Recent data from the National Population Health Survey in Singapore reveals a concerning trend: the prevalence of poor mental health has risen from 13.4% in 2020 to 17% in 2022 [1]. This increase underscores the critical need for accessible and effective mental health care. As individuals face these growing challenges, a paradox becomes evident – despite the clear need, many find the act of seeking help daunting.

The prevailing culture of silence around mental health, fueled by societal norms that equate vulnerability with weakness, exacerbates this issue. People are often hesitant to seek help due to the fear of judgement and the stigma associated with mental health issues. This paradox, where the need for support is evident, yet the pursuit of it is hindered by stigma, highlights a significant barrier in mental health care.

Navigating the complexities of mental health services adds to the challenge. Choosing between a psychiatrist, psychologist, or counsellor can be overwhelming in Singapore, especially when understanding each professional’s distinct roles and specialisations. The struggle lies not just in recognising these distinctions but also in aligning them with personal mental health needs.

So, You Have Decided to Seek Help: A Guide for Approaching Mental Health Services

Recognising the need for mental health support is a crucial first step. For those hesitant to seek help, understanding how to approach mental health services is vital. Here’s an expanded guide on how to navigate your way through seeking mental health services, incorporating important factors such as rapport, honesty, and practical considerations:

1. Start with research

Begin by exploring the different types of mental health professionals. Understand their areas of expertise and what they specialise in. This initial research will provide you with a solid foundation for making an informed decision about whom to approach for your mental health needs.

2. Consultation as a first step

An initial consultation is a great starting point. It’s an opportunity to discuss your concerns, understand the therapy process, and get a feel for how the therapist works. Remember, this first meeting is about gathering information and does not lock you into a specific treatment path.

3. Choose based on rapport and therapeutic alliance

Selecting a mental health professional can sometimes feel more daunting than choosing a life partner. The therapeutic alliance [2], or your rapport with your therapist, is crucial. You will share deep, personal aspects of your life, so feeling comfortable and connected with your therapist is paramount. Don’t hesitate to meet with different therapists to find the one with whom you feel most comfortable.

4. Be open and honest

Approach your sessions with openness and honesty. Being candid about your feelings, thoughts, and experiences is essential. Similarly, be open about practical considerations like the cost of sessions. Discussing fees upfront can help set clear expectations and ensure that the therapeutic process fits within your budget, an important aspect of maintaining a stress-free therapeutic relationship.

5. Seek support

Sharing your decision to seek therapy with a trusted friend or family can provide additional emotional support. You could ask someone to accompany you to your first session if it makes you more comfortable. Knowing you have the support of your loved ones can make a significant difference in your mental health journey.

6. Be prepared for a process

Therapy [3] is a process that involves navigating through complex emotions and thoughts. It requires patience and commitment. Remember that progress in therapy often comes in small steps and requires time.

7. Celebrate your progress

Recognise and celebrate your progress, no matter how small it may seem. Acknowledging your efforts and the steps you’ve taken can be incredibly empowering and motivating as you continue your journey.

8. You are not alone

Finally, remind yourself that you are not alone. Many others have embarked on this journey before you; support is always available. Your decision to seek help is a brave and significant step towards a healthier life.

For the rest of the article, we will first further explore and differentiate between the roles of psychologists [4], psychiatrists [5], counsellors [6], and therapists [7]. We will then shed some light on who you should choose concerning your situation. We hope this guide will empower you with the necessary insights and considerations for starting your mental health journey. With the right approach and support, seeking help can lead to profound personal growth and improved well-being.

What We Do: A Closer Look at Mental Health Professionals’ Roles

Having understood the initial steps in seeking help, it’s important to delve into the specific roles of mental health professionals. 

1. Psychiatrists: Medical experts in mental health

Psychiatrists are medical doctors in Singapore who specialises in diagnosing and treating mental illnesses, uniquely positioned to evaluate both the physical and psychological aspects of their patient’s health. Their role is multifaceted, encompassing a range of responsibilities:

• Diagnostic assessments: psychiatrists are proficient in conducting comprehensive diagnostic evaluations. They use various assessment tools and techniques, including psychiatric interviews and psychological tests. As medical doctors, psychiatrists are particularly attentive to ensuring that psychiatric symptoms are not the manifestation of a medical illness. They often incorporate neuroimaging or lab tests into their assessments to rule out physical health conditions that could present with psychiatric symptoms.

• Medical and psychological expertise: their training as medical doctors is fundamental to their practice. Psychiatrists consider the interplay of biological, psychological, and social factors in mental health, allowing them to offer a holistic approach to treatment.

• Prescribing medication: being medical doctors, they are authorised to prescribe medication. They manage medication plans for a range of mental health conditions, from mood disorders to severe mental illnesses.

• Psychotherapy provision: many psychiatrists are also trained in providing psychotherapy, enabling them to integrate therapeutic techniques into their treatment plans.

• Treatment planning and management: psychiatrists develop and manage comprehensive treatment plans that often combine medication, psychotherapy, lifestyle changes, and other interventions.

2. Psychologists: Specialists in behaviour and mental processes

Psychologists are professionals specialising in understanding the intricacies of the human mind and behaviour. Their expertise is not limited to therapy but extends to a broad spectrum of activities that contribute significantly to mental health care and research. Here are key aspects of their role:

• Deep dive into human behaviour: psychologists extensively study how individuals think, feel, behave, and interact. They are particularly focused on the patterns and motivations underlying human behaviour, making them adept at understanding complex emotional and cognitive processes.

• Conducting psychological assessments: a crucial aspect of their work involves conducting detailed psychological assessments. This includes:

• Personality tests: to evaluate personality traits and identify patterns that may impact mental health and behaviour.
• Cognitive assessments and IQ testing: to measure cognitive abilities such as memory, problem-solving, and intellectual functioning. These assessments are essential in identifying learning disabilities, giftedness, and cognitive impairments.
• ADHD assessments: using various tools and interviews to assess attention, impulsivity, and hyperactivity, which are key in diagnosing Attention-Deficit/Hyperactivity Disorder [8].
• Autism evaluations: through observational assessments and structured interviews, psychologists play a vital role in diagnosing Autism Spectrum Disorder and understanding the individual’s social, communication, and behavioural challenges.

• Diagnostic interviews: to identify specific mental health conditions and understand the individual’s mental health history and current symptoms.

• Providing psychotherapy: psychologists are well-known for their role in providing psychotherapy. They employ various evidence-based therapeutic approaches like cognitive-behavioural therapy (CBT) [9], psychodynamic therapy [10], humanistic therapy [11], and more. Their therapy sessions are designed to help individuals understand and work through their problems, enhance self-awareness, and develop healthier coping mechanisms.

• Specialised areas of focus: many psychologists specialise in areas such as clinical psychology, counselling psychology, child and adolescent psychology, health psychology, neuropsychology, and forensic psychology, providing targeted care and interventions.

3. Counsellors: Advisors for specific life issues

Counsellors are key figures in the mental health landscape, offering tailored support and guidance for various life challenges and transitions. Their role is multifaceted and client-centred, focusing on empowering individuals with the tools and insights needed for personal growth and problem resolution. Here are some key aspects of their role:

• Personalised support: counsellors work closely with individuals to provide personalised support tailored to their unique circumstances. This involves understanding each person’s background, challenges, and goals to offer relevant and effective guidance.

• Development of coping strategies: counsellors are adept at helping individuals develop coping strategies for managing stress, anxiety, and other emotional challenges. They provide tools and techniques for better emotional regulation and resilience.

• Relationship and family counselling: in the realm of relationship and family counselling, they address issues such as communication problems, marital conflicts, and family dynamics, facilitating healthier relationships and improved interpersonal skills.

• Life transitions and adjustments: counsellors often assist individuals navigating significant life transitions such as divorce, retirement, relocation, or losing a loved one, providing support and strategies to adjust to these changes.

Collaborative Approach in Mental Health Care: A Unified Effort

As we have seen, psychiatrists, psychologists and counsellors have different expertise. They bring together their diverse expertise to offer comprehensive care. This collaborative approach combines medical, psychological, and social perspectives to ensure holistic treatment for patients. Psychiatrists often lead in medical evaluations and medication management, while psychologists delve deep into in-depth therapy. Counsellors add a crucial dimension by supporting everyday life challenges and specific life issues.

The success of this approach hinges on continuous communication among all professionals, ensuring that treatment plans are cohesive and adapt to the patient’s evolving needs. Additionally, family involvement is a key aspect, especially with children or adolescents, where family dynamics significantly impact treatment. Counsellors often engage with family members to enhance communication and understanding, while psychiatrists and psychologists guide the management of the patient’s condition in the familial setting. This unified effort ensures a well-rounded and effective approach to mental health care.

Case Example: Collaborating for Comprehensive Patient Care

Jane, a 30-year-old woman, sought help from a psychiatrist due to her struggles with anxiety and mood swings. After a detailed diagnostic assessment, the psychiatrist diagnosed her with bipolar disorder and started a medication regimen to manage her symptoms. To complement the medical treatment, the psychiatrist referred Jane to a psychologist for psychotherapy.

In her sessions with the psychologist, Jane engaged in cognitive-behavioural therapy, which helped her understand and manage her thought patterns and emotions. During therapy, it became evident that Jane was also facing significant challenges in her marriage, which were contributing to her stress.

To address this aspect of Jane’s life, the psychologist coordinated with a counsellor specialising in marriage counselling. The counsellor worked with Jane and her husband, providing them with strategies to improve communication, understand each other’s perspectives, and strengthen their relationship. This counselling was crucial in helping them navigate the complexities of Jane’s mental health condition within the context of their marriage.

Throughout her treatment journey, there was ongoing communication between the psychiatrist, psychologist, and counsellor. This was done with Jane’s consent, of course. This collaborative approach ensured that all aspects of Jane’s mental, emotional, and relational health were being addressed cohesively. The team adjusted their strategies based on Jane’s progress and the evolving dynamics of her personal life.

The integrated efforts of the psychiatrist, psychologist, and marriage counsellor gave Jane a holistic treatment experience. This multi-pronged approach not only helped her manage her bipolar disorder but also supported her in building a healthier, more understanding relationship with her husband, significantly improving her overall quality of life.

So…do I see a psychiatrist or psychologist first?

When faced with whether to see a psychiatrist or psychologist, it’s important to consider the nature of your concerns and your preferred approach to treatment. This decision often hinges on the specifics of your mental health needs, the severity of your condition, and your openness to various forms of therapy.

If you suspect that the issues are linked to an illness, such as in cases of severe depression, bipolar disorder, or schizophrenia, or if you’re experiencing symptoms that significantly impact your daily functioning, seeing a psychiatrist could be the right choice. Psychiatrists, as medical doctors, are adept at managing complex mental health conditions, particularly those requiring medication. Their medical training offers a comprehensive approach that may include medication, psychotherapy, and lifestyle changes.

On the other hand, if you’re primarily seeking to understand your thoughts, emotions, and behaviours or grappling with life challenges, stress, anxiety, relationship issues, or mild to moderate mood disorders, a psychologist might be more suitable. Psychologists specialise in psychotherapy, offering a range of therapeutic approaches to help you explore and manage your mental health concerns. Their focus is on providing profound insights and coping strategies through talk therapy.

Treatment preferences also play a crucial role in this decision. If you are open to the possibility of medication as part of your treatment, a psychiatrist with the authority to prescribe would be the suitable professional to consult. However, for those who prefer a treatment approach focused exclusively on psychotherapy without medication, a psychologist is often the better choice.

The journey of mental health care is sometimes a collaborative one. Psychiatrists and psychologists frequently work together, and it’s not uncommon to start with one and be referred to the other as your treatment progresses. This collaborative care approach ensures that all aspects of your mental health are being addressed.

If you’re still uncertain about which professional to see, a consultation with a psychiatrist or psychologist can be a wise first step. They can assess your situation and, if needed, refer you to another professional for additional support.

Ultimately, whether you see a psychiatrist or psychologist, the most important step is reaching out for help. Both are committed to helping you navigate your mental health journey and can guide you towards the path that best suits your individual needs.

Do I need counselling or psychotherapy?

Understanding whether you need counselling or psychotherapy [12] is an important step in seeking mental health care. While the terms are often used interchangeably, subtle differences in focus and approach might make one more suitable for you than the other.

Counselling typically addresses specific, current issues or life challenges. It is often more short-term and goal-oriented, focusing on providing guidance, problem-solving strategies, and support. Counsellors work with individuals to develop coping mechanisms for managing stress, navigating life transitions like career changes or relationship difficulties, and handling day-to-day emotional challenges. If you need assistance with a particular life event, decision-making, or managing emotional responses to recent changes or stressors, counselling could be the right choice.

Psychotherapy, on the other hand, tends to delve deeper. It is often more long-term and explores underlying patterns of thoughts, feelings, and behaviours. Psychotherapy aims to uncover the root causes of your challenges, providing a deeper understanding of yourself and your experiences. It can be particularly beneficial for individuals dealing with long-standing psychological issues, complex emotional difficulties, or mental health disorders. If you’re looking to explore your past, understand persistent negative patterns, or address more complex emotional or mental health issues, psychotherapy might be more appropriate.

Both counselling and psychotherapy provide supportive environments where you can talk openly about your feelings and experiences. The key difference lies in the depth and scope of the work. Counselling often deals with the ‘here and now,’ helping you to navigate current life situations, while psychotherapy may involve a more extensive exploration into your psychological makeup and past experiences.

In many cases, the decision doesn’t have to be one or the other. Some individuals might start with counselling to address immediate concerns and later transition into deeper psychotherapeutic work as they uncover more about themselves. Mental health professionals can guide you in choosing the most suitable approach based on your individual needs.

Remember, the most important step is recognising when you need support and taking action to seek it. Whether through counselling or psychotherapy, reaching out for professional help is a commendable and significant step towards your mental health and well-being.

Conclusion 

In conclusion, understanding the diverse landscape of mental health care is crucial, particularly in the context of Singapore, where we’re witnessing a significant rise in mental health concerns. Whether it’s a psychiatrist, psychologist, or counsellor, each professional plays a unique role in providing care and support. It’s important to choose the right professional based on your individual needs while also considering factors like therapeutic rapport and practical considerations such as cost.

Seeking help for mental health issues is a sign of strength and self-awareness, not a weakness. It’s a proactive step towards understanding yourself better and improving your overall quality of life. Remember, the mental health journey is not one you must walk alone. Help is available, and reaching out is the first step towards healing and growth.

If you or someone you know is struggling with mental health issues, we encourage you to seek support. Consult a mental health professional for guidance, talk to friends and family for emotional support, and explore the various resources available in Singapore. Let’s break the silence and stigma surrounding mental health together. Your mental health matters, and taking the first step towards seeking help is a courageous move that can lead to transformative change.

Remember, you are not alone, and support is available. Your mental health journey is important, and taking the first step today can lead you towards a healthier tomorrow.

References

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2. Therapeutic Alliance – an Overview | ScienceDirect Topics. https://www.sciencedirect.com/topics/psychology/therapeutic-alliance#:~:text=Therapeutic%20alliance%20(TA)%2C%20a,therapy%2Drelated%20tasks%20and%20goals.  Accessed 2 Jan. 2024.
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7. “What Therapists Do and When to See One.” Verywell Mind, https://www.verywellmind.com/what-is-a-therapist-2672019.  Accessed 2 Jan. 2024.
8. CDC. “Attention-Deficit / Hyperactivity Disorder (ADHD).” Centers for Disease Control and Prevention, 16 Oct. 2023, https://go.usa.gov/xRAsU. 
9. “What Is Cognitive Behavioral Therapy?” Https://Www.Apa.Org, https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral.   Accessed 2 Jan. 2024.
10. Treatment, Center for Substance Abuse. “Chapter 7—Brief Psychodynamic Therapy.” Brief Interventions and Brief Therapies for Substance Abuse, Substance Abuse and Mental Health Services Administration (US), 1999. www.ncbi.nlm.nih.gov, https://www.ncbi.nlm.nih.gov/books/NBK64952/. 
11. Contributors, WebMD Editorial. “What Is Humanistic Psychology and Humanistic Therapy?” WebMD, https://www.webmd.com/mental-health/humanistic-psychology-and-humanistic-therapy.  Accessed 2 Jan. 2024.
12. Psychotherapies – National Institute of Mental Health (NIMH). https://www.nimh.nih.gov/health/topics/psychotherapies.  Accessed 2 Jan. 2024.