Why is it so hard to get psychiatric help in this country?

The BBQ Pit
1

This isn’t about me, it’s about a patient I had. I’m an ICU nurse and this patient comes to me after an attempted suicide overdose. She’s bipolar and was trying to get help and was staying at a rehab clinic, but the rehab clinic would not treat] the bipolar disorder and treated her for substance abuse instead. But there’s no fucking substance abuse! She, understandably, grows desperate and checks herself out and tries another clinic. She’s denied, and I have no idea why. So, right out front of the clinic, she takes every pill she fucking has. Just everything. Lithium, Seroquel, gabapentin, even swallowed all her venofer, which is just an iron pill. No opioids, though, because, again, substance abuse isn’t her problem.

So the Seroquel overdose takes her out and EMS is called. They intubate her, take her to the local rural hospital and then she gets bumped to my hospital, which is the magnet for this area. Bunch of labs, I talk to poison control, etc, etc. and really it’s not that bad. Lithium levels weren’t actually that high, she never took anything with acetaminofin in it, so it’s kinda just waiting for the seroquel to wear off. It does, and we extubate her, and she’s fine. Nothing medically wrong at this point. She’s awake, alert, oriented, and actually very pleasant and honest.

But she ends up being stuck in the ICU on 1013 protocol (suicide watch) for about a week. Now, I’m her nurse, and it’s obvious to me that she doesn’t want to commit suicide, she just needs psychiatric help. Not batshit crazy, very pleasant and rational actually, just with a long history of struggling with bipolar disorder. She’s 1013, which is involuntary admittal, but she’s also voluntary. This woman wants help.

Case management tries to place her, but nobody will take her. I have no idea why. I truly don’t. But, my hospital actually has a psych wing. So, let’s move her there, right? It was like fucking pulling teeth! They used every excuse not to take her. I won’t get into all of it, but I remember trying to explain to these moronic psych nurses that she was medically cleared three days ago, and no, godamnit what the fuck is wrong with you, the fact she had a cough yesterday does not mean you need to wear a mask.

So, here’s the purpose of this thread. This is just wrong. The system is fucking broken. It’s bad enough when this woman was trying to seek help from outside of the hospital system, but even after she pulled a desperation move and I came on the case, it was still hard! I’m a goddamn ICU nurse. I’m the medical equivalent of a master gunnery sergeant. And if I get this much pushback, what hope do the patients have?

2

The problem is that too many people think mental illness isn’t a real illness, it’s “just” an “attitude problem”. If there is something wrong organically just give them a pill to fix it and it’s done, right? :rolleyes: If you can’t find a tumor or leision they just need to get over themselves. :rolleyes:

Here, let me give you another one: :rolleyes:

Now that’s she’s been through substance abuse treatment she’s probably seen as “dual diagnosis” (because doctors never make a mistake, right… uh oh, I feel another one coming on… :rolleyes: ) and now she’s REALLY untouchable.

Great, on top of everything else she’s now had in appropriate treatment that makes it even MORE difficult for her to get help.

Sorry, don’t have any answer.

3

It’s worse than that, I think. I don’t know exactly how or why the system is broken, but I do know my job. If there is something physically wrong, I’m your guy, but not so much if you need a psychiatrist. That is supposed to be available, but remember, it was the psych people that kept denying her. I’m the “organic” guy, and that’s just bullshit. I mean, this is supposed to be their jobs! Seriously, I was about to walk over to the psych wing and just start smacking the staff upside the head.

4

I more or less gave up on psychiatric counseling here in the USA a while ago. Reasons being: 1) too much red tape, 2) it’s absurdly expensive, 3) far too long a wait, and drive, and provides no immediate help when you need an “emotional 911,” and most infuriatingly, 4), a great deal of “counseling” consists of nothing but feel-good trite platitudes or toxic-posivity gaslighting or “close your eyes and breathe deep” (which, while not bad advice, sure isn’t worth $70-90 per hour. I could get the same advice from YouTube for free.)

5

Because drugs are seen as a cure all. When I was diagnosed with “situation depression” because I felt lousy being out of work, I was told to get on disability and take drugs.

People don’t need counseling, they just need drugs to live with and/or forget their problems. Big Pharma must love this.

6

It’s also the area of medical practice least likely to involve patient self-determination. Physicians of all stripes can be annoyingly arrogant (“just do what I say, don’t try to make your puny little mind understand the why and wherefore”) but psychiatrists and institutional staff at psych facilities take it to an entirely different level.

I don’t think it’s necessarily hard to get psychiatric services. All you need to do is insist you don’t need them and don’t want them. But if you do need and want them you can’t have them. If you want them, you’re a malingering hypochondriac. But if you won’t want them, you’re obviously so demented you don’t understand how badly you need psychiatric intervention so we’d better lock you up and shoot you up for your own good.

7

I may be totally off base here since I don’t actually have a whole lot of personal experience in this area (other than the realization of the near impossibility of finding a psychiatrist who takes our insurance and is willing to take on new patients), but I think that a big part of the problem is that there is a incompatibility between the requirements of psychological counseling and our medical system. Actual treatment for psychological issues, will require multiple hour long sessions for an extended period of time. Compare this to other medical treatment in our system where intervention is usually a limited number of appointments each of which lasts about 15 minutes before the doctor moves on to the next patient.

In the time it takes for a psychiatrist to fully treat one patient, a podiatrist can get a dozen or two in and out the door. As a result, there are simply not enough psychiatrists around to give all the care required. It also makes psychiatrists choose to the phenomena of pharmaceutical intervention over long term counseling because it gets the patients in and out faster. I’m not sure about the solution to this problem, but I don’t think its just that people don’t care.

8

I’m guessing it’s because there’s sort of a lack of understanding of HOW you go about getting those services. I mean, it seems to me that a lot of people don’t really get help until they have some sort of event/episode, at which point the ball starts rolling for many. But let’s say that someone’s depressed because of some kind of confluence of bad life events (divorce, job loss, stress, etc…) how DOES one typically go about getting help? Your regular doctor is usually understood not to be the right person for that, but do you go to them for a referral? Do you just google therapists or counselors? Do you need a honest-to-god psychiatrist, or do you need a psychologist? Those are all questions I don’t have the answer to. I know in my case, I did literally google therapists and found one who happened to work out really well for me. But it very well might not have, had I found one who didn’t jibe with my particular way of thinking, or what I needed. And if I had needed medication, then what?

Personally, I think this is the biggest stumbling block to most people- with most other sorts of doctoring/therapy, there’s a more or less clear path- you go to your PCP, or you go directly to a specialist, and you’ll either get treated or referred elsewhere (e.g. physical therapy). Or you go to your dentist, and if he can’t handle it, he refers you to an endodontist, oral surgeon or orthodontist.

But when it’s your mind, I think there’s some confusion whether your PCP is the guy to go to, and it’s not like most people have a PCP for their minds.

9

Whoa, what a timely topic!

As many of you know, I had a miscarriage recently and it sucked real hard and still sucks real hard. I also have depression and have had it for many years. Because of the combination of these factors, my boss was like “Dude, you are very noticably depressed. Here’s the number for the EAP.” So I called them and, the first time, they denied me because my company did not have an active account.

Now let’s pause there a second and get to my first point about getting psychiatric treatment. When you are sick, it hard to make yourself get help. Any barriers may be insurmountable. For me, this nearly was. It was only because my boss was pushing that I even tried again.

So, I went to HR and they cleared up the problem and hooked me up with a therapist. This therapist can only see me during work hours. Ok, whatever, my boss is cool, I can make this work. And I do. But this brings me to my second barrier. When you are sick, it’s hard to miss ever more work. I had already used up all my sick time and my PTO so I didn’t (and still don’t) have time to take off for doctor’s appointments. It is only because my boss is cool about my schedule that I am able to see my therapist when she is available. For others, this might not be the case. Keep in mind, I only have access to this therapist because I am using the EAP at work. I lose my job and I lose the benefit.

In my first session with my therapist, the first thing she tells me to do is see a psychiatrist. I called the EAP for help but they don’t do psychiatric help. I have to call my insurance. I talk to insurance and they give me a list of about a bajillion names to call. Third barrier is the lack of support. How am I supposed to have the motivation to go through the 100s long list to find a psychiatrist who will help me in a timely manner?

I didn’t, btw. In this case, I opted to try telemedicine. It was a game changer but not going to be available to people without reliable internet connections and money. Now, I am not made of money but I was able to find enough spare change to pay the $250 first appointment charge and the subsequent $99 visit charges. But, when you are sick, holding down a job is hard. Paying this kind of money is not easy and may very likely not be feasible. While I have been lucky so far, if I needed more of the psychiatrist’s time, or if the psychiatrist decided that I was just a crazy person he didn’t want to help, it would have been more wasted time and money that could have led to more drastic consequences.

In conclusion, this whole system is broken. It’s almost designed to only help the most supported, financially well off people and leave those at most need of help without it.

10

Where’s Lucy when you need her?

11

Furthermore, how do you change another person’s mindset? A shrink told me “I don’t see why you can’t be happy on disability?” Uh, you are supposedly a trained psychologist and you don’t know some people need to do something with their life to be validated? How is that possible?

And when I asked him “Will disability give me enough to live like I want to live” he changed the subject.

12

As part of the current push of American insurance companies and their multinational owners to “open new markets”, I received some polls which had clearly been designed in the US (1). All of them took it for granted that anybody responding would be on some form of medication. The option “I’m not on any medication” was simply not available.

And this

is medical slavery, damnit.

1: they contained the kind of legal references which are obvious… for people who know there is more than one legal system in the world. PSA to people hiring translators for American-generated documents that will be applied Elsewhere: Elsewhere people do not care about whether you are an EOE or about HIPAA. Some of us do care about whether you comply with our legal systems when you act in our country. If you’re going to be incapable of doing such a thing, kindly stay in Alaska and keep walking North. Morons.

13

Utah recently discovered that the solution to homelessness was…
homes. It used to be that they required homeless people to get clean before they’d place them, which is just fucking impossible. Then they’d get arrested—sometimes deliberately----or go to the ER because they didn’t have health care, and so on. Put them in tiny houses or apartments, get them some help, they stabilize. Who knew?

And that’s the thing. You have to show people that caring for people makes good economic sense. You can’t just argue that’s the right thing to do, no, because nobody gives a shit.

Mental illness is seen as, somebody noted above, self-indulgence or a lack of boot strings. I’m pretty sure people who say that kind of shit also say suicide is selfish. You know what is definitely selfish? Telling somebody, “Well, I don’t care, you’re just not as funny as you used to be.” One suicide attempt was to make the nightmares stop, and partly because of comments like that, and partly out of being so exhausted by not sleeping that hallucinations started whispering that the naysayers were right, that I should kill myself.

Women have an especially hard time of it because we’re supposed to take care of other people, not need help ourselves. There’s a lot of resentment against women who ask for help. You will find out who are your real friends.

Mental illness is also used as a weapon against women, as a way to play into the “crazy, hysterical, emotional, histrionic, wants-attention, untrustworthy woman” trope, as if being mentally ill makes you stupid.
People are also afraid it’s contagious.

Military are allowed to have PTSD as part of that grotesque one-size-fits-both-Eddie-Murdeous-Motherfucket-Gallagher-and-Tammy-Duckworth-First-Of-Her-Name thing. I wish that sympathy for soldiers rubbed off on civilians, too, but it doesn’t, probably because ultimately people do not want to know that some civilians are effectively being subjected to war crimes. Rape victims are just as likely to have PTSD as soldiers, but no guy who’s ever thought, “it doesn’t count without a dark alley and a gun,” wants to think about how rape in war is a war crime, so what does make him? (Maybe that’s why so many rapist apologists cling to the “weapon” standard because without one, it removes some of the “war criminal waging war” aspect of it?/rhetorical)

I hate that moral arguments aren’t enough. Fuck Reagan.

14

When my Other Shoe died a few years ago, my mother pushed me to go to some therapist she’d found for me. During the first session, the guy informed me that I’m quite introverted.

A blind guy three counties over can see that, but hey, thanks for the diagnosis, Captain Obvious.

He then proceeded to lay out his plan to help me … overcome being introverted. Because, you see, that was the root of my problems.

I did not return for a second session, and to this day my mother swears I refused all psychiatric help after joining The “W” Club.

15

Oh, this whole thing is so hard. I’m about as privileged as can be when it comes to this stuff. I live in a major metropolitan area, have good insurance, a stable income, and my own education on mental illness to help navigate all of it, and it’s still hard.

There is a (state, federal?) law saying that a referral is not required to get mental health treatment. I had one insurance company repeatedly deny claims because there wasn’t a referral, which was not required, so they had no way to process a referral when the GP wrote one up anyway. That same company also repeatedly denied claims because the provider was out of network, when the provider was in network. The insurance company and the provider both knew they were in network, but denied anyway. I finally got HR involved, and they said it was a common problem. Fortunately, because fuck them, we made that insurance company pay for a pregnancy and broken leg (unrelated incidents) right before they were dropped by my employer.

I’ve not had claim problems with the current insurer, but finding treatment is incredibly difficult. Their find a provider page is a near useless list of doctor’s and therapist’s names, with very little indication of what that person actually treats. Using that list and google I can usually figure out if somebody is even worth calling, but it is hours of work to come up with a list of providers to start contacting.

The insurance company makes it look as easy as “show me therapists within 10 miles of my home who are taking new patients.” What is returned is a list of ten names. Four of those all work at the same clinic that is for addiction recovery only. A few more aren’t actually at the listed number or address. Of the remaining few some will have the wrong specialty, for example child or senior psychology when looking for adult care. It is extremely easy to end up with no actual providers. So, redo the search at 25 miles, and start over…

All of that is just coming from the insurance company’s web site. Try again with google for “therapists in my area that take my insurance” and it will bring up a whole different list. Each one with the appropriate specialty has to be contacted to find out if they actually take the right insurance and are accepting patients.

And all of that is for somebody who would like to start therapy in the next few weeks, not somebody in a crisis.

16

Right, because your problem was being introverted, not having gone through a major traumatic event which capped a long period of intense stress… Which follows from my previous post. Once a therapist/psychiatrist is actually found there is a strong chance it just won’t work out, and the process has to start all over again.

17

I disagree. Both men and women are expected to never ask for help. Women are supposed to nurture others without needing nurture; men, to be the defenders whose armor never gets a single dent.

Learning when and how to ask for help is a skill which should be super basic, but too many of us were taught that we had the duty to help yet no right to be helped. And too many people have completely inappropriate reactions when someone asks them for help.

18

You are, but it seems most of everyone who is not a patient, their family, or an actual mental health professional are right where you are. So get this: Psychiatry treatment is just like seeing an MD for hypertension or diabetes, or any other chronic illness. It’s maybe a 30 minute appointment maybe once a month or two. Maybe a little more frequent initially while the meds get dialed in. IME psychiatrist is interested in symptoms only inasmuch as they are necessary to verify what the symptoms are so the most likely drugs are identified.

Psychologist doesn’t generally peddle drugs, and these are the ones you talk to for an hour at a stretch and really dig into and manage the issues your illness has caused. If the symptoms can be managed medically and you’re even sort of self-aware, you may never even need one of these guys if you can get your chemistry fixed.

My son saw both for over 10 years until he was 18 and decided he’d take his chances without meds. Lithium wasn’t even helping him at that point. As a favor to me he did a genetic test (Genomind) at a local clinic. They looked at things like how his metabolism is programmed to manage various chemicals/dugs, how he is set up biochemically and what sorts of conditions all that predisposes him to. Short answer: he needs a vitamin, L-methylfolate. Sounds like an organic disease to me, like scurvy or rickets. Would have saved us all a lot of time, money, frustration, and health problems if we’d have started there. Best part: insurance doesn’t cover the $400 test (or the vitamins for that matter), but were totes cool with paying orders of magnitude more for the cabal of physicians & the copyrighted pharmaceuticals they prescribed.

Yeah, our healthcare system is fucked, but don’t act all surprised. Turns out a lot of things we were taught as kids are lies. You are NOT in fact innocent until proven guilty; the medical profession is keenly aware they stop getting paid if people either die or start getting cured–so they focus on doing their best to prevent both; public schooling is not about education, it is about teaching obedience. There are lots of systems in our society advertising themselves as solutions, but they are just another capitalized trap to separate you from your coins and keep you dependent on all the other systems.

19

Women still do far more childcare and housework than men do, and in fact, divorce is far more common when wife becomes sick than when the husband does.

20

What does this have to do with being expected never to ask for help?