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  • Writer's pictureDr Carol Newall

The Best Time to Start Therapy



An odd question indeed because most people should start therapy when they need it. Despite this, even when people ‘need’ it, they often do not get help and delay seeking support. We know that approximately 70% of adults and young people with a mental health disorder do not seek help(1). Unfortunately, stigma, the lack of understanding around mental health, and denial contribute to the delay in help-seeking(2).


Here are a few tips for selecting the right time to start therapy.


1. When you see functional impairment

There is a misconception that mental health is about negative feelings like sadness, stress, or anxiety. However, many of us experience negative emotions and they are not harmful. Experiencing a spectrum of emotions, even when negative, is human and normal.


The tipping point from normal to a mental health challenge occurs when these emotions interfere in our day-to-day lives. These emotions may make it hard for us to manage our roles as colleagues, parents, friends, and family members. For instance, we may find ourselves increasingly and consistently irritable with our kids, withdrawing from activities we use to enjoy, and avoiding things/activities we need to do to succeed (e.g., going for that promotion, finishing the TAFE course, getting to work on time). Functional impairment can be observed in our behaviours and our decision-making.


While we often have fluctuations in moods such as being a little cranky with our spouse after a feral day at work, most people bounce back from feeling sad or anxious in about 1-3 days. However, when we’re seeing functional impairments for more than a week or so, it’s time to go for a check-in with our GP or reach out to someone for a chat (trusted friend or family member).


2. When it’s mid-year (July to October)


This is a strange one that is specific to Australian citizens and permanent residents. We are eligible to 10 Medicare-rebated sessions per year with a psychologist each calendar year. The unused sessions do not roll over.


Because of this, July-October is the perfect time to begin therapy if you’ve been umming and ahhing over this decision. This applies only to people without acutely impairing symptoms and major risks like suicide and domestic violence. It means that you can use the 10 sessions within that final half of the year to gain some momentum and consistency in therapy before spacing out the next 10 sessions the following year to help maintain these gains.


The above of course, is an idealised journey for straight-forward presentations. Unfortunately, most people need more sessions per calendar year to support recovery. Here’s a crucial tip though, if you’re planning on waiting until mid-year: most clinics have a long waiting list. It’s worth making a call now to get a scope of the waiting list. Moreover, please don’t wait until July to get support if you are really struggling. It’s better to get help now than to wait a few more months.


3. When your symptoms are still relatively mild-to-moderate

Yeah, this one is counter intuitive. Most people wait until they feel it is severe enough that it warrants further support. In fact, our entire Medicare system is built around this idea. People must meet clinical diagnosis to be eligible for funding support.


Interestingly, insurance companies do not apply the same rule. They focus on several preventative strategies. Emerging treatment models for mental health also support the idea of ‘stepped-care’. This means different treatment options for differing severity. We want people to get the support they need early because outcomes are generally better than if they wait it out and it becomes chronic and/or severe.


If you see emerging symptoms and your GP feels that you could do with more support, take that opportunity (with both hands!!) to book in with a psychologist or psychiatrist. Please don’t hold on to that referral until you can’t get out of bed to get support. It makes it far harder to treat and recovery will be significantly slower.


What if you see emerging symptoms like acute stress or burn-out but you don’t quite meet clinical diagnosis for a referral to a psychologist or psychiatrist? There are several low-cost options in place of face-to-face therapy that is still therapy:


This Way Up is an online therapy package that can be self-guided and does not require a GP referral. Check this out – it’s $59 for depression and it uses an evidence-based cognitive behaviour therapy program. Here’s another whopper: it works just as well as seeing a psychologist if you can stick with it. There’s also a FREE stress-management program to all Australians residing in the country.


Headgear App is a 30-day challenge that includes two evidence-based strategies: (1) Mindfulness; (2) Behaviour Modification. It has been road-tested with good results for improved wellbeing and resilience. It can give you a taster of some of the important techniques used by psychologists to get and keep people staying well.


Five Ways to Wellbeing is an initiative that started off in the UK. It asked a very important question: “what do individuals who stay well do in their day-to-day life that keep them well?” They did the hard work and combed through the research literature. Head to their website to discover these five important elements to a healthy life.


On a final note….


When really is the best time to begin therapy? I would suggest that therapy is like exercise. We need to do it regularly, daily if possible. We’ll try and eat healthy or go for a run to keep out bodies healthy yet we often neglect the most important organ in our body - our brain. It powers everything.


So, seek out therapy, whether it’s in the form of a book (called ‘bibliotherapy’), an online challenge like Headgear, or a face-to-face session with a psychologist. Keeping our brains healthy needs our daily attention and ongoing gentle care.


References

1. Thornicroft G. Most people with mental illness are not treated. Lancet. 2007;370(9590):807–808.

2. Henderson C, Evans-Lacko S, Thornicroft G. Mental illness stigma, help seeking, and public health programs. Am J Public Health. 2013 May;103(5):777-80.

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