To allay any concern a patient may have that a mental health referral is an indication of the gynecologist’s disdain or disinterest, and to promote good patient care in general, the referring gynecologist should make it clear to the patient that he or she will remain involved in the patient’s care. The mental health professional should be introduced as a member of the health care team, and the gynecologist should ask the patient to call after the mental health appointment to report on how it went. The patient should be given a follow-up appointment with the gynecologist at the time of the referral (19).
Mental disorders are treated by social workers, psychologists, members of the clergy (often the first to be consulted), and various kinds of counselors as well as by psychiatrists (17–19). The lay public or even some medical professionals may not understand the distinctions between types of mental health professionals. The criteria for membership in each profession can vary by region and institution. Social workers and psychologists can receive degrees at the bachelor, master, or doctoral level. In some states, licensure is required. Social workers require a master’s degree and psychologists receive a doctoral degree, in addition to supervised clinical experience to qualify for licensure. The category of counselor includes a wide variety of practitioners, such as marriage counselors, pastoral counselors, school counselors, and family counselors. The training of social workers may focus on social policy, institutional care, psychosocial aspects of medical illness, or individual treatment (17–19).
Practitioners of all these disciplines may or may not be trained in psychotherapy. For a patient whose symptoms do not meet criteria for a major psychiatric disorder and who is able to eat, sleep, and carry out her regular duties, supportive psychotherapy provided by a trained mental health professional may suffice. Supportive psychotherapy calls on a patient’s existing coping mechanisms to combat a stressful situation. Doctoral-level psychologists and neuropsychologists can perform testing that can be helpful in establishing a diagnosis. Such testing is especially useful in identifying and localizing brain pathology and in defining intelligence levels. Undiagnosed cognitive deficits may contribute to noncompliance with gynecologic care as well as other problems (17–19).
Trained social workers are often knowledgeable about community resources for patients and their families and about the impact of gynecologic diseases and treatments on the patients. Self-help or professionally led therapy groups can be helpful for patients reacting to gynecologic problems such as infertility or malignancy. Participation in a supportive group was said to lengthen the survival time and improve the quality of life for some patients with cancer, although this assertion is controversial (20–26).
Psychiatrists are the only medically trained mental health professionals. They play a particularly important role in resolving diagnostic dilemmas, especially when questions arise about the psychological or behavioral manifestations of medical illness and pharmacologic treatment; when a medical understanding of the gynecologic condition and treatment is essential to the care of the patient; and when such issues as drug–drug interactions must be considered (19).
Psychiatrists are the only mental health professionals trained to prescribe psychoactive medications and other biologic interventions and provide psychotherapy. The legislatures of New Mexico and Louisiana have conferred prescribing rights on doctoral-level psychologists with additional training but have not defined the limits of the prescribing authority. It is highly likely that psychiatrists will continue to treat the most seriously ill patients and take ultimate responsibility for psychiatric emergencies (19).