Where to Go For Services


Types of Community Treatment

Several options exist for individuals who wish to receive treatment therapy in a community setting. These include public agencies, therapists in private practice, and community mental health centers.

Community Mental Health Centers

Community Mental Health Centers are government-supported centers that provide a range of mental health services, regardless of a person’s ability to pay. Community Mental Health Center services include outpatient treatment, partial hospitalization, emergency services, alcohol, and drug abuse programs, consultation and education, and many more.

Other Places to Get Help

Partial Listing

  • Family Service and Private Counseling Agencies: provide counseling and referrals for troubled individuals and families.
  • Therapists in Private Practice: psychiatrists, psychologists, social workers, and others provide treatment in a private office setting.
  • Help for Special Populations: school and college counseling services help students with emotional and psychological problems. Treatment centers for children with emotional and behavioral problems provide screening, diagnosis, and treatment for this age group. Children are usually referred to these centers by their school district.
  • Information and Referral: The Mental Health Association gives information about mental health and illnesses and appropriate services. Visit the Mental Health Association’s website at www.mharochester.org for a Support Group Directory that lists groups in our community.

Choosing a Therapist

Therapists have different training and credentials, offer various kinds of therapy depending on their qualifications and school of thought, and may operate in different settings. (See types of community treatments above).

New York State has expanded the mental health professions it licenses to include psychiatrists, psychologists, social workers, nurses, mental health counselors, marriage and family therapists, creative arts therapists, and psychoanalysts. When an individual seeks services, licensure is one way to assess a therapist’s qualifications. By obtaining a New York State license, the therapist has met specific basic requirements, including being a graduate of a licensure-qualifying program of study and meeting specific competency requirements. While the relationship developed between the client and the therapist is the ultimate determinant of whether the therapeutic experience is a success, licensure provides a certain level of quality control.

The nature of one’s problem may be the most important determinant of the type of therapist that should be chosen. A psychiatrist should see a person with a serious mental illness with a probable physical component, such as bipolar disorder or schizophrenia, initially because medical treatment will be required. Persons whose primary problems involve psychological functioning and adjustment to daily living, such as relationships and communication issues, may choose any of the other professions.

Physicians, clergy, and friends can often recommend therapists. Professional organizations such as the Medical Society, the American Psychiatric and Psychological Associations in our area, and the local branch of the National Association of Social Workers may be able to help find a therapist. The Mental Health Association offers a Therapist Referral Service. Individuals can call with their requests, and information on up to three therapists taking new patients will be given. The Yellow Pages list therapists under Physicians, Psychologists, Social Workers, Counselors, Marriage and Family Counselors, Social Service Organizations, and Psychotherapists.

Clients should remember that they are consumers paying for a service and thus have a right to be satisfied with the service received.

Clients may want to ask questions about the therapist’s credentials, the kind of therapy used to cost and the expected length of therapy. As mentioned above, the therapist’s credentials, education, training, licensing, etc., are important, although they alone don’t ensure successful therapy. The therapist’s style and the client-therapist relationship should be considered. A person seeing a therapist in a public clinic has less choice than a person seeking a therapist in private practice. Nonetheless, clients in public settings may ask to change therapists if they are dissatisfied with the one assigned to them.

Who’s Who

Psychiatrist: A medical doctor (M.D.) specializing in diagnosing and treating mental illnesses and licensed to prescribe medications.

Psychologist: A health care professional who diagnoses and treats mental, nervous, emotional, and behavioral disorders and ailments. Psychologists’ practices also include industrial/organizational psychology, research, and teaching. New York psychologists have earned a doctoral degree in psychology from a program registered or accepted as equivalent by the New York State Education Department. Psychologists with doctoral degrees with the letters Ph.D., Psy.D., and Ed.D. all have met the same educational requirements.

Social Worker: A person who helps individuals and families with personal and practical problems. New York State has two professional licenses for social workers with different qualifications. Only licensed social work professionals may legally use the title Licensed Master Social Worker (LMSW) or Licensed Clinical Social Worker (LCSW). Clinical social workers may provide all social work services, including the diagnosis of mental, emotional, behavioral, developmental, and addictive disorders, the development of treatment plans, and the provision of psychotherapy. The Licensed Master Social Worker may provide these clinical services only under the supervision of an LCSW, licensed psychologist, or psychiatrist.

Psychiatric Nurse: A registered nurse (R.N.) who has also received an advanced degree in psychiatric nursing and who may have passed a qualifying examination.

Mental Health Counselors have completed a master’s or higher degree in counseling. They work in both agencies and private practice settings and provide evaluation, assessment, and treatment by the use of verbal or behavioral methods. In New York State, they are referred to as Licensed Mental Health Counselors or LMHC.

Marriage and Family Therapist: A person who uses mental health counseling, psychotherapy, and therapeutic techniques to evaluate and treat marital, relational, and family systems and individuals in relation to these systems. In New York State, they are referred to as Licensed Marriage and Family therapists or LMFTs.

Registered Therapist: A person who has been trained in a particular aspect of treatment related to clients’ daily living skills. These include occupational (O.T.R.), physical (P.T.R.), and recreational therapists (R.T.R.), as well as rehabilitation counselors (C.R.C.).

Creative Arts Therapists: A person trained in psychotherapy and specific arts disciplines. By guiding patients to create and reflect on art and the artistic process, they help people increase awareness of themselves and others to cope with symptoms of stress, illness, and trauma and enhance cognitive abilities. Creative art therapists may be trained in dance/movement therapy, drama therapy, music therapy, poetry therapy, and art therapy. Creative Arts Therapists are licensed under New York State Law.

To check the status of a therapist, go to the Office of the Professions of the State Education Department (see index).

Types of Therapy

There are many kinds of therapy, sometimes used in combination, which can be used in treating a mental illness. Your needs and the therapist’s background and orientation will determine what approach is used. One of the first steps is to determine if you need medications to help decrease or stabilize your symptoms. At this point, it is best to be evaluated by a psychiatrist who can prescribe and monitor medication. In recent years, primary physicians have also become a source of drug therapy. However, medications usually cannot address all of your issues, and most people find it useful to also see a therapist. Many people do not need or want medications and enter psychotherapy to handle their emotional problems. Psychotherapy is a general term that refers to talking therapies where you talk about your condition and related issues with a mental health professional. Psychotherapy varies in length and can take place in individual, couple, family, or group sessions. Most therapists use a combination of approaches to therapy.

Types of Therapy Include:

Psychodynamic: A problem, such as a fear of heights, is considered a symptom of a deep, unconscious conflict, and therapy is focused on helping you to gain awareness and insight into the repressed conflicts. The goal is then to resolve these conflicts so that you can modify the unwanted thoughts and behaviors resulting from the conflict.

Behavioral: The unwanted behavior is identified, and the therapist uses a system of rewards, reinforcements of positive behavior, and desensitization to help you change the unwanted or unhealthy behavior.

Cognitive: This therapy looks at your thought process and helps you to identify and change the distorted thought patterns that lead to self-destructive feelings and behaviors.

Cognitive-Behavioral: Combines elements of both approaches. After the identification of the dysfunctional thought process, therapy focuses on providing new information-processing skills to allow you to replace negative thoughts with more positive thoughts and behaviors.

Dialectical Behavior: A type of cognitive-behavioral therapy that teaches you behavioral skills to help you better tolerate stress, regulate your emotions and improve your relationships with others.

Use of Medication in Psychiatry

It is vital that there be a collaboration between the patient, the primary therapist, the physician, and involved family members. Patients who are educated about their medications are far more likely to succeed than those with less knowledge. This section is meant to provide you with an overview of the various medications, their indications, and their side effects. If any of the material that follows is disturbing to you, please discuss it with your physician. Some of the key questions to discuss when medication is suggested might include:

  • What can we hope for this medicine to accomplish? How will we tell if it is successful?
  • What information do you need from me for this purpose?
  • What side effects might I reasonably expect? (NO doctor can list all of the potential problems; there are simply too many possibilities. The common side-effects and suggestions on how to manage them should be discussed.)
  • What sort of difficulties should I call you for? What will the medication cost?
  • What should I do if I miss a dose?
  • How will we decide when it is time to stop the medicine?


Antipsychotic medications can be divided into two groups: the older “conventional” agents and the newer “atypical” medications. The newer agents have different side effects from conventional agents and are generally better tolerated. But, some of the toxicities associated with the newer medications can be serious. Also, newer medications tend to be more expensive. Some of the newer medications are reserved for patients who are intolerant or non-responsive to conventional agents, while some are now used as first-line medications.

The newer antipsychotic medications will be discussed in the section on Atypical Antipsychotics. The indications for antipsychotics, discussed next, are largely the same for both classes of medication, though there is a suggestion that negative symptoms of schizophrenia (difficulty with motivation, energy, and social interaction) may be more responsive to the newer agents.

Common Indications: used to treat hallucinations, delusions, agitation, thought disorder (difficulties with thought, language, and communication), and acute mania. Some of the diagnostic indications include schizophrenia, schizoaffective disorder, psychotic depression, and mania.

Examples of older antipsychotic medication ranked from low potency to high potency (see side effects for explanation): Chlorpromazine (Thorazine), mesoridazine (Serentil), loxapine (Loxitane), molindone (Moban), trifluoperazine (Stelazine), fluphenazine (Prolixin), thiothixene (Navane), haloperidol (Haldol).

Side-effects: all antipsychotic medications, with the exception of clozapine (Clozaril) and risperidone (Risperdal), which will be discussed separately, are the same in terms of their mechanism of action and what can be reasonably expected. The selection of a particular medication is based on which side effects can be most readily tolerated. High potency agents require fewer milligrams to have the same effect; thus, 2 mgs. of haloperidol, a high potency agent, will have compatible effects to 100 mgs. of chlorpromazine. High-potency antipsychotic medication will pose a greater risk of Parkinsonian side effects and less risk of lowering blood pressure, sedation, or anticholinergic difficulties. Parkinsonian side effects can include tremors, stiffness, akathisia (a sense of restlessness and difficulty sitting still), and lessened facial expressions. Selecting a different antipsychotic, lowering the dose, or taking another medication for the side effects usually manages these. Anticholinergic problems might include dry mouth, constipation, visual blurring, difficulty with urination, sexual difficulties, and confusion.

Unusual and more serious side effects include tardive dyskinesia (TD) and neuroleptic malignant syndrome (NMS). TD is the occurrence of involuntary (not under conscious control) movements that might involve any part of the body but which most often involve the mouth, arising from prolonged use of antipsychotics. NMS also results from exposure to antipsychotics and may be early or late in treatment. Patients can develop a sudden fever and stiffness and may become profoundly confused or lose consciousness. There can be extensive damage to muscles. This is a real medical emergency and could lead to death. It should be kept in mind, though, that NMS is very rare. A physician should promptly evaluate sudden fevers or stiffness.

Special Antipsychotics

Depot Antipsychotic: haloperidol (Haldol) decanoate and fluphenazine (Prolixin) decanoate are the most commonly used. These are medicines given by injection from once a week to once a month. They are used when patients are having difficulty taking daily doses by mouth. Injectable antipsychotics have, unfortunately, been subject to manufacturing shortages, and your physician may have to switch you to oral medication or a different medication, depending on the situation.

Atypical Antipsychotics: clozapine (Clozaril), risperdidone, (Risperdal), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon) and aripiprazole (Abilify). Geodon is the first to market a quick-acting intramuscular preparation.

The effects of these medications are very like those of conventional antipsychotics, but they differ in terms of side effects (usually less), price (usually more), the possibility that they may do a more effective job of treating the “negative” symptoms (lack of interest, difficulty in initiating activities, and social withdrawal) that can plague some people with schizophrenia. Data indicates that as many as a third of schizophrenic patients who have not responded to conventional agents will respond to these atypical agents.

The newer medications can be expensive. The typical cost of a year’s medication with clozapine will be in excess of $5,000. Risperidone will cost about half as much. Clozapine will not be expected to cause parkinsonian side effects or tardive dyskinesia, although one cannot guarantee this. It will cause many other side effects mentioned for low-potency agents. Risperidone at low doses (most typically around 6 mg. or less per day) should also be free of these difficulties, but there is no guarantee. If the dose is advanced much more, it starts to be very like a conventional antipsychotic, and the benefit tends to be lost. Olanzapine has been most effective in the 10 to 20 mg. dose range.

The major problem with clozapine is bone marrow suppression. This occurs in about one percent of patients and can be fatal if not addressed. Because of this, weekly, biweekly, or monthly (depending on how long one has been on the medication) blood tests are required to monitor the bone marrow production of blood cells as long as patients are taking the medication. Although this can seem onerous, it should be weighed against the possibility of a significant improvement in symptoms for people who have not done well on other medications.

Most of the newer antipsychotics can affect glucose (blood sugar) regulation, lipid levels, and weight gain. Weight gain tends not to be related to the dosage. A collection of signs (diabetes, increased lipids, hypertension, and weight gain) has been called Metabolic Syndrome. People taking atypical antipsychotic medication need to have their weight, lipids, blood pressure, and blood glucose monitored by their doctor.

Of note: antipsychotic medication may affect the body’s ability to regulate temperature. This is important to remember for the summer when people tend to spend more time in the sun.

Agents For Sleep

These are almost exclusively benzodiazepines (see the comments about anti-anxiety agents). The important thing to remember is that these medicines will lose their impact after a couple of weeks, so users should not be on a nightly basis for much more than a week. It is possible to create considerable confusion since there will often be a kind of withdrawal effect after prolonged nightly use, leading to more sleep difficulty and the mistaken belief that the appropriate response is to increase the hypnotic. It is also possible to become psychologically dependent on taking something to fall asleep. The other worry is if you are a heavy snorer. This might indicate that you have sleep apnea, which would worsen if you used a benzodiazepine, as these medications can suppress breathing. Examples: flurazepam (Dalmane), temazepam (Restoril), triazolam (Halcion), zolpidem (Ambien) which is not a benzodiazepine, but works the same way. There are many over-the-counter (OTC) sleep aids, the majority of which are active, diphenhydramine (Benadryl), essentially an antihistamine that makes you drowsy.

Many doctors prescribe trazodone (Desyrel) for sleep. This is actually an antidepressant with some anti-anxiety effects. The dosages for antidepressant effect are around 150 to 400 mg. a day in divided doses. Unfortunately, many people complained of drowsiness. When better medications came along, it was rarely used as an antidepressant but instead prescribed as a sleeping aid. Doctors like it because it has no real abuse potential (as do benzodiazepines) and very little if any, problems with drug interactions. One potential side effect of trazodone is called priapism, a sustained erection. If this occurs, the patient should stop the medication and alert the prescribing provider.


Common Indications: not surprisingly, the main indication is depression. This is not the same as sadness but is, instead, a sustained period of depressed mood, which can include: difficulty with sleep and appetite, diminished interest in sex, guilt, limited energy, difficulty in enjoying previously pleasurable activities, suicidal thoughts, hopelessness, and helplessness in its classical form. Other reasons for antidepressants include panic disorder, obsessive-compulsive disorder, some chronic pain syndromes, and some eating disorders.

General Comments: it is important to realize that it is quite common for someone to fail to respond to a good trial of one antidepressant and to do quite well with another, so do not give up if the first agent fails to help. Unfortunately, these medications take 1 to 5 weeks before anything worthwhile happens. To make things worse, side effects can be immediate, making it hard to judge if it is worthwhile to continue the medication. The typical pattern of response is for sleep, appetite, and energy to improve before the mood starts to improve. Curiously, your friends or family might notice some improvement before you are aware of it, so ask for feedback. It is vital that you let your prescriber or therapist know if you are experiencing suicidal feelings. Many of these medications (paradoxically) can cause suicidal thoughts, but this is not common, and there is no good information to prove that they actually cause anyone to harm themselves.

Examples: The traditional tricyclics include imipramine (Tofranil), amitriptyline (Elavil), desipramine (Norpramin), nortriptyline (Aventyl, Pamelor), clomipramine (Anafranil) and doxepin (Sinequan), among others. Medications called Selective Serotonin Reuptake Inhibitors (SSRI) include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), fluvoxamine (Luvox), escitalopram (Lexapro), and citalopram (Celexa). Lexapro and Celexa are very similar.

Atypical antidepressants include nefazodone (Serzone), mirtazapine (Remeron), bupropion (Wellbutrin), venlafaxine (Effexor), Trazodone and duloxetine (Cymbalta). A new medication, desvenlafaxine (Pristiq), is essentially a metabolite of venlafaxine.

Monoamine Oxidase Inhibitors block an enzyme, increasing levels of serotonin, norepinephrine, and dopamine. They include tranylcypromine (Parnate), phenelzine (Nardil), and isocarboxazid (Marplan). MAOI inhibitors require a special diet and caution about other medications taken while on an MAOI. The diet excludes almost all cheese and aged meats, but it is not usually a great problem. MAOI is usually used for patients who fail to respond to other antidepressants or for those who have atypical depression. They are rarely prescribed today but are very helpful to a select group of patients.

Side effects: there is considerably more variation here than with antipsychotics. Some medicines lead to dry mouth and decreased blood pressure with changes in position; others lead to anorgasmia or difficulty in achieving sexual satisfaction. All carry the risk of inducing mania in those with a propensity for mood swings. As with antipsychotics, weight gain is common with many antidepressants. Weight gain is not inevitable, but you will have to watch your intake more closely than usual.

Of note: sometimes, if an SSRI medication is stopped abruptly, the person can have a “withdrawal” syndrome of anxiety, agitation, stomach upset, and flu-like symptoms that can last a few days. This is not a sign of addiction, just the body readjusting to a different level of serotonin. To avoid this (or if it starts), one can taper the use/dose of the medication. It is best to ask the prescriber about this.

Mood Stabilizers

Indications: these medicines can act to prevent recurrent depression or mania and also act acutely to help control a manic episode. In addition, lithium is often used to increase the effectiveness of an antidepressant.

Examples: lithium is the old standby. More recently, anticonvulsants including carbamazepine (Tegretol), clonazepam (Klonopin), valproate (Depakote), topiramate (Topamax), oxcarbazepine (Trileptal), and tiagabine (Gabitril) have also been used. Valproate is considered more effective for “rapid cycle” mood disorders (a series of highs and lows).

Side effects: lithium side effects are usually predictable and related to the dose. For this reason, your doctor will probably want to follow your blood levels closely while trying to establish the right dose for you. Problems at relatively low levels may include a fine tremor and increased thirst. As levels climb, you may notice diarrhea and nausea. (Lithium will irritate your stomach if it is empty, so always take it after eating something.) As levels increase, you might notice difficulties with coordination or speech, and your muscles start twitching. If you reach this point, it is important for you to be seen by a doctor. Lithium levels climb when people lose salt in situations such as sweating profusely or fever.

Sprinkling a little extra salt on your food before a summer outdoor workout is probably prudent. Long-term use of lithium can be associated with kidney damage, so your doctor will want to get a blood test to check for this once or twice a year. Similarly, there is a chance of thyroid dysfunction, especially in women; a blood test will help to monitor for this. If this were to occur, the prescriber and patient would discuss the pros and cons and could decide to switch to a different mood stabilizer or just add some thyroid hormone to the regimen.

Weight gain is distressingly common. Some patients feel as if their thinking slows with lithium, although it is sometimes difficult to know whether this is associated with the loss of mania or the medicine itself.

Carbamazepine has significant side effects. There may be problems in the beginning if it is increased too rapidly. These problems might include problems with coordination, walking, or speech. If these occur, let your doctor know, so the dose can be decreased. The major problem is a rare suppression of the bone marrow (like with Clozaril). Your doctor may want to get a blood test to monitor this. Valproate may cause tremors but is usually well tolerated and has fewer side effects than Lithium or Tegretol. Weight gain is a major side effect. Also, occasionally it might cause pancreatitis, which presents with significant abdominal pain.

Oxcarbazepine (Trileptal), a relative of Tegretol, has fewer side effects. Topamax (Topiramate), which is as effective as Depakote without significant weight gain, should not be used for patients with glaucoma or a history of kidney stones. Neurontin has been used but is less effective in studies. Lamotrigine (Lamictal) has been used but has a serious side effect in a small group of people (a skin rash that can be lethal). All individuals should thoroughly discuss potential side effects with their treating physician or nurse practitioner. While most patients can take these medications safely, liver function should be monitored.

Anti-anxiety Agents

There are two general medication approaches to treating anxiety: 1) Benzodiazepines and buspirone, and 2) antidepressants. Barbiturates and other related compounds should not be prescribed, as they are significantly more dangerous.

Common Indications: these agents are typically given for anxiety. They are also effective for insomnia and are sometimes used for alcohol withdrawal. Examples: alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), diazepam (Valium), lorazepam (Ativan), and oxazepam (Serax) are all benzodiazepines. Buspirone (Buspar) is not a benzodiazepine, instead being a member of a unique class. There is some question about how well buspirone works. It is clear that it cannot be used on an as-needed basis but must instead be used regularly since it may take weeks to become effective.

Anti-anxiety Agents

Side effects of benzodiazepines: these are clearly sedating agents. As a result, motor abilities for such activities as driving decline. They also can suppress breathing, especially when combined with other things, such as alcohol and opiates. Also, when tested on these medications, there is a subtle decrease in people’s cognitive (thinking) performance. There is an interaction with alcohol, so the effects of alcohol are increased. The major issue is that of dependence on these medications (not buspirone). Regular use of high doses will lead to withdrawal effects if you stop them suddenly. Withdrawal symptoms can range from edgy to increased anxiety, tremors, heart rate, blood pressure, and seizures. Benzodiazepines should not be the strategy for treating anxiety but rather a helpful step to allow the patient and the prescriber to manage anxiety in the present while looking for a longer-term strategy that could include other (non-benzodiazepine) medications, psychotherapy, or both.

If you have been on significant amounts of these medications for a long time, it would be wise to have a physician guide you in considering discontinuing their use. It is impossible to list specific guidelines for when you should be concerned about this, so be sure to discuss this with your physician or prescriber. New York State’s concern about the potential for habituation and abuse of these medications led them to be listed as controlled substances.

Some antidepressants (for example, paroxetine, brand name Paxil) work very well with anxiety. A common strategy is to begin with, a benzodiazepine to treat acute anxiety and then switch to an antidepressant with a good anti-anxiety effect, discontinuing the benzodiazepine when the other medication begins to help.

Cost of Community Treatment

The cost of treatment varies depending on whether you are seen by a public agency or by a private therapist. Agencies charge fees based on a person’s income, known as a sliding scale. All agencies and some private therapists will accept Medicaid and/or Medicare.

Insurance plans offered through a person’s employment vary, with some plans requiring a referral from a primary care physician if mental health services are to be covered. All public mental health providers accept these plans as a form of payment. If you plan on seeing a private therapist, you should discuss whether or not they accept your insurance coverage before beginning therapy.

As of January 1, 2007, New York State implemented Timothy’s Law. This law requires that health insurance policies include coverage for the treatment of mental illnesses at the same levels as a treatment for physical illness or injury. This is referred to as mental health parity.

The cost of treatment varies depending on whether you are seen by a public agency or by a private therapist. Agencies charge fees based on a person’s income, known as a sliding scale. All agencies and some private therapists will accept Medicaid and/or Medicare.

Insurance plans offered through a person’s employment vary, with some plans requiring a referral from a primary care physician if mental health services are to be covered. All public mental health providers accept these plans as a form of payment. If you plan on seeing a private therapist, you should discuss whether or not they accept your insurance coverage before beginning therapy.

As of January 1, 2007, New York State implemented Timothy’s Law. This law requires that health insurance policies include coverage for the treatment of mental illnesses at the same levels as a treatment for physical illness or injury. This is referred to as mental health parity.

Self-Help and Professional Treatment: A Collaborative Relationship

Both self-help and professional treatment play an important role in aiding consumers and families. Self-help groups provide mutual support from peers who have experienced similar feelings and concerns. They stress the ability of an individual to solve his or her own problems with the aid of others in the same situation; they offer education and information in an informal setting and the chance for people to explore various alternatives to living with their common concerns.

Mental health professionals stress the importance of a particular therapeutic program delivered in a one-to-one relationship by a trained practitioner. Professionals are a valuable resource for information and can offer a consumer the opportunity to discuss various forms of treatment. They can also offer self-help groups their expertise and perspective as consultants and speakers. By developing a collaborative relationship with self-help groups and group members, mental health professionals may better understand the emotional issues people face.

No one correct type of help is best for all; some may benefit most from self-help, others from professional treatment, and many from using both.