There are two barriers to accessing mental health help. One is waiting lists; while it may be possible to get a prescription for antidepressants from your GP as fast as for any other illness, psychiatry services as well as counselling offered by voluntary agencies may have long waiting lists of weeks to months. This particularly applies to psychotherapy accessed through the NHS.

The other barrier is to do with the nature of mental illness itself and the stigma against it. People may feel ashamed of having depression, anxiety or other conditions; they may even lack terms to adequately describe what they feel like inside. Depression, in particular, may ‘creep up’ on people so that what starts as a low mood may become an incapacitating illness step by step. It is also in the nature of depression for the person to feel that they ‘should’ be able to help themselves and that they do not ‘deserve’ professional help. In many cases it is the patient’s friends or family who make an initial referral for this reason, though it is important that the person acknowledges they have a problem for the more psychotherapeutic interventions to be successful.

A few definitions

There are a confusing (and rather similar-sounding) number of professional labels attached to people who work in mental health.

• Psychiatrist

This is a medically-qualified doctor who had undergone additional training to become a specialist in mental health. He or she may not have undergone training in psychotherapy, though many psychiatrists will have done. They will be the Responsible Medical Officer under the Mental Health Act if you are detained and authorise prescription of medication.

• Psychologist

This essentially means anyone who has completed a degree (usually at least a Masters) in psychology. A clinical psychologist is someone who works in a medical setting and who “aims to reduce psychological distress and enhance and promote psychological wellbeing”. While not being in charge of patients’ medication, they may be in charge of therapy programmes and case-management.

• Psychiatric nurse

This is someone qualified as a nurse who has taken additional mental health training. Some work in hospital settings and may be the first mental health professional you see if you refer yourself to A&E; others work within the community to help and monitor people with mental health problems.

• Occupational therapist

This is not a mental health specialist, but a therapist who works with people with any disability to help them improve their capacity to live a relatively normal life within their disability. May become involved with someone with mental health issues if their condition involves physical incapacity, e.g. dementia.

• Psychotherapist/counsellor

At present these terms have no legal definition as such – see private counselling and psychotherapy for the current regulatory and training framework. Anyone can in theory call themselves a counsellor or psychotherapist. However any worth consulting should have undergone a fairly rigorous process of training and accreditation.

• The difference between counselling and psychotherapy

The difference is in the main one of degree rather than kind; they are essentially the same activity. Counselling will more often tend to be of a time-limited nature and will try to help the client address specific presenting problems in their lives; psychotherapy will more often tend to be open-ended, with termination of treatment decided between practitioner and client, and will tend to address deeper, more unconscious and longer-term patterns of behaviour. There is a tendency for psychotherapy training to be longer and more theory-based than counselling training. However none of these are hard and fast rules; there is, for instance, an established school of brief psychotherapy and counselling may be open ended. Neither label implies more or less expertise or experience on the part of the practitioner.

• Psychoanalyst

This means a psychotherapist trained in a particular tradition. The strict definition is someone trained specifically in the teachings and tradition of Sigmund Freud. A broader definition includes the tradition of certain other pioneering figures in psychotherapy such as Carl Jung, Melanie Klein and Donald Winnicott. Psychoanalysis is in general a particularly intensive (and expensive) form of psychotherapy. It is more likely to involve several treatment sessions a week and most psychoanalysts (except some Jungians) use the traditional technique of the client lying on a couch rather than sitting on a chair.

Primary Care

General practitioners are often the first port of call for patients seeking help. GPs can prescribe drugs for the milder conditions, and many general practices have counsellors either attached to the practice or a register of counsellors they can refer people to. If either patient of doctor feels, however, that the condition is severe or in danger of becoming so, there should be no hesitation in recommending or seeking referral to a psychiatrist.

HIV care

The first port of call for many patients will be their HIV physician. Most of the larger HIV clinics have specialist teams of counsellors and mental health professionals attached to the clinic or who have short-cut referral arrangements with the clinic. Your HIV doctor him/herself may be able to prescribe antidepressants and other medication but for cost reasons this is becoming increasingly more restricted and they may want you to see the psychiatrist for assessment if you need any drugs for mental conditions. Practice varies by clinic.

Psychiatric care

Mental health services in the NHS, perhaps in acknowledgment of the atypical nature of mental illness, are organised and administered separately from primary care or hospital trusts. However in practice this makes little difference to referral pathways, as most large teaching hospitals will have a mental health unit attached.

The important thing for a patient to know is that referral to a psychiatrist does not mean that they are considered ‘mad’; many people need psychiatric help to see them through a crisis.

Emergency referral

A person in severe crisis is a severely ill person, and episodes of severe mental illness, especially with life-threatening characteristics such as suicidality, violent behaviour, disabling panic attacks or drink or drug intoxication should be treated as medical emergencies. All hospitals with Accident and Emergency departments have a psychiatric liaison service with psychiatric nurses in attendance during the day and on call at other times.

For emergency situations where the person has to be detained for safety reasons, the Mental Health Act 1983 comes into play.