BY DANIEL DeGRYSE
Deciding to seek help for a mental health disorder or an addiction is not easy. For the person involved, it is life changing; socially, it can be challenging. The individual may experience guilt, shame, and stigma once he begins therapy. Although our life choices can present obstacles, when they concern our mental and physical well-being, we must focus on the potential benefits.
Acknowledgment
The desire, decision, and motivation to change are the crucial first steps in personal improvement. Along with desire comes the acknowledgment that you, your loved one, or you and your significant other need professional assistance with the challenging circumstances in your life. Your path to better mental well-being is a great decision and a rewarding one. Once you have committed to change and are motivated, identifying the available and reputable therapists and treatment facilities, understanding insurance coverage, and obtaining a general knowledge of the therapeutic process will take time. That’s okay. Reach out. Help is a call, a text, or a Web site away.
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I have seen this experience firsthand. I have seen the wide-eyed, distressed reaction of individuals who do not know where to turn or whom to trust. I’ve heard the frustrated voices and witnessed the expressions of family members when they feel they do not know how to help their loved one. These reactions have led me to write this article to provide a general understanding of the world of therapy and how to navigate it.
Talking About What Really Matters
Being in the first responder and the counseling worlds for many years has afforded me the experience and knowledge to assist others beginning to maneuver through this process. Yet, despite our advances in awareness and openness, talking about mental health and addiction still seems largely off limits and takes place behind closed doors or in hushed voices. At the firehouse, we often find ourselves at the kitchen table discussing home repairs, finding a trustworthy mechanic, the best deals on home appliances, along with sharing our solutions to the world’s problems, but not so much about addiction and mental health.
Historically, the general public sees first responders as strong, tough, capable, and heroic. We have embraced this image and do our best to live up to it. This perception feeds the notion that asking for help and being tough are mutually exclusive. Within the first responder community, accepting the idea that we are vulnerable like everyone else and need assistance at times has been making slow progress. But for someone in need, this acknowledgment is pivotal, regardless of how long it has taken to achieve.
The First Step
Being willing and ready is one thing; however, resources do not fall into your lap. If you want to speak to someone personally, choose a person you trust and share what you are experiencing and that you want help. Discuss options and avenues you can explore to get the assistance you are looking for with a friend, a coworker, an employee assistance program (EAP), a chaplain, a peer supporter, or your physician, among others. You may even embark on your own search using the Internet to research resources. The conversation and information provided can help guide you, give you direction, and hopefully identify treatment services to consider and explore further. Mental well-being and recovery can be achieved with a foundation of trust, support, consistent effort, and dedication to the process, which in turn can lead to better health, happiness, and an overall better quality of life.
Choosing a Direction and a Provider
You have decided to get professional assistance, have reached out, and are exploring your options. At this point, you have two essential decisions to make. First, choose a direction and provider that you believe fits with the person who will be receiving services. Do this, as I mentioned above, in beginning steps, through research and recommendations.
Second, obtain a recommendation that establishes the appropriate level of care needed to address the presenting, identified issue. Meet with a professional for an assessment to do this. Now, I would like to revisit more specifics on what to consider in choosing your treatment resource.
Evaluating Resources
How do you evaluate a service provider or a treatment program? Who would be a good therapist for you? What is the best program for you? You must do your homework. What works for one person may not for another. Finding a therapist or a program with which you are comfortable is of primary importance and directly affects your willingness to work, persevere, and succeed.
Include your demographics and characteristics in your decision. Your age, gender, relationship status, occupation, and general belief system matter in the choice of with whom and where you will be comfortable receiving treatment. You should be comfortable working with a person of the therapist’s age, gender, educational background, approach, and belief system as it relates to therapy.
For a treatment program, consider the population the therapist serves (e.g., gender, age, and diagnoses) and the therapist’s mission. Also consider who comprises the therapist’s clinical team. Consider levels of education, specialized training, and experience of staff, as well as what therapeutic approach is used, such as cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), or eye movement desensitization and reprocessing (EMDR).
To narrow options in this process, identify which clinicians and programs are “in network” and which your insurance company covers at the highest percentage. Most insurance providers have Web sites that identify services and the reimbursement level they provide for each. Keep in mind that you may find a clinician or a program that appeals to you but will cost you more; cost is just one contributing factor in your decision. Consider this and the other factors.
Cost
For a small percentage of people, cost is not a concern. But for many, it is one of the first concerns. All insurance plans are not the same, and not all providers accept all insurances. Consider the following items:
- Does your insurance plan cover mental health or substance abuse treatment?
- What percentage of your expenses does it cover? An in-network provider is always more beneficial.
- What is your deductible, what is your out-of-pocket cost, and what are the annual and lifetime limits or maximums of these benefits? Your insurance provider can provide this information directly or through the treatment provider’s case managers who verify benefits. Specific financial information will help you make an educated decision.
Geography
Travel convenience matters, but do not limit your available choices because they are near you. At Rosecrance, a nonprofit organization and national provider of behavioral health, we have seen clients from all over the country. Families have traveled hours and across state lines to our facilities primarily because they felt comfortable and confident with the care provided. Although that may not be feasible for you or your family, whatever facility you choose, ensure that the facility is accessible and its distance is not an obstacle and adds significantly to your stress.
Recommended/Qualified Providers
When seeking out a behavioral health provider, forget about quick, easy, and convenient! In reviewing a prospective counselor or therapist, examine the provider’s licensing and certifications. Are their education and certifications relevant to the type of care you are seeking? Don’t be afraid to ask how long the counselors or providers have been offering services and what their clinical experience encompasses.
If residential treatment is your direction, make sure the provider is accredited by the Joint Commission [formerly the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)], which is considered the gold seal of approval and standard in the behavioral health industry. Additionally, ask about the center’s treatment team: Who comprises it, and what are their education levels, certifications, training, and years of clinical experience? You want to be supported from the moment you enter treatment through your discharge and into your aftercare. You want a provider who commits to being present every step of the way.
Clinical Approach
Firefighters, paramedics, police officers, and military personnel are among a group of professionals who have unique life experiences that will influence their treatment experience. What we encounter repeatedly through our professions can be what most people hope to never encounter in their lifetime. Whatever your particular needs and goals are, there are therapists and programs to help you achieve a better quality of life.
In 2014, I consulted with Rosecrance’s chief executive officer Phil Eaton and, drawing on my experience and working with Rosecrance psychiatrist Dr. Raymond Garcia, we created the Florian program. We provide education; awareness; and individual, group, and experiential therapies focused around considerations specific to uniformed service personnel, which include all first responders and military personnel.
Family Services
Addiction and mental health disorders affect not just an individual but the family as well. Although each situation and level of involvement varies, depending on the need, education and support for the family greatly increases the potential for success in therapy and for recovery. These services may include family education and family sessions at least once a week.
Program Schedule
If you are seeing a therapist as an outpatient, the sessions usually last an hour. If in an intensive outpatient setting, sessions can range from one to five days and last a few hours to six hours a day. Sessions consist of group therapy led by a clinically trained therapist. In a residential setting, the daily program schedule typically will run from at least eight hours up to 16 hours, seven days a week. The amount of direct care you receive depends on the program’s intensity. These schedules include individual and group therapy, exercise, experiential therapies, education groups, and self-help and peer support groups.
Levels of Care
The level of care recommended will depend on the needs and wants you identify and the results of the assessment you receive. Research on types or levels of care will provide you with information about four or five different levels. Although some may identify natural or self-care as a level, for the intent of my article I am identifying levels in which you search out assistance from others. I describe five levels of care.
Self-Help Support Groups
These groups are typically relaxed and informal and rely solely on the individual’s commitment, attendance, and participation. Alcoholics Anonymous and Narcotics Anonymous are two of the most recognized self-help groups; others may address depression, anxiety, and grief and loss, for example. Such groups meet at various locations such as a church, hospital, or free-standing facility. Participants can just listen but are encouraged to share their thoughts and feelings. Peer volunteers with similar mental health, addiction, or emotional issues most often lead these groups and want to offer others guidance and support that they have received.
Peer Support
Some may think this is a new concept; however, peer support has been around for almost a century. Beginning back in the 1920s, psychiatrist Harry Stack Sullivan employed former patients as aides in a hospital to support and connect with patients experiencing similar mental health disorders. In 1935, the founders of Alcoholics Anonymous, Bill W. and Dr. Bob, provided peer support to one another. In 1974, Jeffrey Mitchell developed the critical incident stress management (CISM) model, a comprehensive and organized program to intervene in stressful work incidents that included peer support, which some identify as an essential component of recovery. Peer support brings together nonprofessionals with similar stressors or health problems for mutual support or unidirectional support from an experienced peer to a peer wanting or needing support. Awareness of education and training for individuals on peer support practices has grown in recent years and become a viable first step for people to consider when seeking help. Presently, fire department, local union, and regional and state peer support teams are organizing across the country.
Individual Counseling
Also known as therapy, talk therapy, and psychotherapy, this counseling is a one-on-one experience between an individual and a therapist. For couples, one therapist will meet with both individuals. The main objectives include speaking about the individual or couple’s past, which includes their physical, mental, and emotional health while addressing present concerns; determining the best course of action; and working through one or several of a variety of techniques and approaches to reach a desired outcome. Sessions typically last about an hour.
It is critical to check the credentials of the therapist you choose and also to determine if the therapist is licensed by the state. Licenses to practice include a master’s degree in social work (MSW), licensed clinical professional counselor (LCPC), and doctor of psychology (Psy.D.), to name a few.
In researching clinicians, you can learn about their personal mission, their counseling approach, and their clinical experience and expertise. Remember, however, that although insurance companies widely cover individual counseling, they may not cover marital or couples counseling.
Intensive Outpatient
Intensive outpatient programs (IOPs) are designed for individuals who need more care than traditional counseling can provide but do not need, want, or meet the criteria for hospitalization. Those who may benefit from such a program are individuals coping with a mental disorder and a substance use/abuse issue and working to avoid a decline in their functioning, those who are in therapy and need extra support since they do not have a supportive network at home, and those transitioning from a residential/inpatient stay to home and will benefit from a step-down approach with structured continued care. The programs are short-term and flexible and typically meet several hours a day ranging from three to five days a week, which can accommodate a person’s work/school schedule. The programs provide individual and group therapy from a multifaceted treatment team as well as education and a network of support.
Partial Hospitalization
This level of care is one step down from an inpatient setting of 24-hour care. These programs provide a level of care parallel to that of an inpatient setting while allowing an individual to return home each evening. Such a program is appropriate for individuals needing structure and support with a high level of care.
These programs typically meet six or more hours a day, five to seven days a week. The program is an alternative to inpatient treatment and can be a transitional program when an individual is transitioning out of an inpatient setting but not yet ready to return home and attend outpatient therapy.
This fifth and highest level consists of three intensive forms of treatment: residential, inpatient, and detox.
Residential. These are 24/7 programs with less monitoring than in an inpatient setting. The facility environment is more home-like than a hospital. Residents participate in daily treatment programs typically eight hours a day including individual, group, family, and experiential therapies. Additionally, they are educated regarding their condition and how to manage their own well-being.
The strength of residential treatment is that it provides quality, consistent care for an individual in that person’s efforts to work on developing healthy, effective, coping life skills. The length of stay is typically several months or more, and the accommodations are more homelike or comfortable living spaces. Insurance does not often support this level of care.
Inpatient. This is the highest level of treatment offered. Inpatient care is typically received in a hospital or hospital-like setting, which is secured and considered crisis management. It is short term, typically lasting from days to a month for crisis-management needs. The setting provides a structured full-day schedule with therapeutic interventions from all levels of the clinical team, medication management, medication-assisted treatment, and constant supervision while working to stabilize and support the patient’s independent functioning. Family involvement is recommended and encouraged throughout the stay.
Detox. This program is a short-term, 24-hour medically monitored inpatient program that lasts one to five days. It is designated specifically for individuals who need assistance in safely withdrawing from the effects of various drugs and/or alcohol. Education, intervention, counseling, and medically assisted treatment are offered, and clients are referred to additional services directly following discharge.
Therapy, counseling, recovery—whatever you call it—is a journey. Recent statistics from the Centers for Disease Control and Prevention have indicated that annually one in five will have a mental health disorder and that in a lifetime, 50 percent of the population will experience a mental health disorder.
We must be vigilant and intentional in our daily lives to maintain balance. Many accessible resources can help us work toward and maintain a better quality of life. Our life circumstances don’t have to be critical before we are willing to change. A recipe for change includes sufficient rest, proper nourishment, adequate exercise, spirituality, connection with others, coping skills, and learning.
You can initiate this yourself through researching, reading, and attending classes on practical healthy life skills or do so with the support of a therapist. If you or a loved one is committed to change, I hope these guidelines will help you find the right path.
DANIEL DeGRYSE is a battalion chief with the Chicago (IL) Fire Department and is the director of the Rosecrance Florian Program.
