Behavioral Health Resource Guide

When you or your family member(s) are experiencing difficulty, uncertainty or even crisis, it may be difficult to find the right mental health professional to address your needs. Sometimes it is difficult to even know where to begin to look. We hope the information provided will help you make the most informed decision.

Mental Health

Mental illness is a term used to describe a broad range of psychological and emotional disorders that seriously interfere with the way a person is able to live and function. It is not, as many people still believe, the result of personal weakness, a bad upbringing, or sinful behavior.

Symptoms of mental and emotional disorders generally present themselves in a person’s thinking, behavior and personal habits. Evolving habits and personality are common during the course of life; however, sudden, frequent, transient, or prolonged lifestyle changes are among the first signs of a serious problem.

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Warning Signs

• Marked personality change
• Confused thinking; strange or grandiose ideas
• Prolonged, severe feelings of depression or apathy
• Abrupt mood swings from emotional highs or lows
• Excessive, almost uncontrollable anxieties, fears, or suspicions; habitually blaming others
• Social withdrawal, abnormal self-centeredness; preoccupation with body functions
• Denial of obvious problems; strong resistance to accepting help
• Dramatic, persistent changes in eating or sleeping habits; heightened restlessness, hyperactivity

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Factors that Affect Mental Health

Hundreds of thousands of people need mental health services at any given time, with one in five individuals actually experiencing a mental health or emotional disorder at some point in life. Like almost all health problems, mental disorders are believed to stem from a combination of causes.

• Biological Factors: Rooted in the body itself and often genetic in nature, biological factors may include problems in the chemistry of the nervous system or structural defects of the brain.
• Psychological Factors: One’s personal history may play a strong role in psychological factors that can affect or cause mental disorders. For example, a particularly traumatic event (such as the loss of a loved one) or long exposure to emotional stress (such as extended unemployment) can make some people vulnerable to mental health problems as reflected in warning signs listed earlier.
• Social Factors: Just as they affect physical health, social factors such as nutrition, shelter, group relations, and personal safety are important to one’s mental health.

Mental and emotional disorders are oblivious to race, gender, and social status, affecting one in every four American families. Taken together, the estimated 27 million adults and more than 8 million children and youth with diagnosable mental or emotional disorders outnumber those with cancer, heart disease, and lung disease combined.

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Choosing the Right Mental Health Therapist

At some point in our lives, we all run into problems that seem too big or too persistent to handle alone. Yet our pride and fears can get in the way of asking for help. But making the decision to find help is a sign of strength and courage. And help is available. In fact, it can make the difference between feeling that things are spinning out of control and gaining new tools to turn life around in positive ways. Having taken that crucial first step to seek help, you may have some questions about therapy. You may wonder, for example, about sharing information that is uncomfortable – will it be kept confidential? What is the best way to go about finding the right therapist? You can rest assured that all mental health professionals are ethically bound to keep what you say during therapy confidential. However, therapists also are bound by law to report information such as threats to blow up a building or to harm another person, for example.

Therapy is a collaborative process, so finding the right match – someone with whom you have a sense of rapport – is critical. You may have to shop around before you find someone with whom you are comfortable. After you find someone, keep in mind that therapy is work and sometimes can be painful. But it can also be rewarding and life-changing. So whether you seek help from a marriage and family therapist, a social worker, a clinical psychologist, or a psychiatrist, the steps to choosing the right mental health practitioner for you will be basically the same.

1. See your primary care physician to rule out a medical cause of your problems. If your thyroid is “sluggish,” for example, your symptoms – such as loss of appetite and fatigue – could be mistaken for depression.
2. After you know your problems are not caused by a medical condition, find out what the mental health coverage is under your insurance policy or through Medicaid/Medicare. Many employer-sponsored insurance policies have limits on mental health services and may cover only 50 percent of the costs of a fixed number of visits per year.
3. Get two or three referrals before making an appointment. Specify age, sex, race, or religious background if those characteristics are important to you. Your primary care physician and/or your faith leader probably know mental health care workers in your area. Also, ask friends, colleagues, neighbors and family members for referrals. Chances are, you will find that several people in your circle of acquaintances have been (or are) in therapy and can refer you to a competent therapist.
4. Call to find out about appointment availability, location and fees. Many mental health professionals schedule evening appointments so you do not have to miss work. Selecting a therapist whose office is easy to get to – either from work or home – can also make a difference in your progress toward improved mental health. Ask the receptionist:
   • Does the mental health professional offer a sliding-scale fee based on income?
   • Does he or she accept your health insurance or Medicaid/Medicare?
5. Make sure the therapist has experience helping people whose problems are similar to yours. You may want to ask the receptionist about the therapist’s expertise, education and number of years in practice.
6. If you are satisfied with the answers, make an appointment.
7. During your first visit, describe those feelings and problems that led you to seek help. Find out:
   • What kind of therapy/treatment program he or she recommends.
   • The benefits and side effects of the recommended treatment program.
   • How much therapy the mental health professional anticipates you will need.
   • If he or she is willing to coordinate your care with another practitioner if you are personally interested in exploring credible alternative therapies, such as acupuncture.
8. Different psychotherapies and medications are tailored to meet specific needs. Be sure the psychotherapist does not take a “cookie cutter” approach to your treatment – what works for one person with major depression does not necessarily work for another. The best therapists will work with you to create a treatment program – perhaps using a single approach, perhaps incorporating several different ones – that works for you.
9. Although the role of a therapist is not to be a friend, rapport is a critical element of successful therapy. After your initial visit, take some time to explore how you felt about the therapist. For example:
• Was he or she someone with whom you felt comfortable?
• Did he or she listen?
• Did he or she seem to understand your concerns and address them?
• Is this a person you feel you can trust?
• Did he or she seem knowledgeable about your problem and suggest a therapy/treatment program that suits you?
• Was the “chemistry” right?
10. If the answers to these questions and others you may come up with are “yes,” schedule another appointment to begin the process of working together to understand and overcome your problems. If the answers are “no,” call another mental health professional from your referral list and schedule another appointment.

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What to Do in Emergency Situations

If a person becomes violent or assaultive, or is completely out of control or attempts suicide, the following suggestions can help:

• If assaultive or other behavior dangerous to the person or others occurs, call 911 and request immediate assistance from the police department.
• If the crisis does not involve behavior dangerous to the person or others, call his/her family physician or psychotherapist. If the person does not have either, telephone numbers are not available, or if neither can be reached, transport the person to the emergency room of the nearest general hospital. If transportation by automobile is not available, call an ambulance or fire/rescue squad at 911.
• Check the local telephone directory for emergency “hotline” numbers whose description may fit the particular crisis situation the person is facing. If the person is known to belong to a specific religious congregation, you may elect to call that congregation’s minister, priest or rabbi.
• Refer to listings in this directory for those providers of mental health care or organizations such as Alcoholics Anonymous, and call the number listed. These providers and organizations may provide additional telephone numbers for use other than during working hours.

Maintaining an attitude of calm, decisive readiness, and willingness to help is the most important “first aid” reassurance to a person in emotional crisis.

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Treatment Methods

 The goal of all treatment modalities is to reduce or diminish the crippling effect of the symptoms of a mental disorder; to improve self-confidence and enhance social functioning; to develop and strengthen coping skills; and to increase self-knowledge toward the end of more durable personal integrity. There are many types of treatment that may be used alone or in various combinations. They are:

Psychotropic medications (pharmacotherapy) - May be the first treatment prescribed by a psychiatrist or other physician if the symptoms of the illness are acute or (potentially) disabling. The type of medication depends on the nature of the illness, the person’s age, and general medical condition. Medication is often combined with other therapies.

Psychotherapy (“talking” treatment) – Accomplished through a series of face-to-face sessions with the therapist, during which the person is encouraged to talk about, define, clarify, and resolve the problems that are troubling him/her. Short-term or session limited therapy lasts for a few weeks to several months and is appropriately employed to help a person through a stressful life event. Long-term or intensive therapy may last from several months to several years, and the work focuses on the life history of the person and their traumatic experiences and stressful events which have predisposed him/her to the mental disorder. There are several “schools” of psychotherapy, which are distinguished by differing techniques employed by the therapist, although the goals of treatment are similar. These include:

• Psychodynamic psychotherapy (which may be short or long term) examines important relationships with significant others from early childhood to the present in an effort to modify or improve unsettling or destructive behaviors which have given rise to emotional problems or created psychological stress. Psychoanalysis is a type of intensive, long-term psychodynamic therapy in which conflicts underlying the development of the person’s illness are analyzed, with the goal of providing him/her with additional conscious choices to modify his/her maladaptive behavior.
• Interpersonal therapy is confined primarily to the person’s contemporary life, especially his/her relations with family, friends, and colleagues.
• Family therapy involves other family members with the focus on identifying, discussing and resolving conflicts within the family.
• Couples (marriage) therapy aims to develop more rewarding relations with the significant other by identifying and examining each person’s contribution to the couple’s problem-generating interaction.
• Group therapy involves a group of (usually) 6-8 people with similar problems who, guided by the therapist, identify maladaptive patterns of behavior and individual problems toward the goal of members of a group helping each other to deal more appropriately with his/her problem.
• Play therapy is a technique used by therapists trained in working with children to establish communication with children and help them through constructive play to identify and resolve problems. Parents or guardians are also seen regularly by the child’s therapist or by a colleague during therapy.
• Cognitive therapy focuses on the person’s pattern or style of thinking with the aim of identifying and correcting distorted thinking that contributes to troublesome emotions and behaviors. It is often combined with behavior therapy.
• Behavior therapy uses principles evolved from learning theory to change disturbing and distressing thought patterns and behavior by systematically addressing such behavior and helping the person learn more effective coping skills to obtain rewards and satisfaction. It includes such techniques as stress management, biofeedback, and relaxation training.

Adjunctive therapies are those used most often in combination with other therapies and in a hospital inpatient situation. They include occupational, recreational, music, art, and special education therapies.

Inpatient treatments are the treatment methods employed by a psychiatric unit of a general hospital or by a mental hospital during a person’s hospitalization for a serious mental illness. These methods may include, but are not limited to psychotherapy, group therapy, behavioral/cognitive therapy, electro stimulation therapy (also known as electroconvulsive therapy or “shock treatment”), pharmacotherapy and the various adjunctive therapies.

Off-site services are delivered by some mental health providers to the mentally ill person in the home or at other locations in the community to respond to a variety of situations that, without these off-site services, would result in no service being delivered or a significant reduction in the effectiveness of the service delivered. Individuals needing off-site services are advised to ask the provider if that service is available before agreeing to accept services.

Crisis intervention occasioned by the person’s loss of control may consist of visiting the person at the site of his loss of control, assessing the situation and taking appropriate action. If the person resists or refuses hospitalization, the police may have to be notified. Alternatively, the person may be taken by relatives, friends, or the police to the clinic, office of the professional or hospital emergency room for assessment of the crisis.

Partial hospitalization is a short-term, intensive psychiatric treatment program generally equivalent to the treatment rendered in full hospitalization, except the patient does not stay overnight in the hospital. It must provide a minimum of four consecutive hours of treatment each day the program operates.

Psychiatric day treatment is the equivalent of partial hospitalization except that it does not occur on hospital grounds.

Residential crisis services are short-term, intensive mental health and support services provided in a residential setting designed to provide an alternative to psychiatric hospitalization.

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Mental Health Professionals

A mental health professional is a person formally trained to help people in emotional distress. Most mental health professionals have earned additional credentials, usually in the form of state licensing, certification or both. Therapist, psychotherapist or counselors are terms often used to refer to mental health professionals. Be sure that the person you choose has extensive training and experience in his/her specialty and is well respected in the community.

You have the right to ask questions regarding the training and qualifications of any mental health professional you are consulting. Equally important is that he/she treats people with understanding and respect and can be trusted. If you are not comfortable with a mental health professional after meeting with him/her several times, you have the right to seek a different helper. Be sure to do what is right for you.

Psychiatrists are medical doctors who specialize in the diagnosis and treatment of mental disorders and are qualified to prescribe medication, in addition to providing psychotherapy. Psychiatrists must have completed at least three years of specialty training and be licensed by the Maryland Board of Medical Examiners. A board-certified psychiatrist has practiced his/her specialty for at least two years and has passed the written and oral examination of the American Board of Psychiatry and Neurology. For a referral to a psychiatrist, contact the Maryland Psychiatric Society at (410) 625-0232.

Clinical psychologists are specialists in the evaluation, testing and treatment of emotional problems. They must have a doctoral degree in psychology and be licensed by the Maryland Board of Examiners of Psychologists. For a referral to a clinical psychologist, call the Maryland Psychological Association at (410) 992-4258.

Psychiatric Advanced Practice Nurses are registered nurses who hold a master’s or doctoral degree and specialize in psychiatric and mental health nursing. They must complete a certification process and be licensed by the Maryland Board of Nursing. For a referral, call the Psychiatric Advanced Practice Nurses of Maryland at (888) 565-0033.

Licensed Clinical Social Workers (LCSW-Cs) must have a Masters Degree in Social Work and at least two additional years of weekly supervised service provision to individuals and families. They must possess a current license from the Maryland Board of Social Work Examiners. Clinical Social Workers are able to diagnose and treat people with emotional disorders.

Licensed professional (mental health) counselors have a master’s degree and specialized training in a clinical mental health setting. They must possess a current license from the Maryland Board of Examiners of Professional Counselors.

Pastoral counselors are often clergy with training in clinical pastoral education, although not all pastoral counselors are ministers, priests, or rabbis. Certification is not required for pastoral counselors, yet many choose to be certified through the American Association of Pastoral Counseling or the American Association of Clinical Pastoral Education. If you would like a referral, call Pastoral Counseling Services of Maryland at (410) 433-8861.

Case managers are mental health workers who are usually associated with mental health centers, psychosocial rehabilitation programs, and other mental health agencies. They provide advocacy, linkage, and monitoring of services to persons with disabling mental illness in such areas as housing, social services, vocational rehabilitation and the securing of entitlements to health and human services.

Certified Addiction Counselors are specialists in the assessment and treatment of substance related disorders that may include the problematic use of alcohol, prescription medications, or illicit drugs. They must be licensed or certified by the Maryland Board of Professional Counselors

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Mental Health Facts

• An estimated 22.1% of Americans ages 18 and older – about 1 in 5 adults – suffer from a diagnosable mental disorder.
• About 20% of children are estimated to have mental disorders with at least mild functional impairment.
• Major depression is the leading cause of disability (measured by the number of years lived with a disabling condition) worldwide among persons age 5 and older.
• Eight to nine percent of the general population is reported to suffer from Post Traumatic Stress Disorder.
• Studies reveal that less than one-third of adults with a diagnosable mental disorder, and even a smaller proportion of children, receives any mental health services in a given year.
• The Maryland Public Mental Health System is now serving over 80,000 individuals.
• The direct costs of mental health services in the United States in 1996 totaled $69 billion. This figure represents 7.3% of total health spending. An additional $17.7 billion was spent on Alzheimer’s disease and $12.6 billion on substance abuse treatment.

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24-Hour Emergency Hotlines

Rapid Assessment Teams
Dorchester General Hospital & Memorial Hospital at Easton
1-888-514-4500

Youth Crisis Hotline
Crisis intervention, support and referrals.
1-800-422-0009

For All Seasons, Inc. Hotline
Counseling, advocacy, and education to victims of rape,
sexual assault and abuse.
1-800-310-7273

Mid-Shore Council on Family Violence
Provides direct services for victims of family violence including a 24-hour hotline, crisis intervention, counseling, support group, emergency shelter, client advocacy, children's program, court accompaniment, information and referral.
1-800-927-4673

Life Crisis Center Hotline
Provides counseling for victims of domestic violence or
sexual assault, suicide prevention, support groups, emergency shelter, shelter referral, medical care, and assistance with the process of prosecution.
1-800-422-0009

Homerun Hotline
Information and referral; staffed by trained listeners; any issue discussed.
1-800-HIT-HOME

Maryland State (AIDS) Hotline
Information on testing and other referrals.
Monday through Friday - 9 AM to 5 PM (Except Holidays)
1-800-638-6252
Hearing Impaired: 1-800-553-3140

Americans with Disabilities Act Hotline
Provides information on the Americans with Disabilities Act.
1-800-USA-ABLE

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List of Providers

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