Identifying and describing a range of mental health problems
As categorised by The National Institute for Health Care Excellence (NICE), the most common mental health problems are:
Depression – The main symptom is a low feeling and a loss of pleasure in things that were once enjoyable. Other symptoms include feeling irritable all the time, having drastic changes in appetite, as well as feeling tired all the time, not being able to sleep, and having problems with memory and concentration. People with depression typically lack confidence, criticise themselves harshly, have a low opinion of themselves and have overwhelming negative thoughts as well as feelings of worthlessness and guilt.
Generalised anxiety disorder – The main symptom is difficulty in controlling ones worries. Sometimes it is having a large number of worries; sometimes it is a smaller collection of overwhelming worries – in both cases the worries are excessive and out of proportion in relation to the particular situation. People with generalised anxiety disorder may be easily irritable, have problems sleeping or concentrating, and could also have physical symptoms such as restlessness, feeling easily tired, or having tense muscles.
Panic disorder – The main symptoms are having unexpected or recurring panic attacks, the anxiety that worrying about having another panic attack brings, as well as an elevated heart rate, which can compound the other symptoms. A panic attack may have no obvious cause, or it may happen because of a particular situation that the person feared, or wanted to avoid. People that have panic attacks may modify their behaviour due to not wanting to experience them anymore and could develop phobias as a result.
Obsessive-compulsive disorder (OCD) – The main symptoms are having obsessions (which are recurring images or thoughts that are difficult to get rid of), and compulsions (which are strong feelings or impulses that certain physical acts or mental processes must be performed or repeated). Obsessions and compulsions feed off of each other; the compulsive physical acts are rituals that reinforce the obsessive thoughts, which then further influence the necessity of performing the actions again – and so on.
Post-traumatic stress disorder (PTSD) – The main symptoms can be both psychological and physical, and usually follow on from life-threatening or distressing events. The most common symptoms of post-traumatic stress disorder are intrusive and distressing memories as well as re-living the event through flashbacks or nightmares. There can also be physical reactions such as shaking, sweating, and having vague discomforting feelings reminiscent of the event. These two aspects can combine and overlap, and make a person feel as if they were physical transported back and were re-living the trauma. It is important to note that a person does not have to remember the event for the trauma to “trigger” and manifest symptoms – it could have occurred before they were able to form memories. Or alternatively, the person may not remember what caused the trauma because they have repressed the distressing memory.
These are the most common because when combined, they affect a greater number of people than other mental health problems. It is worth noting that it is possible to have more than one mental health problem – and when combined they can exacerbate each other, often making the conditions much worse.
Understanding the differences between mild and severe mental health problems
In order to show my understanding of the differences between mild and severe mental health problems, I will compare two conditions, depression and schizophrenia. Depression is a mood disorder, in which a person feels sad, empty and hopeless and it is typically categorised as a mild mental health problem. While it can get worse, or manifest other disorders, it is very treatable through a mixture of drugs and a talking therapy. Schizophrenia is a mental disorder that affects a person’s mental state, and causes them to be unable to distinguish between fantasy and reality, and is accepted to be a severe mental health problem. It can be treated using powerful drugs, and a mix of intense psychotherapy and electroconvulsive therapy (which involves short bursts of electricity being transmitted through the brain). As you can see from the difference in treatments, a person with schizophrenia tends to require more in-depth help.
Both conditions have a lack of pleasure or interest in activities as a symptom, but are wildly different in the ways they affect a person’s day to day life and their ability to function independently, and this is the key factor which determines how a mental health problem is categorised. The National Institute for Health Care Excellence has a scale that measures the different levels of mental health problems using the terms mild, moderate and severe.
Mild refers to a mental health problem in which a person has a small number of symptoms that have a limited effect on their daily life.
Moderate refers to a mental health problem in which a person has more symptoms that can make their daily life much more difficult than usual.
Severe refers to a mental health problem in which a person has many symptoms that can make their daily life extremely difficult.
I would class depression as a problem that can range from mild to moderate, as while it does cause problems with removing people’s motivation to go out and live their lives, it is eminently treatable. On the other hand, Schizophrenia affects the very fabric of a person’s reality and can make independent living and a normal life impossible – going by the above scale, I would class that as a severe mental health problem.
Which mental health problems are appropriate for counselling as a treatment option?
While some counselling theories would be more effective than others (depending on the background of the client and the nature of the problem), all of the common mental health problems I have listed above can be treated appropriately with counselling. To qualify this, I refer to the Counselling and Psychotherapy Central Awarding Body’s Model of Helping Work and Counselling Practise (which will further be referred to simply as the CPCAB model). It presents various service levels to determine which mental health problems are appropriate to have counselling as a treatment option. The CPCAB Model was developed in the late 1980’s, and has been continually updated and refined over the years. It has three “Service Levels”, and they are:
Service Level A: Everyday life problems
Everyone has down days, and sometimes they last for weeks, and they can overwhelm us. This level supports people by enabling them to reflect on themselves and their lives in order to understand their problems as well as finding better ways to cope with life’s troubles. It’s also helpful for when people instinctively know they are stuck and just need some emotional support through a rough patch, or a safe place to let their guard down and explore their feelings.
Service Level B: Common mental health and other psychological problems
Sometimes the problem is not something in our life, but something within us. This service level deals with such problems. All the common mental health problems listed above fall into this category: depression, generalised anxiety disorder, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder, as well as other mental health problems such as addiction, self-harm, and eating disorders such as anorexia and bulimia. Counselling at this level allows the client to be more collaborative within themselves, as they develop resilience towards their everyday life problems. It also teaches them that although they cannot change other people, they can change their own ways of relating with others – they can change their habitual patterns of perceiving, communicating and behaving with other humans. It also enables them to come to terms with their past; again, this is something that cannot be changed, but their perception of past events can be examined and accepted, which can help eliminate their implicit emotional responses towards triggering traumatic events.
Service Level C: Severe and complex mental health problems
Severe mental health problems like psychosis and schizophrenia, along with other personality disorders like bipolar disorder, tend to be treated by psychiatrists rather than counsellors. Also, problems that originate from physical brain damage (such as developmental learning difficulties), or from wear and tear to the brain, (such as dementia), are often beyond the remit of any talking therapy. While counselling cannot provide a cure for these problems, it can help manage their secondary symptoms.
How does counselling have a positive impact on mental health?
In the overwhelming majority of cases, counselling has a positive impact on someone’s mental health. If a client comes to counselling willingly, it shows that they know they have a problem, and that they are actively looking for help to solve it. It is also a signal that they are already in a mindset to challenge their beliefs and work towards change. However, it is important to mention that sometimes, harm is caused by a counsellor to a client. Such occasions are thankfully rare, and are often caused for reasons such as the counsellor using the wrong modality to treat a client’s presenting problems, or a counsellor that held too much belief in their own perspective, rather than looking at the client through the client’s lens. Harm could also be caused if a client is not honest. Overall though, counselling does have a positive impact on a person’s mental health.
Counselling can help greatly with obtaining and maintaining positive mental health as it helps make people aware of any underlying negative psychological mental health issues they may have. Understanding yourself, and sorting out faulty thought processes is a massive step in the direction of someone becoming their best self. Counselling is a positive thing, not a sign of weakness, and as a society we should be working towards removing the stigma many people feel about it, and let people know that it’s ok to go and see a professional. We all have problems, biases and unconscious ways of living our lives that were formed when our survival depended on them and are now redundant that could be holding us back from self-actualisation. Counselling brings these issues into the light so they can be examined, understood, and overcome. It is not good to dwell on these things, or believe them to be immutable, unchangeable attributes that are forever a part of you. It is possible to get out of these destructive or unsociable patterns.
The first step, to acknowledge that a problem exists, is the hardest for almost everyone that suffers from a mental health condition.
