From Referral to Results: How to Navigate Behavioral Health Services

When and how should a person determine if they need behavioral health services? The process of determining the need for mental health care varies from person to person. Many people seek out care on their own, and others have a friend or family member suggest this to them after seeing noticeable changes in the person’s condition. A friend or family member may even make the initial call to a provider on behalf of the client. Other times, a medical doctor will refer care elsewhere when a case becomes complex enough or if medications are suggested. Medical doctors can provide some level of mental health services, but they offer a more general approach, and appreciate being able to refer out to a specialist. In extreme cases like a suicide attempt or psychotic episode, the client may be admitted to an inpatient hospital for observation. Lastly, an emergency room may contact a local provider to see the client quickly after they have left the ER but have no imminent safety concerns.

Here is a quick note to differentiate what each person working in mental health care does: A therapist is trained to speak with the client about their problems. This could be a social worker or a person with a more specialized degree, like marriage counseling or psychotherapy, which is intensive personal work that involves deep discussion about the client’s history. A psychiatric provider is trained to not only counsel and treat the client through discussion, but also to prescribe medications if they are warranted. This can be a medical doctor with advanced training, or someone like myself with a Doctoral degree. Licensing is required to treat patients and each person must work within their scope of practice.

In terms of definitions, “mental health” care generally refers to a person having not necessarily a physical illness but instead a problem in thought processing, attention and focus, anxiety, mood dysregulation, emotional stability, or in extreme cases, psychosis, which refers to audible or visual hallucinations, or extreme paranoia. All of these problems can be treated by a competent professional who can and should refer to a higher level of care if it is deemed necessary, like an inpatient hospital. Physical causes of these problems should always be ruled out, as they often contribute to mental health problems.

Following through on visits with your provider can be a challenge. A paradox arises; knowing that there is a need for help from a mental health professional, but also feeling unmotivated to the point of not seeking it out or following up as scheduled. Luckily, access to mental health care has been made easier by the advent of telehealth, which flourished during the COVID-19 pandemic, and has continued to be allowed by governing bodies as a good replacement for in-person care, although it can tend to be impersonal. Of course, many people would argue that in-person appointments are best, and I do ask that people make every effort to come see me in person at least at first, but telehealth is a workable replacement especially for those in rural areas living far from their mental health provider’s office. Most people have Zoom on their phones, and this, or another proprietary form of video call will suffice. Many electronic health records have built-in software that reminds the client of their upcoming appointment and alerts them if they miss it.

Once care has been established, various avenues can be taken. If a client is being prescribed medications, depending on what they are prescribed these can take weeks to work fully, so a follow-up visit may be scheduled three to four weeks from the initial visit, usually less so if the patient has never taken psychiatric medications before. More acute problems like psychosis should be followed up on in one to two weeks, as medications for this problem tend to work faster. The psychiatric prescriber should keep open lines of communication with the patient and/or their family to ensure help is available if side effects or adverse effects arise. If therapy/counseling is more in line with their needs, this can be done weekly, or every other week, or even less frequently. Occasionally a more frequent schedule for visits can occur, but this is relatively rare. I find that it is best to allow at least a week between visits so the client can use the strategies discussed in the meetings, and report back with results in the follow-up. Also, therapy visits usually last one hour, and excessive visits can consume too much of the clients time and may be costly, so this should be factored in to the follow-up schedule.

Over time, we can see the results of therapy, counseling and/or medications. We track symptoms using assessment tools, and subjective reports of the client, i.e. how they say they feel, or what they can do that they couldn’t before, like getting up on time in the morning, or dealing with work or family problems. A competent provider should take accurate and specific notes so the progress of the client can be tracked over time and compared with the last visit. Over time, as medications work or the client learns and utilizes new strategies to properly deal with their problem, the client’s condition will ideally subside, and less frequent visits are necessary. If a client is established on a medication regimen and symptoms are managed, a three or even six month follow up schedule may be appropriate. Again, consideration must be taken for the client’s time and cost of services.

Behavioral/mental health care is important. Depression and other problems often stem from life circumstances, and discussion during meetings with your provider should be open and honest; built on trust and compassion, utilizing the experience of the provider to establish better habits and thinking patterns.

 

About the Author

Dan Watts, DNP, APRN, PMHNP-BC, is a psychiatric nurse practitioner and founder of Unlimited Roads Behavioral Health who provides psychiatric care, therapy and medication-assisted treatment (MAT), with a focus on mental health and substance use disorders. With more than 16 years of experience in nearly every aspect of nursing, he brings deep clinical expertise to his work. He earned his Doctorate in Nursing Practice in 2019 and currently operates a private psychiatric and substance use treatment practice, where his services include diagnosis, medication management, talk therapy and MAT.

Over the course of his career, Watts has worked with thousands of clients in both inpatient and outpatient settings. He has long been drawn to mental health nursing for its potential to help clients make meaningful behavioral changes and improve their self-perception and relationships. He also collaborates with other 245D organizations to provide behavioral support services, offering guidance on interventions for clients with a wide range of concerns, including intellectual and developmental disabilities (IDD).

Watts believes the best approach to care is something developed over time, and he has honed the ability to adapt to new clients and environments through years of experience.