Mental Health Services, A Consumers Manuel
by Charles Emmrys Ph.D. L. Psych
September 2005


Who Are Mental Health Practitioners?

Mental health practitioners are highly skilled licensed professionals who are trained to provide assessment and therapy for individuals, groups and families. The licensing and certifying boards and colleges for the various service providers have as their first mandate the task of protecting the public by ensuring that all practitioners with a license or certification offers services of the highest quality. They are also there to accept complaints by clients and to act on these complaints.

The licensed or certified professionals include clinical social workers, psychologists, mental health nurses, psychiatrists, occupational therapists, guidance counselors among others.
When consulting a practitioner, it is important to ask about their license or certification. The consumer must know that if a practitioner is not licensed or certified by a provincially mandated body, the client has no protection in the event of malpractice nor do they have any guarantee of the practitioner’s competence.

When do you consult a mental health Clinician?

Many adults or children experience personal problems at different times in their lives. Usually they are able to work them out by themselves or with the help of family and friends. When attempts at working things out do not bring relief, seeking help may be of considerable benefit. This is especially true when the problems begin to interfere with the normal daily activities and in important relationships.

Problems that individuals frequently consult mental health clinicians for would include anxiety, problematic or uncontrolled emotions such as fear, anger or depression, social difficulties such as extreme shyness or fear of public places, family problems, eating problems, uncontrolled stress, marital problems, school related difficulties, and problems at work. Some individuals will have more severe and long lasting mental illnesses such as schizophrenia or important mood disorders. Still others will consult mental health clinicians because they are not sure just what is wrong in their lives and they need help defining the problem more clearly, a process called diagnosis.

How do mental health clinicians work for their clients?

A clinician will usually begins by developing a working relationship with you in much the same way other professionals would, that is, by being as specific as possible about what needs to be done and what are the best ways of doing it. Usually the following steps are followed:

1. The clinician will help you to define just what your work together will be. This may involve some assessment procedures to help define the problem better.

2. Once the problem is defined, the clinician will describe to you the service approach she/he feels will best answer your needs. He/she will also try and give you an idea of how many visits or sessions will be needed.

3. In describing the services offered, clinicians are obliged to describe other approaches which could be used in treating the problem. Should you choose a treatment option that is not available through the clinician, then he/she must make reasonable efforts to redirect you to a professional who is able to offer the other service if possible.

4. It is also true that some clinicians will devote much of their work to treating a certain type of problems. If a clinician feels that you would be best served by one with a greater experience in the area of your difficulty, he will make this clear to you.

5. At times, the therapy approach recommended will include medications. There are a number of conditions where medications are very important. Psychiatrists or other medical doctors are the only ones that can prescribe these medications. Other clinicians may inform you of the advisability of considering the use of medication but only a psychiatrist or other medical doctor can actually prescribe it for you.

What is confidentiality?

Confidentiality is a word used to indicate that your identity and the information you give to a clinician cannot be given or shared with anyone else without your permission. Clinicians are obliged to protect the privacy of their clients in this way. But there are five circumstances where confidentiality can and must be broken. That is if:

(1) the clinician has reason to believe that the client could be a danger to his/herself,

(2) the clinician has reason to believe that the client may harm another person,

(3) when a client informs the clinician that a former licensed clinician has behaved unethically or sexually towards a client,

(4) when the courts order the clinician to release information to the court and

(5) when the clinician learns that any person who is under 16 may be the victim of physical or sexual abuse by another.
In each of these five situations the clinician must act to protect the client, other persons or comply with the court even if consent is not given.

If you are seeing a clinician in a clinic or a private practice where more than one clinician works, it is possible that your clinician will want to consult with other professionals in that clinic or office. In our practice, such consultations do take place on a regular basis. Those who hear the information usually do not hear the name of the persons being discussed and are all licensed clinicians and therefore bound by the obligation to confidentiality. If you have concerns about this, you should share them with your clinician.
If a child or adolescent is being seen individually, the clinician will keep discussions confidential from the parents unless the child or adolescent gives permission. This is often necessary to ensure that important issues are dealt with honestly by the child or adolescent. The parent should remember that the clinician will break confidentiality if he or she discovers that the child or adolescent’s wellbeing is threatened.

What is consent?

Consent is a permission you give to a professional who is offering his/her services. Usually, clients are asked to give 2 kinds of consent. These are (1) consent to using a specific therapy approach to deal with the problem presented, and (2) consent for releasing information to others. Consents can be verbal or in writing.

If a child or adolescent under the age of 16 is involved in therapy, the parent will be asked to give his or her consent in the child’s stead. If the client is an adolescent (aged twelve or older), the adolescent and their parent or guardian will both be asked to provide consent for the interventions proposed.

What is the Client Clinician relationship?

Clinicians are trained to help people deal with difficult and important life situations. For this, clients are asked to reveal more about themselves than they usually would with others. Because clinicians are privy to sensitive information about clients, the professional Colleges and Boards ask all clinicians to abide by a strict code of conduct. This code includes the following:
That they will respect the integrity of the client and his family at all times.

That therapy issues will not be discussed outside of formal therapy sessions. Should you meet in a shopping center for example, one would not ask about the problems that were discussed in therapy.

That various forms of personal intimacy (emotional, physical, sexual, close friendship) are strictly prohibited and not allowed under any circumstances between client and therapist.

As a rule, touching is not part of the therapist client relationship except for occasional hand shakes with adults or high fives and pats on the head (for children) or shoulder. Any other form of touching that might be included in therapy for children (usually related to play) would be discussed in detail with you prior to the therapy and would usually only occur in the presence of the parent.
It is inevitable in smaller communities that clinicians will meet up with some clients in social settings from time to time. These situations are always a bit awkward since saying hello may cause friends to ask where you have met the clinician. This is especially difficult for the clinician since he/she is the one who is most obliged to respect the rules of confidentiality. For this reason, clinicians usually will say as little as possible if anything to the client in these situations. The client must remember that this is done out of respect for their right to privacy and is not a snub or sign of disrespect.

Receiving and paying for psychological services.

Mental health services are free to the public if they are provided in hospitals or in mental health clinics. Mental health clinics are found in every region of New Brunswick and can be accessed directly or through your family doctor. You should call your local clinic for information on how to access their services or speak to your family doctor if you want to access these community resources. There are clinicians who work in other services such as school districts and local Children’s Aid Societies. Each of these agencies will have their own policies regarding how to access clinical services from them. Most psychiatrists services are covered by medicare.

Clinicians in private practice are not covered by government medical plans. These other professionals such as psychologists, social workers and nurses must charge for their services as would a lawyer or accountant. Usually these clinicians will ask for payment at the end of each session. Fortunately, most employee insurance plans cover some or all of the fees these professionals charge. It is useful for the client to check with their insurer to see what their plan covers, which kinds of professionals are included in the coverage and what the limit is for each person in the family might be.

For people without insurance and with low incomes, many private practitioners have a sliding fee scales so that the less a person makes per year before taxes; the less they are charged. Clients should check with the private practitioner for details concerning the fee scales used in their practice.

Success and failure in therapy.

The client comes to the clinician with the goal of having their problems solved. By and large, most clients are helped through the process of psychotherapy. At times, however, the client’s goals for therapy are not achieved. There are no guarantees of success in the relatively new field of psychotherapy. If the client's needs have not been met within a reasonable time, they should feel quite free to discuss it with the clinician. At that time, the approach may be changed or he/she may refer you to another therapist. Clinicians are taught early that they cannot help all clients and are comfortable with referring on if progress is not sufficient. As a consumer of mental health services, you should not let a therapy that is not working go on forever.

What if you are concerned with how a clinician has provided services for you.

If you believe that a licensed clinician has broken the guidelines referred to above, you should discuss it with him or her right away. If your attempts to do so fail or if you feel unable to do so, consulting the College Association or Board that governs his or her profession is an option given to you for your protection. The Boards, Associations and Colleges can be reached by calling the following numbers. If the numbers are not current, please consult your directory.

Social Workers: 506-459-5595
Psychiatrists: 800-667-4641
Psychologists: 506-382-1994
Nurses: 506-453-0747
Teachers (Guidance): 506-452-8921