The Mental Health Authority of St. Mary’s has two roles: that of a manager of the mental health system in St. Mary’s County and that of a provider of case management services.

As an administrative organization, we have oversight of the public mental health system in the county.  We are also the link to the state Mental Hygiene Administration and their Administrative Services Organization, Maryland Health Partners.  We are used as a resource to services in the county, a sounding block for gaps in those services, and a pipeline of information to and from the state mental health authorities.

We have up-to-date knowledge of mental health resources and providers.  If you have any questions or need information about how to get in touch with a mental health clinic or other service, please call us at (301) 475-4361.

As a provider of case management services, we can work with you to assess your needs and link you to the appropriate services in the county or in the state.  We work with all ages.  For more information on these case management services, call (301) 475-4286.

Mental illness is a term used to describe a broad range of psychological and emotional disorders that seriously interfere with the way a person is able to live and function.  It is not, as many people still believe, the result of personal weakness, a bad upbringing, or sinful behavior.

What are the signs of mental illness?  Symptoms of mental and emotional disorders generally present themselves in a person's thinking, behavior and personal habits.  Evolving habits and personality are common during the course of life; however, sudden, frequent, transient, or prolonged lifestyle changes are among the first signs of a serious problem.

Marked personality change
Confused thinking; strange or grandiose ideas
Prolonged, severe feelings of depression or apathy
Abrupt mood swings from emotional highs or lows
Excessive, almost uncontrollable anxieties, fears, or suspicions; habitually blaming others
Social withdrawal, abnormal self-centeredness; preoccupation with body functions
Denial of obvious problems; strong resistance to accepting help
Dramatic, persistent changes in eating or sleeping habits; heightened restlessness, hyperactivity

What Factors Affect Mental Health?

Biological Factors:  Rooted in the body itself and often genetic in nature, biological factors may include problems in the chemistry of the nervous system or structural defects of the brain.
Psychological Factors:  One's personal history may play a strong role in psychological factors that can affect or cause mental disorders.  For example, a particularly traumatic event (such as the loss of a loved one) or long exposure to emotional stress (such as extended unemployment) can make some people vulnerable to mental health problems as reflected in warning signs listed earlier.
Social Factors:  Just as they affect physical health, social factors such as nutrition, shelter, group relations, and personal safety are important to one's mental health.

Mental and emotional disorders are oblivious to race, gender, and social status, affecting one in every four American families.  Taken together, the estimated 27 million adults and more than 8 million children and youth with diagnosable mental or emotional disorders outnumber those with cancer, heart disease, and lung disease combined.

Choosing the Right Mental Health Therapist

At some point in our lives, we all run into problems that seem too big or too persistent to handle alone.  Yet our pride and fears can get in the way of asking for help.  But making the decision to find help is a sign of strength and courage.  And help is available.  In fact, it can make the difference between feeling that things are spinning out of control and gaining new tools to turn life around in positive ways.

Having taken that crucial first step to seek help, you may have some questions about therapy.  You may wonder, for example, about sharing information that is uncomfortable - will it be kept confidential?  What is the best way to go about finding the right therapist?

You can rest assured that all mental health professionals are ethically bound to keep what you say during therapy confidential.  However, therapists also are bound by law to report information such as threats to blow up a building or to harm another person, for example.

Therapy is a collaborative process, so finding the right match - someone with whom you have a sense of rapport - is critical.  You may have to shop around before you find someone you are comfortable with.  After you find someone, keep in mind that therapy is work and sometimes can be painful.  But it also can be rewarding and life-changing.

So whether you seek help from a marriage and family therapist, a social worker, a psychologist, or a psychiatrist, the steps to choosing the right mental health practitioner for you will basically be the same.

1. See your primary care physician to rule out a medical cause of your problems.  If your thyroid is "sluggish," for example, your symptoms - such as loss of appetite and fatigue - could be mistaken for depression.

2. After you know your problems are not caused by a medical condition, find out what the mental health coverage is under your insurance policy or through Medicaid/Medicare.  Many employer-sponsored insurance policies have limits on mental health services and may cover only 50 percent of the costs of a fixed number of visits per year.

3. Get two or three referrals before making an appointment.  Specify age, sex, race, or religious background if those characteristics are important to you.  Your primary care physician and/or your faith leader probably know mental health care workers in your area.  Also, ask friends, colleagues, neighbors and family members for referrals.  Chances are you will find that several people in your circle of acquaintances have been, or are, in therapy and can refer you to a competent therapist.

4. Call to find out about appointment availability, location and fees.  Many mental health professionals schedule evening appointments so you do not have to miss work.  Selecting a therapist whose office is easy to get to - either from work or home - also can make a difference in your progress toward improved mental health.  Ask the receptionist:

Does the mental health professional offer a sliding-scale fee based on income?

Does he or she accept your health insurance or Medicaid/Medicare?

5. Make sure the therapist has experience helping people whose problems are similar to yours.  You may want to ask the receptionist about the therapist's expertise, education and number of years in practice.

6. If you are satisfied with the answers, make an appointment.

7. During your first visit, describe those feelings and problems that led you to seek help.  Find out:

What kind of therapy/treatment program he or she recommends.

If it has proven effective for dealing with problems such as yours.

What the benefits and side effects are.

How much therapy the mental health professional recommends.

If he or she is willing to coordinate your care with another practitioner if you are personally interested in exploring credible alternative therapies, such as acupuncture.

8. Different psychotherapies and medications are tailored to meet specific needs.  Be sure the psychotherapist does not take a "cookie cutter" approach to your treatment - what works for one person with major depression does not necessarily work for another.  The best therapists will work with you to create a treatment program - perhaps using a single approach, perhaps incorporating several different ones - that works for you.

9. Although the role of a therapist is not to be a friend, rapport is a critical element of successful therapy.  After your initial visit, take some time to explore how you felt about the therapist.  For example:

Was he or she someone you felt comfortable with?

Did he or she listen?

Did he or she seem to understand your concerns and address them?

Is this a person you feel you can trust?

Did he or she seem knowledgeable about your problem and suggest a therapy/treatment program that suits you?

Was the "chemistry" right?

10. If the answers to these questions and others you may come up with are "yes," schedule another appointment to begin the process of working together to understand and overcome your problems.  If the answers are "no," call another mental health professional from your referral list and schedule another appointment.

What to Do in Emergency Situations

If a person becomes violent or assaultive, or is completely out of control or attempts suicide, the following suggestions can help.

If assaultive or other behavior dangerous to the person or others occurs, call 911 and request immediate assistance from the Sheriff's Department.

If the crisis does not involve behavior dangerous to the person or others, call his/her family physician or psychotherapist.  If the person does not have either or telephone numbers are not available or if neither can be reached, transport the person to the emergency room of the nearest general hospital.  If transportation by automobile is not available, call an ambulance or fire/rescue squad at 911.

Check the local telephone directory for emergency "hotline" numbers whose description may fit the particular crisis situation the person is facing.  If the person is known to belong to a specific religious congregation, you may elect to call that congregation's minister, priest, or rabbi.

Refer to listings in this directory for those providers of mental health care or organizations such as Alcoholics Anonymous, and call the number listed.  These providers and organizations may provide additional telephone numbers for use other than during working hours.

Maintaining an attitude of calm, decisive readiness, and willingness to help is the most important "first aid" reassurance to a person in emotional crisis.

Treatment Methods

The goal of all treatment modalities is to reduce or diminish the crippling effect of the symptoms of a mental disorder; to improve self-confidence and enhance social functioning; to develop and strengthen coping skills; and to increase self-knowledge toward the end of more durable personal integrity.  There are many types of treatment that may be used alone or in various combinations.  They are:

Psychotropic medications (pharmacotherapy) - May be the first treatment prescribed by a psychiatrist or other physician if the symptoms of the illness are acute or (potentially) disabling.  The type of medication depends on the nature of the illness, the person's age, and general medical condition.  Medication is often combined with other therapies.

Psychotherapy ("talking" treatment) - Accomplished through a series of face-to-face sessions with the therapist, during which the person is encouraged to talk about, define, clarify, and resolve the problems that are troubling him/her.  Short-term or session limited therapy lasts for a few weeks to several months and is appropriately employed to help a person through a stressful life event.  Long-term or intensive therapy may last from several months to several years and the work focuses on the life history of the person and the traumatic experiences and stressful events which have predisposed him/her to the mental disorder.  There are several "schools" of psychotherapy, which are distinguished by differing techniques employed by the therapist, although the goals of treatment are similar.  These include:

a. Psychodynamic psychotherapy (which may be short or long term) examines important relationships with significant others from early childhood to the present in an effort to modify or ameliorate unsettling or destructive behaviors which have given rise to emotional problems or created psychological stress.  Psychoanalysis is a type of intensive, long-term psychodynamic therapy in which conflicts underlying the development of the person's illness are analyzed, toward the end of providing him/her with additional conscious choices to modify his/her maladaptive behavior.
b. Interpersonal therapy is confined primarily to the person's contemporary life, especially his/her relations with family, friends, and colleagues.
c. Family therapy involves all family members with the focus on identifying, discussing and resolving conflicts within the family.
d. Couples (marriage) therapy aims to develop more rewarding relations with the significant other by identifying and examining each person's contribution to the couple's problem-generating interaction.
e. Group therapy involves a group of (usually) 6 - 8 people with similar problems who, guided by the therapist, identify maladaptive patterns of behavior and individual problems toward the goal of members of a group helping each other to deal more appropriately with his/her problem.
f. Play therapy is a technique used by therapists trained in working with children to establish communication with children and help them through constructive play to identify and resolve problems.  Parents or guardians are also seen regularly by the child's therapist or by a colleague during therapy.
g. Cognitive therapy focuses on the person's pattern or style of thinking with the aim of identifying and correcting distorted thinking that contributes to troublesome emotions and behaviors.  It is often combined with behavior therapy.
h. Behavior therapy uses principles evolved from learning theory to change disturbing and distressing thought patterns and behavior by systematically addressing such behavior and helping the person learn more effective coping skills to obtain rewards and satisfaction.  It includes such techniques as stress management, biofeedback, and relaxation training.

Adjunctive therapies are those used most often in combination with other therapies and in a hospital inpatient situation.  They include occupational, recreational, music, art, and special education therapies.

Inpatient treatments are the treatment methods employed by a psychiatric unit of a general hospital or by a mental hospital during a person's hospitalization for a serious mental illness.  These methods may include, but are not limited to psychotherapy, group therapy, behavioral/cognitive therapy, electrostimulation therapy (also known as electroconvulsive therapy), pharmacotherapy and the various adjunctive therapies.

Off-site services are delivered by some mental health providers to the mentally ill person in the home or at other locations in the community to respond to a variety of situations that, without these off-site services, would result in no service being delivered or a significant reduction in the effectiveness of the service delivered.  Individuals needing off-site services are advised to ask the provider if that service is available before agreeing to accept services.

Crisis intervention occasioned by the person's loss of control may consist of visiting the person at the site of his loss of control, assessing the situation and taking appropriate action.  If the person resists or refuses hospitalization, the police may have to be notified.  Alternatively, the person may be taken by relatives, friends, or the police to the clinic, office of the professional or hospital emergency room for assessment of the crisis.

Partial hospitalization is a short-term, intensive psychiatric treatment program generally equivalent to the treatment rendered in full hospitalization, except the patient does not stay overnight in the hospital.  It must provide a minimum of four consecutive hours of treatment each day the program operates.

Psychiatric day treatment is the equivalent of partial hospitalization except that it does not occur on hospital grounds.

Residential crisis services are short-term, intensive mental health and support services provided in a residential setting designed to provide an alternative to psychiatric hospitalization.

Mental Health Professionals

A mental health professional is a person formally trained to help people in emotional distress.  Most mental health professionals have earned additional credentials, usually in the form of state licensing, certification or both.

"Therapist," "psychotherapist," or "counselor" are terms often used to refer to mental health professionals.  Be sure that the person you choose has extensive training and experience in his/her specialty and is well respected in the community. You have the right to ask questions regarding the training and qualifications of any mental health professional you are consulting. 

Equally important is that he/she treats people with understanding and respect and can be trusted. If you are not comfortable with a mental health professional after meeting with him/her several times, you have the right to seek a different helper.  Be sure to do what is right for you.

Psychiatrists are medical doctors who specialize in the diagnosis and treatment of mental disorders and are the only mental health professional in the State of Maryland qualified to prescribe medication, in addition to providing psychotherapy.  Psychiatrists must have completed at least three years of specialty training and be licensed by the Maryland Board of Medical Examiners.  A board-certified psychiatrist has practiced his/her specialty for at least two years and has passed the written and oral examination of the American Board of Psychiatry and Neurology.  For a referral to a psychiatrist, contact the Maryland Psychiatric Society at (310) 625-0232.

Clinical psychologists are specialists in the evaluation, testing and treatment of emotional problems.  They must have a doctoral degree in psychology and be licensed by the Maryland Board of Examiners of Psychologists.  For a referral to a clinical psychologist, call the Maryland Psychological Association at (410) 992-4258.

Clinical social workers must have a master's or doctoral degree in social work and be licensed by the Maryland Board of Social Work Examiners.  For a referral, call the Maryland Society for Clinical Social Work at (410) 298-3226.

Psychiatric Advanced Practice Nurses are registered nurses who hold a master's or doctoral degree and specialize in psychiatric and mental health nursing.  They must complete a certification process and be licensed by the Maryland Board of Nursing.  For a referral, call the Psychiatric Advanced Practice Nurses of Maryland at (888) 565-0033.

Licensed professional (mental health) counselors have a master's degree and specialized training in a clinical mental health setting.  They must be licensed by the Maryland Board of Examiners of Professional Counselors.

Pastoral counselors are often clergy with training in clinical pastoral education, although not all pastoral counselors are ministers, priests, or rabbis.  Certification is not required for pastoral counselors, yet many choose to be certified through the American Association of Pastoral Counseling or the American Association of Clinical Pastoral Education.  If you would like a referral, call Pastoral Counseling Services of Maryland at (410) 433-2241.

Case managers are mental health workers who are usually associated with mental health centers, psychosocial rehabilitation programs, and other mental health agencies.  They provide advocacy, linkage, and monitoring of services to persons with disabling mental illness in such areas as housing, social services, vocational rehabilitation and the securing of entitlements to health and human services.