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Mental Health Systems in Other Countries? - June 19th 2011, 03:27 AM

Hey guys! As some of you may already know, I'm pursuing a career in clinical psychology, and I live in the United States. As a result, I can offer decent advice to other members about who to get referrals from, how to get financial support, etc. There are a lot of members who live in Canada, the UK, Australia, and other countries, though... and I don't know how to help them! It seems like the procedure for getting a diagnosis, for instance, is different in the UK than it is in the US - so the advice I offer may not necessarily be applicable to members who live in the UK.

So inform me, as well as other ignorant Americans - in your country:
- How does one get a referral to a psychological professional or clinic?
- What are the types of psychological professionals one can see?
- What is and is not covered under one's insurance/healthcare plan?
- How does one get diagnosed with a mental disorder?
- How does one obtain medication?
- How does one obtain therapy, individual or group?
- What are some of the major pros and cons to your country's system?

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Re: Mental Health Systems in Other Countries? - June 19th 2011, 09:10 AM

Hey, I live in Canada but I'll tell you right now things vary here from province to province as each has their own health care system. From what I know they're all mostly the same with slight differences but I live in Alberta specifically.

You're first question, a referal to anything in Alberta is gained through your family doctor. Any government funded health program or facility needs a referal from your doctor. You can however be refered by a doctor in a hospital if you are an inpatient as you're legally under their care. You can sometimes refer yourself to a clinic by calling HealthLink.

The types of profesionals are the same as in the USA.

Everything is covered under your healthcare plan except medication.

You must be diagnosed by someone with a medical phd, so your family doctor, or more ideally a psychiatrist.

Medication is obtained from a pharmacy, or if you can't afford it most clinics or family doctors have free sample packs available to them that they will give you. Prescriptions are obtained through the same two types of doctors described above.

Therapy is obtained through many of the clinics in the public healthcare system.

Pros to this system, everything is free to everyone. Cons, that means doctors are paid somewhat less, meaning lots move away which causes the doctor to patient ratio to be way off which causes wait times for a lot of things to be pretty long. An example would be I'm on the wait list for the Mood Disorders clinic in Calgary which is free and supposed to be one of the best clinics for people with Bipolar, the con is I have to wait for almost 2 years to even do intake with them.

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Re: Mental Health Systems in Other Countries? - June 19th 2011, 06:30 PM

Right, well I live in the UK and I'm smack bang in the middle of all this at the moment, so I'll try and help

- I saw my GP and explained to him that I thought I was depressed. He started me on anti-depressants and referred me to the mental health team.

- First I had to have an assessment from the local single point of access service which decides where to send you after a few meetings. Then they reffered me to both Psychotherapy and Psychiatric help, the former for help with my depression, the latter for help with my self harm and suicidal thoughts. You can only see one at once, I was told, and Psychotherapy wont see me until Psychiatric have finished with me because I'm a high risk patient.
Psychotherapy is basically seeing a counsellor but I'm not at that stage yet. My mum went straight to a counsellor, because she has stress and anxiety issues, so it depends on the individual.
So GP -> Assessment -> Psychiatric/Psychotherapy keyworker -> ?????

-Everything here works on the NHS, so as far as I'm aware, all options are available to me, unless I decided I wanted private healthcare. For example, if I were to require inpatient care, and the local ward wasn't suitable [Ours here is for seriously mentally disabled people - so I would rather not use it] I could register and pay for private healthcare and be put into privately supplied accomodation on something like BUPA. However, I know BUPA and private care here comes under different categories [Like phone contracts in a way] in that the lowest band will offer this, that and the other, whereas only the highest and most expensive will cover dental care.

-In my case, I simply saw my GP who agreed with my depression and it goes from there. I imagine that if they're unsure, they'd refer you to a consultant or to a mental health team who are more specialised in that area.

-Medication is obtained through a GP/Medical professional provided prescription, which you hand in to a pharmacy and collect. It costs 7.40 unless you are exempt from the costs i.e. on benefits, under 18, pregnant or it is necessary to keep you alive [My dad gets his heart medication free]
Obviously you can get some medicine without doctor's permission, like cough medecine, painkillers and basic stuff.

-You can ask about recieving group therapy in your area or your counsellor can reccommend it to you. I'm meant to be starting a series of meetings in late July but they are optional. I can't help much here, sorry

-Pros: Healthcare is free, prescribed medication is cheap and widely available, and you will get seen to no matter what the problem, as there are no insurance issues.

Cons: In my area, the hospitals aren't well funded so are extremely basic - we have no cardiac unit, no maternity unit, and the mental health unit is closing soon. It's also very limited on staff and equipment - getting an x-ray is practically impossible without travelling 30 miles or more, and there's no MRI scanner nearby. It depends where you live as to the quality of healthcare you get.
You also have to be very patient - I saw my GP in mid March, and I've only just met my allocated keyworker for the Psychiatric team, so it can be frustrating.

Sorry it's so long, I had a LOT to say

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Re: Mental Health Systems in Other Countries? - June 19th 2011, 10:42 PM

Hey, I live in the UK

- How does one get a referral to a psychological professional or clinic?
First point of contact is usually your GP. They will either offer some basic help themselves or refer you on when needed.

- What are the types of psychological professionals one can see?
The same ones as in any other country I'd imagine. There's psychologists, psychiatrists, mental health nurses, counsellors, art therapists etc

- What is and is not covered under one's insurance/healthcare plan?
Well under the NHS treatment is covered, medication & therapy etc however waiting lists are long and things like that. There is a small charge for prescriptions but thats it. There is the option to go private but then you would have to pay.

- How does one get diagnosed with a mental disorder?
Either by your GP or a psychiatrist

- How does one obtain medication?
Again, this is done by either a GP or psychiatrist

- How does one obtain therapy, individual or group?
If it's on the NHS you will need to be refferred, usually through your GP

- What are some of the major pros and cons to your country's system?
The NHS has long waiting lists & is often overstretched but then it's free

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Re: Mental Health Systems in Other Countries? - June 19th 2011, 11:05 PM

To add to the UK info you can also be sectioned under the Mental Health Act if a Family member, Social Worker or Doctor feels you are in danger of hurting yourself or others. This will get you admitted to hospital and treated without consent.

If any of the above feel you are a threat you will be assessed by 2 doctors (A psychiatrist and a doctor who knows you well) and a social worker has to also agree.

Different sections determine how long you have to spend in hospital:

Section 4: Allows you to be kept in hospital for 72 hours, usually used in an emergency. (For this only one doctors approval is needed) At the end of the 72 hours you may then be put on to a section 2 after being assess by 2 doctors and a social worker.

Section 2: Allows you to be kept in hospital for 28 days and you will undergo a full assessment and be treated. An after care plan will also be created.

Section 3: Allows you to be kept in hospital for 6 months. This is usually used if medical staff feel you are not ready to be released after being on a Section 2.

You (if you are in a reasonable mental state) or your immediate family can appeal against a section but you cannot discharge yourself.

(Hope that is clear enough, if not just ask)
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Re: Mental Health Systems in Other Countries? - June 20th 2011, 04:34 AM

Hey there, I live in Australia.

- How does one get a referral to a psychological professional or clinic?
You need to see a normal GP who will listen to your symptoms or story and then recommend you see a psychologist if it sounds like a mental health problem. GP's can act as normal counsellors, so you can talk to them about your problems and they'll give you advice, but could not diagnose you with depression or anything. They generally will not make the suggestion that someone has depression or another mental health problem, unless the patient specifys that they think they may be suffering for something. The subject of depression was pretty taboo in Australia a few years back, and it's not until recent years that awareness has been raised. I think most of the doctors at the moment were probably trained when depression wasn't something people talked about or knew much about, so it's not an area that they really understand, hence why they won't tell someone that they may want to get checked out for it.
- What are the types of psychological professionals one can see?
urm, I know there are normal psychologists and then many that specialise. My friend sees a psychologist who only is a specialist in eating disorders for example. psychologists are consulted for depression, body image issues, bullying etc. A psychatrist is consulted for conditions that may be more complex (Schizophrenia or severe bipolar for example)and when people require medication specific to the inidividual and their symptoms, rather then the symptoms of the condition generally, if that makes sense...for example 3 people withSchizophrenia may be taking completley different medications.
- What is and is not covered under one's insurance/healthcare plan?
I'm pretty sure mental health expenses are now covered by Medicare (australias chief health insurance provider), including a certain number of psychologist consults.
- How does one get diagnosed with a mental disorder?
By a psychologist after being refered by a GP. As mentioned earlier, the patient will most likely have come up with a self diagnosis of sorts though. There are a series of tests for depression I believe.
- How does one obtain medication?
Some phsychologists can write perscriptions, others do not have the qualifications (not sure exactly what it requires). Phsycologists can however, recommend medication which would then be perscribed by a GP. GP's cannot perscribe medication for mental health disorders without the recommendation of a psychologist. For more complex issues Psychiatrists would be consulted, who can perscribe medication. GP's cannot perscribe some medications, and a psychiatrist would need to do this.
- How does one obtain therapy, individual or group?
After being refered by a GP, an individual would arrange this through the psychology clinic.
- What are some of the major pros and cons to your country's system?
It's very difficult for young people to get help independantly. Medicare is a family arrangement...all the children in a family will be part of the 'family medicare' system until the age of 21. So for example, I as a 19 year old, couldn't go to the doctor and have the bills sent to medicare unless I had the family medicare card and was in the company of my father who holds the account. The invoices would also be sent to my dad, so there wouldn't really be any privacy. There almost needs to be a youth system set up where young people can get consults independantly and with some kind of financial support. for example: when I was younger my parents did not believe me when I told them I was depressed, and instead accused me of drug and alcohol addiction (could not be more untrue ha). They told my GP, who was supossed to act as my counsellor for the 'addiction.' I told the GP my side of the story and he believed me, but could not refer me to a psychologist as he did not have my parents support and they were technically his clients. Also if he did, my parents wouldn't have allowed me to go anyway which would mean I literally couldn't as I wouldn't be given the health insurance cover and didn't have the money as a 15 yr old to pay for it! My GP basically disgnosed me with depression and gave me his personal mobile number in case I ever needed help. That was the best he could do. Talk about a flawed system! Hope this helped (I looked into all this stuff when I was going through it, but obviously am not an expert! Things might have changed, or be different in different states).

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Re: Mental Health Systems in Other Countries? - June 21st 2011, 03:12 AM

Although I am in Canada, I agree with Rick in that the system varies from province to province. He covered Alberta so I'll cover my province, Ontario.

Getting a referral to a professional or clinic can occur in several ways. First, and most common, one sees their family doctor or GP, who then gives a referral. Second, one enters an out-patient immediate intervention or crisis program. There are many offered for youth and can be quite specialized. For this, a psychiatrist sees you on the first visit and possibly a social worker. Later visits involve the psychiatrists and psychotherapist. Third, voluntary admission to a hospital, either for a psychiatric issue or a non-psychiatric issue. For example, one waits in the waiting room at the emergency department and once investigated, the doctors believe it may better be dealt with by the psychiatric ward. Fourth, involuntary admission to a hospital. This leads to four "forms", each of which require a doctor to sign off that the patient needs to stay for however long the form is. Generally, it goes from 48 hours to 48 hours to around a month or so, to indefinite. The longer the stay, the more severe the patient so they may be bounced around from place to place. Lastly, jails and prisons offer a large array of psychological assistance.

There are no restrictions regarding the type of psychological professional you can see. All that is needed is a referral. You can see someone without a M.D., such as for certain assessments like the MMPI-II but ultimately they cannot prescribe medications.

Medications are generally covered through one's insurance although you may end up paying a left-over amount. Therapy I think is usually covered. Since some medications can be expensive, sample packs are given, however, they may also be given to people who can afford them but are very unsure about getting them.

Obtaining psychotherapy of any form can be done by referral from a psychiatrist. Many psychotherapists work in the same building or hospital as the psychiatrist, so it's just a matter of bumping it to the therapist. Some therapists are specialized in a certain field, such as eating disorders. One can hire a psychotherapist without a doctor's referral although they usually end up paying all or most of the fees.

There are many cons and pros to the system. Cons include long waiting lines due to so few doctors, difficulty in doctors from other countries being re-certified, little funding so often have small amount of beds, prisons and jails turn into alternatives for areas where hospitals are too full of psychiatric patients, overload results in very short sessions with doctors and therapists, etc... . Unfortunately, this overload and shortage is not only for the psychiatric patients, as emergency in-take waiting rooms can have patients waiting for hours despite a broken arm, leg, extreme back pain, etc... .

Some pros are that there are more sophisticated rooms and buildings at universities, allowing for more doctors to be trained. For example, University of Toronto St. George is well-known for having a multitude of hospitals, however, University of Toronto Mississauga has just gotten a teaching hospital, additional research building and lecture halls built. Whether the potential future doctors practice outside of Ontario or Canada is another question but as it stands, more opportunities are available. Another benefit is pretty much every hospital (maybe with the exception of a few small ones, not sure) all have operating rooms, X-ray scanners, MRI scanners, CT scanners, angiograms, ultra-sound, and specialized doctors, such as cardiologists. Although not all the small hospitals have such specialized doctors on staff, such as the nearest hospital doesn't have a neurologist on staff, they can commute from much larger hospitals that aren't too far away, so it usually is not a problem.

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