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Certain mental health disorders are more prevalent in women. Learn the reasons behind these gender differences and how you can protect your emotional well-being.

If you are a woman experiencing depression, an anxiety disorder, or another mental health condition, you are not alone.

According to a recent survey by the Substance Abuse and Mental Health Services Administration, 29 million American women, or about 23 percent of the female population, have experienced a diagnosable mental health-related disorder in the last year alone. And those are just the known instances.

Experts say that millions of other cases may go unreported — and untreated.

Mental Health: Women’s Health Issues

Some mental health conditions occur more often in women and can play a significant role in the state of a woman’s overall health.

While men experience higher rates of autism, early onset schizophrenia, antisocial personality disorder, and alcoholism, mental health conditions more common in women include:

• Depression. Women are twice as likely as men (12 percent of women compared to 6 percent of men) to get depression.
• Anxiety and specific phobias. Although men and women are affected equally by such mental health conditions as obsessive-compulsive disorder and social phobias, women are twice as likely as men to have panic disorder, generalized anxiety, and specific phobias.
• Post-traumatic stress syndrome (PTSD). Women are twice as likely to develop PTSD following a traumatic event.
• Suicide attempts. Men die from suicide at four times the rate that women do, but women attempt suicide two or three times more often than men.
• Eating disorders. Women account for at least 85 percent of all anorexia and bulimia cases and 65 percent of binge-eating disorder cases.

Mental Health: Women’s Symptoms Are Also Different

Even when men and women share a common mental health diagnosis, the symptoms, and subsequently the treatment, can be different.

For example, a man who is depressed is likely to report job-related problems, while a woman is more likely to report physical issues, like fatigue or appetite and sleep disturbances. Unlike their depressed male counterparts, women tend to develop problems with alcohol abuse within a few years of the onset of depression. Women are more likely to use religious and emotional outlets to offset the symptoms of depression compared to men, who often find relief through sports and other hobbies.

Women with schizophrenia more often experience depression and thought impairment, while men with schizophrenia are more likely to become apathetic and socially isolated. Women with schizophrenia typically respond faster to antipsychotic medication and need less personal care. Schizophrenic women also report more mood symptoms, which can complicate the diagnostic process and may require a prescription for mood stabilizers in addition to anti-psychotic medications.

Mental Health: Why the Gender Differences?

What goes on in the female brain and body to differentiate these responses to mental illness? The answers may lie in:

• Biological influences. Female hormonal fluctuations are known to play a role in mood and depression. The hormone estrogen can have positive effects on the brain, protecting schizophrenic women from severe symptoms during certain phases of their menstrual cycles and maintaining the structure of neurons in the brain, which protects against some aspects of Alzheimer’s. On the less positive side, women tend to produce less of the mood stabilizer serotonin and synthesize it more slowly than men, which may account for the higher rates of depression. A woman’s genetic makeup is also believed to play a role in the development of such neurological disorders as Alzheimer’s.
• Socio-cultural influences. Despite strides in gender equality, women still face challenges when it comes to socio-economic power, status, position, and dependence, which can contribute to depression and other disorders. Women are still the primary caregivers for children, and it is estimated that they also provide 80 percent of all caregiving for chronically ill elders, which adds stress to a woman’s life.

  Girls tend to become dissatisfied with their bodies at puberty, a reaction that is linked to depression. Girls are also sexually abused more often than boys, and one in five women will experience rape or attempted rape, which can lead to depression and panic disorder.

• Behavioral influences. There is some thinking that women are more apt to report mental health disturbances than men and that doctors are more prone to diagnose a woman with depression and to treat the condition with mood-altering drugs. Women are more likely to report mental health concerns to a general practitioner, while men report tend to discuss them with a mental health specialist. However, women are sometimes afraid to report physical violence and abuse.

Mental Health: Ongoing Research

While distinctions between men and women weren’t always clearly made in mental health research, in recent years government mandates have encouraged federal agencies such as the National Institutes of Health to respond to the need for mental health research specific to women. Private organizations are also responding to the need to research men’s and women’s health issues separately.

For example, researchers at the Women’s Health Research Center at Yale University in New Haven, Conn., are studying many issues related to women’s mental health, including:

• Differences in brain development that may provide insights into treating and preventing depression and bipolar disorder
• Mood and memory processes in women that may make it harder for them to quit smoking
• Effects of estrogen on memory, behavior, cognition, and emotion, and particularly how estrogen seems to increase rates of PTSD and depression
• Genetics specific to women that may contribute to alcoholism

As more research comes to light and there is greater understanding of women’s mental health issues, experts are hopeful that targeted treatments will bring better results and more positive outcomes for women with mental health conditions.

Being part of a group can offer insights that you may be too close to your situation to see. Discover why participating could be a helpful type of treatment for you.

At first, the idea of participating in group therapy might seem intimidating. Who wants to share their story with strangers? But group therapy, in which one or more psychologists lead a group of 5 to 15 people, can be very beneficial. In fact, “participants are often surprised by how rewarding their experience can be,” says Ben Johnson, PhD, ABPP, a clinical psychologist, director of Rhode Island Cognitive Behavioral Therapy and Coaching, and a clinical assistant professor at the Warren Albert Medical School of Brown University in Providence, R.I. “I’m a big fan of group therapy.”

Patti Cox, PhD, CGP, in private practice in New York and president of the Eastern Group Psychotherapy Society, a regional affiliate of the American Group Psychotherapy Association, says anyone can benefit from group therapy “What’s important is to be in the right group at the right time,” she says. “An acute crisis is not the best time to start group therapy because your needs are so great.”

Groups generally meet once or twice a week for 90 minutes to two hours. How much people want to reveal about themselves is very individual, but there’s security in knowing that what’s said in group, stays in group.

Benefits of Group Therapy

Here’s how group therapy for mental health treatment can help:

Groups provide support. Hearing from others with similar issues helps you see that you’re not alone in having challenges, whether you’re grappling with panic attacks, depression, or another mental health issue, Johnson says. Many people experience a sense of relief.

Groups provide a sounding board. If, for example, you talk about a fight you had with your partner, group members can see things in the way you present it that you don’t. “Hearing from other people about how you come across can be very powerful,” Johnson says. “You get a wider range of perspectives on your situation, and that can help you deal with your problems better.”

Groups can propel you forward. Hearing how other members successfully overcame their fear of flying or how they confronted a family member over drug abuse can be very encouraging. “Patients often push themselves harder when they see what others are doing,” Johnson says.

Groups promote social skills. “Groups not only help to ease that sense of isolation, but also give the opportunity to practice re-engaging with people,” Johnson says. By participating in a group, you see that you can get along with others.

Group therapy costs less than individual counseling. Some people believe that, because group therapy costs less, it’s not as good, but “that’s not the case at all,” Cox says. “Group therapy can be incredibly powerful.”

Groups teach you about yourself. “Every person in the group holds up a mirror and you get to see yourself through their eyes,” Cox says. It’s a way of uncovering the blind spots that may be blocking your ability to overcome your issues.

Sharing Can Be Healing

Like many people, Traci Barr, 51, of Greenville, S.C., who was diagnosed with bipolar disorder as a teen, was skeptical that she could benefit from a group. However, three years ago, after a failed suicide attempt, Barr went into group therapy while recovering in the hospital.

“I had a much more open mind to it because, at that point, I had nothing left to lose,” she says. “I was going to do whatever the doctors told me, and doctors told me I would benefit from group therapy.”

Right away, though, Barr found that the suggestions the group offered were exactly what she needed.

RELATED: 5 Health Risks Linked to Depression

“The group helped me most with coping skills,” she says. “I learned very simple and very effective things — such as what boundaries are and not to allow things in my life that were not good for my manic side.” Barr also found that sharing her story with others was “very meaningful and very healing.”

The group experience, Barr says, “definitely helped me over the hump.” From there, she says, it was a matter of building on small victories — going from being unable to do laundry to launching a new career as a chef and now being able to make presentations about healthy eating in front of large crowds.

How to Get the Most From Group

Try these steps to maximize group therapy:

Take a pledge. Each group should have participants sign a contract that spells out what’s expected of them, Cox says. Knowing this can help you overcome any fears about participating.

Participate. You might have days when you don’t feel like talking, and that’s fine, Cox says, but the more you contribute, the more you’ll get out of it.

Share. Your experiences might be meaningful to someone else, and you’ll find that helping others helps you, too.

The Affordable Care Act counts mental health and substance abuse coverage among essential benefits.

Mental health parity has finally arrived, and hopefully it’s here to stay. Under the Affordable Care Act, all exchange plans, individual and group, must provide mental health and substance abuse coverage, which is one of the 10 “essential benefits.”

A few weeks ago, the federal government issued its final rules for the Mental Health Parity and Addiction Equity Act, passed in 2008. The act requires insurers to use the same financial requirements (such as co-pays) and treatment limitations (such as limits on office visits) for mental health and substance abuse coverage as they do for medical and surgical coverage.

Prior to this ruling, the definition of mental health and substance abuse parity was unclear. According to Dr. John Bartlett, senior project advisor for the Primary Care Initiative of the Mental Health program at the Carter Center, the ruling corrected two fundamental problems with the 2008 parity act: The act didn’t require insurers to provide mental health and substance abuse coverage, and it didn’t clearly define what parity meant in the “operational sense.”

The final ruling does just that. According to the Health and Human Services press release, the final rules mandate insurers follow certain regulations:

• Ensure that parity applies to intermediate levels of care received in residential treatment or intensive outpatient settings.

• Clarify the scope of the transparency required by health plans, including the disclosure rights of plan participants, to ensure compliance with the law.

• Clarify that parity applies to all plan standards, including geographic limits, facility-type limits, and network adequacy.

• Eliminate the provision that allowed insurance companies to make an exception to parity requirements for certain benefits based on “clinically appropriate standards of care,” which clinical experts advised was not necessary and which is confusing and open to potential abuse.

It may sound like a maze of verbiage, but it’s much better than before. These new standards guarantee that each state will be subject to the same parity requirements. This is crucial because the federal  government had allowed each state to determine its own definition of  parity for mental health and substance abuse coverage. Without federal standardization, each state would have likely had different, probably inadequate, mental health and substance abuse benefits.

Now, the states have a federal standard they must meet. As Dr. Bartlett said about the final rule, “It operationalized the concept of parity very specifically. We now have a standard with which to evaluate plans to see if they comply with the parity standard.”

Because of this, if you purchase an ACA-compliant plan, your insurer should cover your mental and physical health benefits equally: That includes co-pays,  co-insurance, limits on hospital stays, and limits on the number of outpatient visits your plan will cover.

If your insurer uses a third-party provider (Magellan, for example) to provide mental health coverage, they must follow the same parity requirements. If your plan offers out-of-network medical and surgical benefits, then the plan must also offer out-of-network mental health and substance abuse benefits. Most exchange plans don’t offer out-of-network coverage, but there are a few that do. In fact, I found one on the Washington D.C. exchange and purchased it.

Of course, grandfathered and other ACA-exempt plans don’t have to follow these parity requirements. In fact, they don’t have to provide mental health or substance abuse coverage  at all. If they do provide coverage, they can limit inpatient and outpatient services. My previous health plan is a case in point. If I had needed inpatient psychiatric treatment, Aetna would only have covered up to 60 days of treatment. If I had needed inpatient substance abuse treatment, they would only have covered 12 days of treatment. (For the record, I didn’t need either.)

So if you want to keep your current health plan, examine its mental health/substance abuse benefits closely before selecting it. Of course,  your current plan may offer comparable or better mental health coverage than the exchange plans. As I often say, if you are unsure of which plan to choose, err on the side of caution, and choose an ACA-compliant plan. If you do so, you will definitely receive comprehensive psychiatric care along with the other “essential benefits.”

It’s hard to overstate the importance of these new rules. It is, undboutedly, a game-changer for all Americans, especially those who provide and receive psychiatric care. Of course, we have to wait until the rubber meets the road before we celebrate a victory.  As Dr. Richard Summers, co-director of the psychiatric residency program at the University of Pennsylvania Perelman School of Medicine, told me: “There is an attitude of cautious optimism that this may be helpful, but what’s going to be interesting is to see how this rule will be interpreted and implemented.” Let’s keep our fingers crossed that this rule, unlike previous ACA rules, is here to stay.

Speaking of rule changes, if you want coverage beginning January 1, you now have until December 23 to sign up. The previous deadline of December 15 was moved. When other Obamacare changes occur, I’ll tweet the news.

Dear Mr. Manners: My wife is being treated for a severe mental health condition that often means she’ll bow out of social events at the last minute. We’ve been reluctant to let even our closest friends know of her diagnosis because of the stigma so now many of them think she is either rude or flakey. When does one let others know? And how much is appropriate to reveal? — Anonymous

A: I’m so sorry to hear about your wife’s illness. I’m sure you’re both facing some tough challenges. It’s worth remembering, however, that the social stigma around mental illness has lessened considerable in the past two decades as more and more of us accept a“neurobiological” understanding of these conditions, rather than blaming family members or someone else, as Dr. Marvin Swartz, a professor of psychiatry at Duke University Health System, explained to me last week. At the same time, there are more and more advocacy groups helping patients and their families to come out and garner much needed support. (Check out theNational Alliance for Mental Illness and Mental Health America.)

As I often do, I posted your question on my Facebook wall to see what others had to say and, as usual, found much wisdom:

• “I have physical issues along with PTSD and severe depression that cause me to either not make plans, cancel plans or leave early. In the beginning I lost a lot of friends because of it. Now I don’t worry about it. I only plan with those who totally understand. She’s lucky to have a partner. I am doing this alone.”
• “If you acknowledge your own problems once in a while – so will the good people around you. And that way we become closer and better friends. It’s not such a big deal that none of us is perfect. We are pretty awesome anyway.”
• “I think you disclose if you feel like it will help both of you… i.e. to someone who is going to be supportive and helpful. AND obviously you need her permission as well. But it’s also perfectly acceptable to say she’s ill and can’t make it. You don’t need to supply a diagnosis.”

For those considering disclosure:

1. REMEMBER, YOU’RE IN CONTROL: While, there are no hard and fast rules for revealing a mental health condition, it’s often helpful to remind yourself that while you can’t always control the condition you can choose whether to disclose it or not.
2. GET PERMISSION: Any family member who is considering revealing the mental health diagnosis of a spouse or other relative must get permission before doing so. As Dr. Swartz told me: “It’s not okay without their approval.”
3. THERE’S NO TAKING IT BACK: Remember that once revealed, major announcements cannot be retracted and that while stigma has lessened, it has not evaporated completely. If you tell a friend, let her know whether this news is meant to be kept private – or not.
4. BEING VAGUE IS OK: You don’t need to supply a diagnosis. In fact, Dr. Swartz suggests not getting overly specific and using catchall conditions like depression and anxiety. He suggests: “My wife has been having trouble with depression and sometimes hits particular tough spots. She was feeling particularly bad the other night and I’m sorry we had to cancel our plans.”

If you’re the friend or relative being confided in:

1. RESPECT PRIVACY: Be sure to respect the trust and confidence extended to you. Do not share the news with others unless you’ve gotten permission.
2. DO NOT SUCCUMB TO THE STIGMA: Respond as you would if a friend told you he had heart disease or diabetes; a condition is a condition is a condition. Ask how you can help, while giving as much emotional support as possible. Dr. Swartz notes that it’s a common reaction to withdraw – so do your best not to. He adds: “Often family members will say if my loved one had cancer they’d bring a covered dish over and ask how they are. With mental health conditions you don’t get the same support.”
3. SUPPORT THE SUPPORTERS: Be sure to provide support and encouragement to caregivers, too. They may be just as much in need. Ask: “How are you doing with your wife’s illness?” and then follow his social prompts.

In fact, that last point raises the importance of taking care of the caregiver (that’s you!). Family members often feel isolated or ashamed. Speak up about your own needs and, if helpful, don’t be reluctant to seek professional help – for yourself. As Dr. Swartz said: “I often want to touch base with family members to make sure they have the resources they need to take care of themselves with supporting a loved one.”

Every Thursday, Steven Petrow, the author of five etiquette books, and the forthcoming “Mind Your Digital Manners,” addresses questions about medical manners. Send your question to stevenpetrow@earthlink.net. Follow him on Facebook:www.facebook.com/stevenpetrow Or Twitter: www.twitter.com/stevenpetrow

MOST POPULAR QUESTIONS

• How can I see a psychiatrist?

• How can I see a psychiatrist privately?

• How do I get hold of a psychiatrist who will act as an ‘expert witness’?

• How do I make a complaint about the conduct of a psychiatrist?

• How do I make a complaint about my care and treatment, or the care and treatment of another?

HOW TO CONTACT A PSYCHIATRIST

• What is the difference between a psychiatrist, a psychologist, a psychotherapist and a Community Mental Health Team?
• How can I see a psychiatrist?
• How can I see a psychiatrist privately?
• What kind of psychiatrist can I be referred to?
• Can you give me a list of psychiatrists?
• Is the psychiatrist a member of the College?
• Can I speak to a psychiatrist at the College?
• How can I find out what speciality a psychiatrist is trained in?
• Where do psychiatrists work?
• What qualifications does a psychiatrist need?
• How do I find a psychiatrist in another country?

HOW TO MAKE A COMPLAINT

• What do I do if I am unhappy with my psychiatrist?
• How do I make a complaint about my care and treatment, or the care and treatment of another?
• How do I make a complaint about the conduct of a psychiatrist?
• What should I do if I wish to make a complaint about a psychiatrist working in the private/independent sector?
• Can I as a carer make a complaint on behalf of the person I care for?
• If I’m sectioned under the Mental Health Act, how do I make a complaint?

WHERE CAN I GET FURTHER INFORMATION (ASSISTANCE)?

• What should I do if I am worried about a relative or friend?
• Who else can I talk to if I am worried about a mental health issue?
• How can I find out more about a mental health topic, or problem?
• How do I get further information about the drugs I am taking?
• How do I get hold of a psychiatrist who will act as an ‘expert witness’?
• What is the 1983 Mental Health Act?
• What does it mean to be ‘sectioned’?
• How can I access my health records?
• I need urgent support.
• I need urgent medical help.
• I am in a public place, and concerned that someone is very ill, and may be a risk to themselves or others.

INFORMATION ABOUT THE COLLEGE

• What does the Royal College of Psychiatrists do?
• What does it mean by being a Member or Fellow of the College?
• I am a member of the public and would like to know more about or become involved in the work of the College?

A CAREER IN PSYCHIATRY?

• I am interested in a career in psychiatry.

Q: What is the difference between a psychiatrist, a psychologist, psychotherapist and a community mental health team?

A psychiatrist is a medically-qualified practitioner who will have spent 5-6 years training as a doctor. He or she will then have worked as a doctor in general medicine and surgery for at least a year. He or she will then have had at least 6 years of further training in helping people with psychological problems.

What are a psychiatrist’s special skills?

All psychiatrists will learn how to:

• assess a person’s state of mind
• use the “biopsychosocial” model of understanding. This emphasises the importance of a person’s past experiences, family, culture, surroundings and work as well as any medical features.
• diagnose a mental illness
• use a range of psychological treatments
• use a range of medications
• help a person recover

As well as these ‘core’ skills, a psychiatrist will specialise and develop skills in working with the particular problems that affect different groups of people.

Psychologists have a degree in psychology. Chartered Clinical Psychologists are not usually medically-trained, but have undertaken a long and robust training following their psychology degree. They are primarily concerned with the study of how people think, act, react and interact. For further information about psychology, visit the British Psychological Society website.

A psychotherapist may be a psychiatrist, psychologist, or other mental health professional who has had further specialist training in psychotherapy.As well as listening and discussing important issues with you, the psychotherapist can suggest strategies for resolving problems and, if necessary, help you to change your attitudes and behaviour.

The Mental Health Team is a group of mental health professionals who work together to help people with a wide range of mental health problems. The different professions all have different knowledge and skills which can be used to tackle problems together.

Futher information on the differences between psychiatry, psychology and psychotherapy

1. How can I see a psychiatrist?

To see a psychiatrist, you will usually need a referral from your general practitioner (GP), in the same way you would with any other specialist. Within the NHS, most referrals will go to the mental health team. Initially, you may be seen by a team member who is not a psychiatrist. If the team member feels that you ought to see a psychiatrist, they will arrange an appointment for you.

1. How can I see a psychiatrist privately?

Most private psychiatrists would still prefer a referral from your GP. Your GP may be able to recommend psychiatrists who practise privately. Local private hospitals may also be able to advise you about this. Some psychiatrists may advertise in your local business directory. If they have the title ‘MRCPsych’ (Member of the Royal College of Psychiatrists) or ‘FRCPsych’ (Fellow of the Royal College of Psychiatrists), this means that they are current members of the College.

1. What kind of psychiatrist can I be referred to?

You will most likely be referred to a psychiatrist who specialises in an area of psychiatry that relates to your problem. The areas include:

• Addiction Psychiatry
• Child and Adolescent Psychiatry
• Eating Disorders
• Forensic Psychiatry– Psychiatrists who work in the criminal justice system
• General Adult Psychiatry
• Intellectual Disabilities Psychiatry
• Liaison Psychiatry– Psychiatrists who work in general hospitals
• Old Age Psychiatry
• Perinatal Psychiatry
• Psychotherapy
• Rehabilitation and Social Psychiatry

1. Can the College provide a list of psychiatrists?

The College is unable to recommend or supply names of psychiatrists. In order to find a psychiatrist, you should ask your GP or local hospital. You can obtain lists of local GPs, from your pharmacist and/or hospitals by contacting NHS Choices.

1. Is the psychiatrist a member of the College?

You can search the Public Online Membership List to confirm whether or not the psychiatrist is a member of the Royal College of Psychiatrists. Please note, not all psychiatrists are members of the College.

1. Can I speak to a psychiatrist at the College?

The Royal College of Psychiatrists is the professional body for psychiatrists in the UK, but the College is unable to supply names of members, or to recommend psychiatrists.

1. How can I find out what speciality a psychiatrist is trained in?

You can search for their details on the Medical Register, a directory of all doctors practising in the UK, by visiting the General Medical Council website.

Q: Where do psychiatrists work?

The majority of psychiatrists work within (NHS) the National Health Service, although some work privately. Psychiatrists also work as part of a mental health team.

Q: What qualification does a psychiatrist need?

A qualified psychiatrist will have a medical degree.  They will then have completed two years of Foundation Training and a further six years of specialty training within psychiatry.

To become a consultant psychiatrist, they would also need to obtain a Certificate of Completion of Training (CCT), be fully registered with the General Medical Council (GMC) and listed on theirSpecialist Register.

Q: How do I find a psychiatrist in another country?

The Royal College of Psychiatrists is the professional and educational body for psychiatrists in the United Kingdom. It is not possible to include information on issues outside of our geographical area as the availability of mental health services, local legislation, and the types of treatments available is different in each country.  We are only able to comment on psychiatric practice in the United Kingdom.

You will be able to find which psychiatric organisation is relevant to your country by looking at theWorld Psychiatric Association website. The World Psychiatric Association is a group of International Psychiatric Societies.

Q: What do I do if I am unhappy with my psychiatrist?

Everyone is entitled to a second opinion.  You need to ask your GP, or your psychiatrist, to refer you to another psychiatrist for a second opinion.

Q: How do I make a complaint about my care and treatment or the care and treatment of another?

The Royal College of Psychiatrists is not the disciplinary body for its members and, as such, is not able to deal with complaints about psychiatrists. You can write to, or speak with your psychiatrist to tell them how you feel about your care and treatment. Your hospital will have a complaints procedure. To make a complaint, contact either the Complaints Officer or the relevant Hospital Manager, or ask somebody to do this on your behalf.

If you have concerns about a hospital, care home or health service, you should contact the body which is responsible for the inspection, monitoring and regulation of health and social care in your area

• England – Care Quality Commission (Tel: 03000 616161)
• Scotland – Care Inspectorate (Tel: 0345 600 9527)
• Wales – Care and Social Services Inspectorate Wales (Tel: 03000 628 888)
• Northern Ireland – Regulation and Quality Improvement Authority (Tel: 028 9051 7500)

Q: How do I make a complaint about the conduct of a psychiatrist?

You can complain directly to your psychiatrist. If you are unhappy with their response, you can complain to their employer, clinic or hospital. If the complaint is to report serious misconduct, you can complain to the General Medical Council (Tel: 0845 357 0022).  The last step for dealing with unresolved complaints is to contact the Health Service Ombudsman (Tel: 0345 015 4033) who acts as a final arbitrator.

Q: What should I do if I wish to make a complaint about a psychiatrist working in the private/independent sector?

You can complain to the clinic where the psychiatrist works. In cases of professional misconduct, you can also contact the General Medical Council (Tel: 0161 923 6602).

Q: As a carer can I make a complaint on behalf of the person I care for?

Yes you can.  In some cases you may need the consent of the person you care for. You may follow the same complaints procedure as above.  The College has more information on the Partners in Care pages.

Q: If I’m sectioned under the Mental Health Act, how do I make a complaint?

If your complaint is about the use of the Mental Health Act, you can contact the Care Quality Commission (Tel: 03000 616161). You can write or speak to the Complaints Officer at the hospital, or ask somebody to do this on your behalf.

Q: What should I do if I am worried about a relative or friend?

You should encourage them to go and see their GP. Further information about mental health problems and their treatment are available on our website.

If you are worried about someone who is very unwell and appear to be a risk to themselves or others, you can call the police or NHS 111 (Tel: 111). The police can take someone who appears to be very ill to a mental health professional for assessment and help.

Q: Who else can I talk to if I am worried about a mental health issue?

There are many organisations that run helplines with advice, information and support. Details of key helpline numbers and website addresses can be found on the College website.

Q: How can I find out more about a mental health topic or problem?

The College publishes a series of leaflets which give information about different mental health problems and treatments. These are free to view and download from our website.

Q: How do I get further information about the medication?

There are many different ways to find out this information. You can ask your:

• GP
• Pharmacist
• Psychiatrist
• Mental Health Team

You could look up medications in the British National Formulary (BNF). This is a directory of drugs which are listed alphabetically.  There is an entry for every drug which gives information on dosage and side-effects, etc…

Some drug companies run helplines.  Contact details are available on the drug information leaflet or pack label.

The Electronic Medicines Compendium (EMC) website stores a copy of all approved drug information leaflets.

The College has also published information on some drugs and therapies that are used to treat specific mental health problems, such as Alzheimer’s disease.

Q: How do I get hold of a psychiatrist who will act as an ‘expert witness’?

The College cannot to recommend or supply names of psychiatrists.

Solicitors can search through the lists of psychiatrists that are registered with any of the following websites:

• UK Register of Expert Witnesses
• Expert Witness
• The Expert Witness Directory
• The Society of Expert Witnesses

Q: What is the 1983 Mental Health Act?

The Mental Health Act is an Act of Parliament that allows for people who are mentally unwell to be admitted to hospital for assessment and treatment against their wishes. Many people will be admitted to hospital as informal patients; this means that they have voluntarily agreed to go. However, compulsory admission may sometimes be necessary when someone who has such severe problems that they are a risk to their own health or the health or safety of other people, and refuse to go to hospital. In these cases, compulsory admission can be arranged under one of the sections of the 1983 Mental Health Act, and the person is detained ‘on section’ (or ‘sectioned’).

Q: What does it been to be ‘sectioned’?

The College has produced a factsheet on being detained on a section in England and Wales.  The factsheet also includes links to organisations which provide information on being detained on a section on Scotland and Northern Ireland.

Q: How can I access my health records?

To request access to your health records, you must make a request in writing, or by email, to:

• for GP records, your doctor.
• for hospital records, the hospital’s Records Manager.

The maximum fee charged is £10 for computer records, or £50 for copies of paper records, or a mixture of computer and paper records.  Your records are protected by the Data Protection Act.

Q: I need urgent support:

You can contact the following organisations:

• Samaritans: 08457 90 90 90
• Saneline: 0845 767 8000

Q: I need urgent medical help:

Contact one of the following:

• Your GP
• NHS Choices: 111

Q: I am in a public place and I am concerned that someone is very ill and may be a risk to themselves or others:

Call the police, or the ambulance service (999).  The police can take someone who appears very ill to see a doctor for assessment and help.

Q: What does the Royal College of Psychiatrists do?

The Royal College of Psychiatrists is the professional medical body responsible for supporting psychiatrists throughout their careers, from training through to retirement, and in setting and raising standards for psychiatry in the United Kingdom.

The College aims to improve the outcomes of people with mental illness, and the mental health of individuals, their families and communities.  In order to achieve this, the College sets standards and promotes excellence in psychiatry; leads, represents and supports psychiatrists; improved the scientific understanding of mental illness; works with and advocates for patients, carers and their organisations.  Nationally and internationally, the College has a vital role in representing the expertise of the psychiatric profession to governments and other agencies.

For further information about the history of the College and its work, visit the College Archives.

Q: What is a Member or Fellow of the College?

Members of the College are awarded different grades of membership depending on various factors, including:

• the contribution they have made to the field of psychiatry
• their degree of experience as a professional psychiatrist
• the amount of time they have been a member.

For further information see About College Membership.

Q: I am a member of the public and would like to know more about, or become involved in the work of the College?

If you are a member of the public and would like to hear more about what the College is doing, or be involved in the work of the College, such as new publications, consultations about policy issues, or even help us to improve mental health services, you can join the College Service User and Carer Network.

Q: I am interested in a career in psychiatry

If you are still at school, you can find information about the psychiatric profession and how to become a psychiatrist: Information for Sixth Formers and also take our quiz to see whether you would make a good psychiatrist.

If you’re a medical student who is interested in specialising in psychiatry, you can find information about further training, day-to-day work and the areas of specialisation on: Information for Medical Students and Foundation Trainees.

To treat ADHD or not? To use prescription medications or not? Behavioral therapy or not? Diet or other natural or alternative approaches or not? Partly because the illness primarily affects children, partly because the prescription medications currently available are burdened by stigmas relating to drug abuse, and partly because of societal issues questioning the very existence of Attention Deficit Hyperactivity Disorder (ADHD), its treatment raises many questions whose answers need to be based on science, independently created and unbiased, and easily understood. To those ends, HealthTalk produced a two-part webcast on ADHD treatment.

To supplement the HealthTalk programs, the American Academy of Child and Adolescent Psychiatry and the American Psychiatric Association have published a new ADHD Parents Medication Guide. It is available in both English and Spanish. The guide provides information on ADHD symptoms, treatment options, types of medications, drug side effects, disorders that can co-occur, psychosocial treatments as well as a section on unproven treatments.

Left untreated, ADHD can have profound effects on a child’s school performance and can increase their risk of disciplinary problems and dropping out. I’ve previously written about both the negative impacts it can have on school and the proven improvement that treatment can provide. But ADHD can also lead to a host of other problems as this list from the Parents Medication Guide dramatically shows:

Potential Consequences when ADHD is Left Untreated
• Increased risk for school failure and dropout
• Behavior and discipline problems
• Social difficulties and family strife
• Accidental injury
• Alcohol and drug abuse
• Depression and other mental-health disorders
• Employment problems
• Driving accidents
• Unplanned pregnancy
• Delinquency, criminality, and arrest

Numerous studies have proven the value of medication in treating ADHD. The largest of these is called the Multimodal Treatment Study of Children with ADHD, or MTA for short. It showed that methylphenidate (one type of the various stimulant medications used in ADHD treatment) is effective in treating ADHD, either alone or in combination with behavioral therapy. Moreover, it found that treatment that includes medication is superior to behavioral treatment alone. Best of all are approaches that combine medication with behavioral therapy.

Behavioral therapies include three approaches; namely, parent training, child-focused treatment, and school-based interventions. These methods teach the parents, the children and their teachers about ADHD and how they can all better develop skills needed to manage its frustrating behaviors and their negative consequences.

There are two major groups of ADHD medications: stimulant and non-stimulant. The stimulant medications include methyphenidate and amphetamines, which have been available for decades and are known to be highly effective. They have been shown also to be quite safe when prescribed, taken and monitored properly. Only one non-stimulant medication is currently approved by the FDA for ADHD: Strattera (amoxetine). It too has been shown to be both safe and effective and may be more appropriate for certain children who either don’t respond well enough to stimulants or who have other co-existing disorders.

The ADHD Parents Medication Guide was developed by an independent group of medical professionals and parent advocacy groups. Of note, no pharmaceutical funding or editorial support was used in its preparation. The following organizations contributed to its development:

American Academy of Child and Adolescent Psychiatry (AACAP)
• American Psychiatric Association (APA)
• Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD)
• Child and Adolescent Bipolar Foundation
• Federation of Families for Children’s Mental Health
• Mental Health America
• National Alliance on Mental Illness (NAMI)
• National Institute on Mental Health (NIMH)

The ADHD Parents Medication Guide is available for free. More information about ADHD including archives of past webcasts, news about upcoming programs, reference materials and blogs is available on our ADHD homepage.

In 1990, Congress designated the first full week of every October to be National Mental HealthAwareness Week. This year that week is October 7-13, 2007 and October 11th is both National Depression Screening Day, sponsored by Screening for Mental Health, Inc., and Bipolar Disorder Awareness Day. Bipolar Disorder Awareness Day is organized by the National Alliance on Mental Illness (NAMI), a non-profit group which is the nation’s largest grassroots mental health organization dedicated to improving the lives of persons living with serious mental illness and their families.

Bipolar disorder is also called manic depression or manic-depressive illness, but its treatment is different from that of depression (see below). It is a chronic brain disorder that causes extreme shifts in mood, energy and ability to function. It is characterized by episodes of mania (being overly ‘high’) and depression (being irritable, sad or hopeless) that can last from days to months. Symptoms often begin in adolescence or early adulthood and can result in poor school performance, poor job performance, damaged relationships, substance abuse, criminal or other irrational behavior and even suicide. Oftentimes depression dominates the clinical picture and mania may go unrecognized, especially if it is mild (called hypomania) or occurs only rarely. However, the recognition of mania is critical to the proper diagnosis of bipolar disorder, which might otherwise be diagnosed as depression (also called unipolar depression).

The treatment of bipolar disorder is different from the treatment of depression. Everyone knows that depression is treated with anti-depressants. But bipolar disorder, even though it has depression as a component, needs to be treated with mood stabilizers first and foremost. Anti-depressants play a much lesser role, if any, in the treatment of bipolar disorder, and they can actually make the illness worse (especially if used alone without mood stabilizers). You can see why proper diagnosis is so important.

In recognition of Bipolar Awareness Day, HealthTalk has created a Special Feature page with a wide variety of useful information, including treatment information, on this illness.

Bipolar Awareness Day was created by NAMI and Abbott Laboratories to, according to the NAMI Web site “increase awareness of bipolar disorder, promote early detection and accurate diagnosis, reduce stigma, and minimize the devastating impact on the 2.3 million Americans presently affected by the disorder.” The government’s National Institute of Mental Health states that about 5.7 million American adults have bipolar disorder in any given year. Other estimates put the number of people with bipolar disorder at 10 million.

When combined with traditional psychotherapy, activities involving horses can help people suffering from a range of mental conditions, including depression and ADHD.

Humans and horses have maintained a healthy relationship for millennia — research suggests people first domesticated the large ungulates 6,000 years ago in the western region of the Eurasian Steppe. But far from being the simple beasts of burden or transportation tools they were in the past, horses today have become key players in the mental rehabilitation of many people around the world.

Equine-assisted therapy is an umbrella term encompassing several therapeutic activities involving horses. Hippotherapy, for example, utilizes the movement of horses for physical, occupational, or speech therapy, and has been used to treat motor and sensory issues associated with cerebral palsy, multiple sclerosis, and stroke, among other things. Though horses have been used for physical therapy since at least the fifth century B.C., the formal discipline of hippotherapy wasn’t established until the 1960s.

RELATED: 6 Ways Dogs Help Ease Depression Symptoms

On the other hand, equine-assisted psychotherapy (EAP) — a type of experiential psychotherapy that uses horses to help in the treatment of psychological and behavioral issues — is a much newer activity that isn’t widely practiced yet, says Hallie Sheade, a licensed professional counselor who runs Equine Connection Counseling, an EAP practice based in Texas. “It is a very exciting and rapidly growing field,” she says.

How Horses Help

While scientists understand how the rhythmic movement of horses can assist with motor and sensory problems, how horses help with mental or behavioral issues hasn’t been completely worked out.

“The mechanism of action hasn’t been well established for equine-assisted therapies with relation to non-physiological, non-mobility activities,” says Alexa Smith-Osborne, an associate professor of social work at the University of Texas at Arlington, who studied equine-assisted therapy. “Nevertheless, on a practical basis, there are some theoretical perspectives.”

For one thing, horses are prey animals, she says. Because of this, horses are more highly attuned to environmental activity and sensitive to people’s emotional states than dogs and other animals typically used in assisted therapies.

“They’re capable of reading or becoming aware of how [a patient’s] feeling before I’m aware of it or the even the client is,” Sheade says. “The horse will then give feedback to the client, such as by moving towards the client or away.”

Additionally, horses are large and powerful and have the potential of allowing people to overcome fear and develop confidence that can be translated into real-life situations. They can also help put people at ease because they’re unbiased and non-judgmental, responding only to people’s intent and behavior. What’s more, they’re social animals with their own personalities, and are most willing to interact when people are engaged and work to build a relationship with them.

Uses and Benefits of EAP

EAP has been used in the treatment of a wide range of conditions, including:

• Depression
• Post-traumatic stress disorder
• Attention deficit hyperactive disorder
• Anxiety
• Behavioral issues, including aggressive behavior
• Substance abuse
• Eating disorders, including anorexia and bulimia
• Relationship problems
• Communication issues

Equine-assisted therapy sessions, which involve a therapist and horse handler, vary depending on the condition being treated and the person(s) involved. In general, traditional experiential psychotherapy techniques, such as role-playing, role-reversal, and mirroring, are combined with equine-based activities, including choosing, grooming, and walking a horse. After the activity, patients then process or discuss their feelings and behaviors associated with the session.

Though qualitative case studies have demonstrated benefits to equine-assisted psychotherapy, well-controlled, quantitative studies are lacking. But in a study published in the journal Health Psychology, Smith-Osborne and her colleague Alison Shelby reviewed previous research on EAP, and found that the practice is a promising adjunct to traditional therapy.

“It’s really only possible to say with any confidence that there’s empirical evidence that equine-assisted activities appear to be helpful as a complementary treatment for a range of disorders,” Smith-Osborne says. “And for people who have not responded well to first-line treatments, it does show promise.”

Anecdotally, the horse-based therapy can provide numerous benefits, which can arise in as little as two to three sessions, Sheade says. Benefits include improved:

• Self-esteem
• Communication skills
• Self-awareness
• Relaxation
• Empowerment
• Interpersonal relationships
• Self-control
• Focus and concentration
• Happiness

Studies have also suggested EAP can decrease anger, depression, dissociation, and aggression.

Adverse effects from EAP are rare, but decreased self-esteem and increased aggression in children and adolescents have been reported. Researchers think these negative effects may be due to attachment and subsequent loss of the horse companion after the therapy ends.

Seeking Horse Therapy

Given that EAP isn’t widely available yet, it may be difficult to find an establishment offering this service in your area. However, PATH International and EAGALA— reputable equine-assisted therapy associations — have listings of accredited centers by location.

When you visit a center, a therapist will discuss with you your background and goals, and come up with a treatment plan. Keep in mind that your insurance may not cover some or all of the therapy costs.

“But there have been cases where individuals have gone to court with insurance companies and won,” Smith-Osborne says.