Awareness without care navigation leaves you stranded

The titles are not interchangeable, and choosing the wrong one wastes time and money. In South Africa, the difference also determines who can prescribe and what medical aid will cover.

• A psychiatrist is a medical doctor who can diagnose, prescribe and admit; some also do therapy.
• A clinical psychologist is trained in assessment and therapy but cannot prescribe medication.
• A counsellor or social worker may offer supportive or structured counselling — check their registration and training.

The first session is an assessment, not an interrogation. You will not be expected to disclose everything at once, and you are allowed to ask questions.

• Expect questions about the current problem, its history, your background, health, sleep and any risk.
• You decide the pace. 'I would rather not go into that yet' is a completely acceptable answer.
• By the end you should have a shared understanding of the problem and a plan — ask if you do not.

The therapeutic relationship is one of the strongest predictors of outcome, more so than the specific technique. It is worth assessing deliberately.

• Good signs: you feel heard, you are given a clear framework, and you are challenged without being judged.
• Bad signs: you dread sessions, feel dismissed, or are given no explanation of the approach.
• Changing therapists is normal and not a rejection — say so plainly and ask for a referral.

Most evidence-based therapies are variations on a few core approaches. Knowing which one you are being offered helps you understand what the sessions are for.

• CBT targets the link between thoughts, feelings and behaviour — structured and skills-based.
• DBT adds distress tolerance and emotion regulation, designed for intense emotions and self-harm.
• Psychodynamic therapy explores how past patterns shape present relationships, over a longer timeframe.

CBT is the most widely researched psychological treatment. It is structured, active and usually time-limited, and it depends on work between sessions.

• The core idea is that how you interpret a situation drives how you feel and behave — and interpretations can be tested.
• Expect thought records, behavioural experiments and homework. The work between sessions is where much of the change happens.
• Typically 8 to 20 sessions for anxiety and depression, with clear goals reviewed along the way.

Trauma-informed therapy recognises that trauma affects the nervous system, memory and the sense of safety — and that treatment has to account for that to avoid re-traumatising.

• It prioritises safety, predictability, choice and control in every session.
• Trauma processing usually comes after skills for managing intense emotion are in place.
• Approaches include trauma-focused CBT, EMDR and somatic therapies — all with reasonable evidence.

Online therapy widened access dramatically, and it works for many people. It also has limitations worth understanding before you commit.

• Evidence supports online CBT for depression and anxiety at similar effectiveness to in-person work.
• Check privacy: where are sessions held, is the platform encrypted, and what happens in a crisis?
• It is less suited to severe illness, active suicidality or complex trauma, where in-person support is safer.

Antidepressants work by increasing the availability of serotonin and noradrenaline in the brain, which over time allows the brain's stress-response systems to normalise.

• They usually take two to four weeks to have any effect, and six to eight weeks for the full benefit.
• They are not addictive in the way opioids or alcohol are, and they do not change your personality.
• Mild depression often responds to therapy alone; moderate to severe depression usually warrants medication.

Most side effects appear in the first week or two and settle. A few need to be reported straight away.

• Common and usually temporary: nausea, headache, mild anxiety, sleep changes, delayed orgasm.
• Persistent problems worth raising: sexual side effects, weight change, ongoing sleep disruption.
• Report immediately: a rash, severe agitation, or any increase in suicidal thoughts, especially in people under 25.

Anti-anxiety medication splits into two very different groups — one for long-term control and one for short-term relief — and confusing them causes real harm.

• SSRIs and similar drugs are used for ongoing anxiety control and take weeks to work.
• Benzodiazepines act within hours but carry a genuine dependency risk and are not a long-term solution.
• Never stop a benzodiazepine abruptly after regular use — the withdrawal can be dangerous.

Mood stabilisers and antipsychotics are used for bipolar disorder, schizophrenia and severe depression. They are effective and they require monitoring.

• Lithium is the gold standard mood stabiliser but needs regular blood tests for levels, thyroid and kidney function.
• Antipsychotics can cause metabolic effects — weight gain, raised blood sugar and cholesterol — which need checking.
• These medications are usually long-term; stopping without medical advice is the most common cause of relapse.

Stopping psychiatric medication abruptly is a common and avoidable cause of relapse and withdrawal symptoms. Tapering matters.

• Discontinuation symptoms include dizziness, nausea, flu-like feelings, electric-shock sensations and mood swings.
• Tapering is usually gradual — over weeks or months — and should be planned with your prescriber.
• The right time to stop is when you have been well for a sustained period, not when you feel better for a fortnight.

The public sector is the main provider of mental-health care in South Africa, and knowing how the pathway works makes it far easier to navigate.

• Start at a primary-care clinic — that is the entry point for assessment, medication and referral.
• District hospitals run community mental-health teams; a clinic or GP referral is usually required.
• Psychiatric medication is dispensed free at state facilities, and waiting times are the main limitation.

Medical schemes must cover certain mental-health conditions by law, but the detail matters and most people never check it.

• Prescribed Minimum Benefits cover the diagnosis and treatment of major depression, bipolar disorder and schizophrenia.
• Psychologist sessions are typically limited to 10 to 30 a year depending on your plan.
• Your treating psychiatrist can motivate for additional sessions — ask for it in writing.

When private therapy is out of reach, there are real alternatives in South Africa. None of them are a compromise on quality in the way people expect.

• SADAG offers free counselling and runs over 180 support groups nationwide.
• Lifeline centres in major cities provide free telephone and face-to-face counselling.
• University training clinics and NGOs offer reduced-fee therapy with supervised trainees.

Consultations are often short, and preparation makes a real difference to what you get out of them.

• Write down your main symptoms, when they started and how they affect your day-to-day functioning.
• Bring a list of all current medication and supplements, including doses.
• Take notes, and ask for the plan in writing — diagnosis, treatment, what to expect and when to follow up.