questions relating to depression/anxiety for instance about eating and sleep patterns, and if you have any thoughts of self-harm or suicide. They may ask questions that at first glance you may not realise are related to depression/anxiety. Your honest answers to these questions will help the doctor to make an accurate diagnosis and allow a suitable plan for your treatment to be put in place.

If you have had thoughts of suicide, it is important to talk about these. Don’t be worried that by admitting to these you will be immediately admitted into hospital. Fleeting suicidal ideas are common in depression. Your doctor may ask for more details about these thoughts to make sure that you are offered the right level of support. This is particularly important if you are being increasingly troubled by such thoughts and are beginning to make plans to kill yourself. Surprisingly, talking about these thoughts may bring you some relief and reduce your anxiety.

Your doctor may also suggest that you have one or more blood test. Don’t be alarmed - this is to rule out the possibility of any underlying physical illnesses that may be worsening how you feel. Some physical illnesses can cause symptoms that are very similar to those of depression and anxiety; for example, some thyroid problems can produce a similar clinical picture to anxiety and anaemia can produce low energy and make you feel tired all the time in a similar way to depression (see Chapter 4 of "I'm not supposed ...). It may take a couple of weeks for these blood test results to be processed and the results sent to your doctor.

Possible outcomes of seeing your doctor.

Your doctor may ask you to come back to see him or her at a later date - possibly for a longer appointment. This will help provide a more thorough assessment. Your doctor may suggest you start taking an antidepressant or anti-anxiety medication (see a related article in this section) and arrange to see you to review this in several weeks. In some instances, practices provide on-site access to counsellors or psychologists. Some practices may have a specialist nurse who will deal specifically with people who have problems with depression and anxiety.

Sometimes your doctor may suggest you take some time off work. If you are unwell you may not be able to function as well as usual at work and this may add to your stress. Taking time off work may be a difficult decision to make; it will depend on your symptoms and the type of work you do. If you have difficulty being around other people, you may find it is difficult when you have to work in a busy, noisy office, but you may manage if you work in quieter circumstances or on your own in a setting where you can pace yourself. Ideally if there is a colleague in whom you can confide, you could ask them for their opinion as to how you are managing. This has the advantage of providing an independent opinion rather than just relying on your own judgement that may be biased by your depression. Many organisations have good occupational health departments that will be able to see you confidentially and it can be worthwhile consulting them.

Referral to specialist workers or to voluntary sector organisations.

Sometimes your doctor may suggest a referral to another professional or a voluntary support agency who can offer specific help. In the United Kingdom some possibilities are:

• Cruse – if your problem is due to bereavement. Contact Cruse Bereavement Care, Cruse House, 126 Sheen Road, Richmond, Surrey TW9 1UR. Tel. 020 8940 4818

• Relate - if your problem is due to relationship difficulties.

• National Association of Citizens Advice Bureau -for financial advice. Use your local Yellow pages for the local branch.

• Occupational Health - if your problem is due to work related difficulties.

• Social Services for difficulties of a social nature. Contact can be made through the Yellow Pages.

• Addiction Services if there is a problem with alcohol or drugs. You can obtain details from your own doctor, or through Yellow Pages.

Another possibility is that your doctor may wish to refer you to a specialist mental health team.

What is a Community Mental Health Team?

In the United Kingdom mental health professionals often work together within a Community Mental Health Team - CMHT. Generally the team is made up of a doctor (psychiatrist), who works with several Community Psychiatric Nurses (CPN’s), an Occupational Therapist (OT), Psychologist and a Social Worker.

All of these individuals work together to assess and plan an individual’s care. Not every patient will need the full team to be involved in his or her care, and in many cases the individual may only need to be seen by one member of the team. If more than one member of the team is involved, in the United Kingdom a Care Programme Meeting will often take place at regular intervals. This is a joint meeting between yourself and the various health care practitioners you are seeing in order to make sure that everyone is clear about who is doing what, and that you agree with the treatment plan that is being offered. This can also be an opportunity to have relatives or carers present.

The following summarises the different practitioners who you may see if you are referred for specialist help. It is worth noting here that although the staff are called specialists, that shouldn’t be interpreted as meaning that by seeing one of them you are such a complex case that you can only be helped by an expert. Instead all the term “specialist” means is that the person you see has received special training in the area of mental health.

a). What is a Psychiatrist?

A psychiatrist is a doctor who has completed his or her usual medical training and then specialised in psychiatry, which is the branch of medicine that involves the assessment and treatment of mental health disorders. If you are referred to a psychiatrist you may see a doctor who is still in psychiatric training or a Consultant who has completed their training. You may be seen in a general hospital, in a community clinic or sometimes at home. Most psychiatrists will use a combination of approaches - medication, social and psychological treatments and may work with other colleagues – often within a community mental health team - to offer you help.

b). What is a Community Psychiatric Nurse (CPN)?

These are nurses who have trained specifically in mental health, have experience of working in a hospital setting but now work in the community. Some nurses will be trained in general nursing as well. Community Psychiatric Nurses can visit people at home to offer short-term counselling, support during bereavement, and short or longer-term follow-up.

c). What is an Occupational Therapist (OT)?

Occupational therapists undergo general training and may then specialise in mental health. Occupational therapists look at the life skills an individual has and how well that individual is able to perform various activities (e.g. shopping and communicating with others). If you are finding it difficult at the moment coping or organising various life skills such as cooking or cleaning and this is causing you problems, the OT may be able to work with you to help you to overcome these problems and encourage greater independence.

d). What is a Clinical Psychologist?

Psychology is a non-medical discipline concerned with the normal functioning of the mind in areas such as learning and remembering. Clinical Psychologists complete a psychology degree at university and then go on to do further training in mental health difficulties. The treatment that is offered is usually one of a number of psychological or “talking” therapies. Psychologists are not doctors and therefore do not prescribe medication.

e). What is a Mental health Social Worker?

Social workers complete a general training in social work and may then specialise in mental health. They assess social needs such as housing and finance and have particular knowledge about how this applies to those with mental health problems. Within the United Kingdom, some social workers may do further training and become ‘Approved Social Workers’. This means that they are able to carry out certain roles as determined by the Mental Health Act.

f). What is a Psychotherapist?

There are different types of psychotherapy (see later) and so psychotherapists tend to come from a variety of professional backgrounds. They have trained in a particular branch of psychotherapy. Within the UK at the moment there is no central professional body regulating the practice of psychotherapy, unlike the other professions mentioned here. This means that anyone can legally call themselves a psychotherapist. It is important to ensure that any psychotherapist you see has received adequate initial training, is committed to continuing training, and receives regular clinical supervision. In the UK, this is normally shown by the person being accredited by a nationally recognised organisation such as the British Association for Behavioural and Cognitive Psychotherapies BABCP (Telephone 01254 875277).

The BABCP is the lead organisation for CBT in the United Kingdom and will be able to provide the names and contact details of CBT practitioners who work within the NHS or privately in different parts of the country. Another organisation that accredits practitioners from a range of different psychotherapeutic backgrounds is the United Kingdom Council for Psychotherapy UKCP (Telephone 0207 4363002).

What happens when you are referred to a mental health specialist? The initial assessment.

Your own doctor will normally organise an appointment with the mental health practitioner. This will take place either in a local hospital, a local community health centre or may even be at your own home. Usually the first appointment lasts for about an hour, although follow-up appointments – if they are offered – are often for shorter periods.

Take with you any medication you have been prescribed. You may wish to ask a friend to go with you. Again you may wish your friend to wait in the car for you, to sit in the waiting area or to go into the appointment with you. Be clear about what you want. If they do go in with you be aware that having them there may help boost your confidence. Their presence however, may make you more reluctant to talk about some of the problems you face since you may not want them to hear all of what you say.

You are likely to be asked about how you feel in detail and also about your past including your childhood, schooling and employment as well as information about your family, medical history and past mental health problems. These are all routine questions, which are designed to provide as much information as possible about you. This allows the psychiatrist or team member to decide what is wrong with you and how you can best be treated. You may be asked about previous and current relationships including questions about difficulties in any current sexual relationships. This is asked because sexual difficulties are often not mentioned spontaneously by people but can be present. If you find these particular questions intrusive, just say that you would prefer not to talk about those issues. If you do have problems in this area (which is often the case in anxiety and depression), we recommend that you just say so. The practitioner will have spoken to many people who have similar problems, they won’t be shocked by your answers and will try to help you with any difficulties.

At the end of the initial assessment, the treatment options will be discussed with you. If there is anything you are uncertain about just ask so that you can understand what is offered. Write the options down if you think you may have problems remembering what is said (or the practitioner may be able to offer you information leaflets summarising many of the main treatment options – ask if these are available).

Reference:

I'm not supposed to feel like this: A Christian self-help approach to depression and anxiety. Williams, C., Richards, P and Whitton, I. Hodder Christian Books (2002). ISBN 0340786396

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