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

The BBQ Pit
21

I hear the OP loud and clear, had a 3 year journey trying to get help for my teenage daughter. SHe was in a dark place, the first two counselors kind of blew us off since there was no underlying trauma like physical or sexual abuse and pretty much told us to go see your PCP for a chemical cocktail that’ll set her right up.

We did and the doc gives her script and says go off and be well. What a disaster, a few weeks later my child calls me in a mighty panic one night screaming “MOM MOM I did something stupid please help me” Ended up in the ER, and gets the all clear to go home after 5 hours with the instructions to follow up with your doctor. WHile we wait for an appointment with a different PCP, my kid is resisting me when I tell her she also has to eat well, get exercise and do her part to get better. She was stuck in one place. It was devastating to see. Until one day she goes in to get birth control, meets a nurse who sets her up with a counselor and who advocated for her with a new PCP who prescribed her meds and monitored her situation, making changes in dosage and brands. She finally started breaking out of the rut, got her drivers license, enrolled in college, cleaned her room without being asked too, working now, is pleasant to be around. Still bipolar etc. but managing it, doing so much better now. She no longer sees the counselor she said she doesn’t need it and can always call her if the need arises. A little part of my brain is fearful of a relapse but I’ve learned a lot and hope it doesn’t come to that if it does we’ll deal with it.

I am thankful that our health plan covers mental illness.

22

This, too.

The patient is crazy, therefore any objections that he or she may have (no matter how rooted in fact or reasonable) are to be vetoed.

23

I worked as secretary/bookkeeper/office manager for a psychiatrist in solo private practice for nearly 30 years. Unlike many, he did in fact do counseling. Not just pill prescribing/supervision, but 25 and 50 minute sessions on a on-going basis for patients with recalcitrant problems made up at least 70% of his practice.

I’ll add my ‘amen’ to any complaint about how Insurance companies do their best to keep patients from getting mental health care – even when it is explicitly included in their plan. If I hadn’t had to deal with insurance companies denials/resubmissions/redenials/appeals/re-redenials/re-appeals… well, my work week could have dropped from full time to maybe five hours a week.

As for the difficulty in finding a doctor to take you on – a big factor is that doctors should not/cannot/will not simply dump patients when their insurance won’t pay, whether or not the patient can scrape the money up elsewhere. What do you do if the patient’s plan ‘generously’ allows them to have six sessions per year – and that simply isn’t enough to keep them stable and functional? Refuse to treat them any more? “Sorry, Joe, I know you’re still suicidal, but Aetna won’t pay for any more sessions so you have to go.”?

Many, maybe most, psychiatrists will try their damnedest to insure the patient still gets the care he needs. My own doctor (who charged on the lower end of the ‘usual and customary’ fee schedule to begin with) was generous about discounting his rates for patients in those circumstances, all the way to free in quite a few cases, but in truth you CANNOT do this for too large a percentage of your practice or you find yourself unable to pay your rent and other business costs. Do you have any idea how much doctors pay for their malpractice insurance? Even ones that have never had a complaint against them in over thirty years of practice??

Fortunately, a large number of his patients either had good incomes or families that would help them, but some of their situations would make me sick.

I especially remember one young guy. He was in his middle twenties, not long out of college and with student loans, who needed long term care. He came in monthly, though he really should have been more often, but he was paying something like a quarter of the normal rate and he flat out refused to ‘abuse the doctor’s charity’ more often than that. He was working full time, but not making very much because he was near the bottom of the ladder, and the insurance policy his company offered was laughable.

One winter day I noticed he was wearing just a light weight jacket, and scolded him mockingly, telling him to stop acting so macho and put on his winter coat. (We’re in New England, winter’s are serious.) He said he didn’t have a winter coat, he couldn’t afford to buy one. I was horrified, but he tried to pass it off – he was naturally warm blooded, he had his car, he was only really outside a few minutes at a time – but really???

He was doing everything ‘right.’ He’d come from a poor family, managed to get through college but with heavy loans, he worked full time at the best job he could find/handle with his emotional problems… and he was so strapped he couldn’t afford a decent coat.

Yeah. The system is broken. I will vote for anyone who promises Universal Health Care, I don’t care where they stand on just about any other issue.

24

My daughter has mental health issues. Really, she always has had anxiety / ADHD and possibly low-level depression, but she really went downhill after high school graduation. We were able to get her in to see local psychiatrist relatively quickly; he prescribed an antidepressant, something for the ADHD, and an older antidepressant that is used to help sleep (Trazodone, I think).

OK, so far, so good. Except this was after a 15 minute initial appointment. Followups were 80 dollars for a 5 minute appointment where he just wrote new scrips without really bothering to find out if they were working well enough. They were helping for a bit but not nearly enough.

So she went to someone else. A 3 hour initial visit which impressed me but was about 450 bucks; subsequent visits were half that for about 200 bucks.

Note: NONE of these were in-network, and the providers did not even submit bills to insurance, and usually didn’t even give me the appropriate paperwork so I could file it myself. All in all, we spent many thousands of dollars over the years.

Now, it didn’t help that the kid wouldn’t try to follow self-help advice (the second doc was very into determining whether nutritional supplements might be helpful - I had my doubts but it was, in my mind, worth a try). That doc at least did try to help, but as I said, my daughter was refusing to try alternatives, just wanted her existing meds continued. They were, doubtless, bette than nothing, but nowhere near sufficient.

Meanwhile, the kid’s behavior was spiralling downward and she was having suicidal thoughts. I don’t know if we could have had her put on a hold - she could behave normally if she needed to, at least for brief periods. I’m convinced that she would be dead now if she had not been lucky enough to develop a seizure disorder.

Yes, “lucky”.

You see, the neuro I finally pushed her to see, months after she said “Oh, by the way, I think I may be having seizures”, said “Well, given your moods, if you do show seizure activity let’s try you on Lamictal, which also helps stabilize moods”.

NO OTHER DOCTOR took the time to figure out whether a different cocktail would be a better choice for her. She is (and was then) a legal adult, so I wasn’t in on the appointments with her, but I am pretty sure they never suggested alternatives.

We had the means to pay out of pocket to see someone local and out of network. Most people do not. And our daughter still got inadequate care. Given her truly amazing response to the Lamictal, I’m wondering whether she doesn’t have a mild form of bipolar, something she really hates to have suggested.

She’s doing somewhat better now - we’ve spent all her college money and pretty much all of our other savings on a residental placement in another state. We have issues with that, though, including the psych’s tendency to respond to a medication side effect with adding another med to counteract that. It can be a pretty scary spiral - though I think they’ve backed off on some of that.

Even when there’s someone around whose job it is to find inpatient placement, the process can fail horribly,as a Virginia legislator found.

The OP’s tale is stunning. Patient in THE SAME HOSPITAL, and the psych department tried to weasel out of admitting her??? Did they ever give any kind of reason for it?

25

When women suddenly require help themselves instead of providing it, they get dumped, whereas the expectation for women with sick husbands is they suffer and be loyal and saintly. It’s the Angel of the Hearth mythos, or whatever you call it, and it’s still an expectation today, that women take care of others before themselves—or in place of themselves. It’s one of the ways in which roles are loaded into the culture and linger on whether they’re named or not.

26

Bolding mine. Even those who will admit to having depression, being diagnosed as bipolar or schizophrenia comes as a shock. Anti-depressants do horrible things to people with bipolar, unless there is a mood stabilizer as well.

My uncle suffered for decades because of inadequate health care. Especially as even his parents would support him when he would decide he didn’t need his medication, because he felt fine.

It’s difficult for someone who has a measureable medical condition (diabetes, high blood pressure) to take their medicine consistently. It’s even more difficult for someone who has a non-measureable medical condition to take their medicine.

27

This obviously doesn’t fix the problem in your post, but I have to offer this: a big thing around here at least are charities that take in coat donations specifically for poorer people who have trouble affording them. You can donate your coats you don’t wear anymore that are in decent condition, though some even will just go out and buy coats, particularly when they are on sale like in the warmer months, and give them.

I don’t know if you’re still in any contact with this guy, but I’d definitely suggest you look into and see if there are charities around you like that. Even if you can’t help that guy, you might be able to help someone else.

(And if your worried about pride, I could see getting one yourself and then conveniently leaving it behind, or telling him he could “borrow” it.)

28

Yes, those charities are a great thing. Some local dry cleaners will even take the donated coats and clean them for free before passing them on to the charities for you, so there’s no ‘it’s inconvenient’ excuse to stop you.

But this incident happened quite a long time ago. Since then the doctor has retired and we tried to get all of his current patients moved onto other suitable for them psychiatrists/psychologists – and that was tough in quite a few cases. (Hey, doc: you want a patient who can only pay $25 a session? And will need care for probably the rest of his life. And no insurance…)

So, no, I no longer have any contact with this guy. All I can do is hope things somehow worked out for him.

29

To build on that - I have an almost visceral reaction to people suggesting I have bipolar disorder. See, two of my aunts and two of my cousins are diagnosed bipolar and they have all had really hard, nonfunctional lives. Both of my aunts had their kids taken away and I just don’t want that for us. I suppose that I associate bipolar disorder as being actually crazy in a way that hurts others while depression only hurts me. But this is all emotional. Logically, I know that untreated bipolar is WAY WORSE than treated bipolar and that ignoring the problem doesn’t make it go away. So I take my mood stabilizer like I should.

(Speaking of - I was only just recently prescribed a mood stabilizer even though my family history puts me at high risk. Funny, right?)

30

Bravo!

31

Yes, all mental illness is caused by body chemistry and drugs are always the answer. How to determine if depression is caused by the situation or the chemistry? Just shove a pill down the throat. And if that one doesn’t work, try another. If none helps, try a different diagnosis and a different drug family. Repeat until the patient walks away in disgust or dies.

32

Two basic issues, I think:

  1. Shortages: here’s a severe shortage of psychiatrists and psychologists. 77% of US counties report a severe shortage of mental health care professionals. 65% of rural counties do not have a single psychiatrist. The shortage of child psychologists and psychiatrists is even greater. Wait times of weeks or months are not unusual for those few therapists who ARE taking new patients.

  2. Insurance: Few mental health care professionals accept Medicaid. Some low-end private insurance is also not accepted. Nor do most insurers cover treatment. When the do they typically cover only 20-50% of each session for a very limited number of sessions.

In far too many cases, GP’s are forced to prescribe medications to address mental health issues, and their knowledge on this is limited. It’s not that a pill is supposed to fix the problem; it’s that there are no other resources available.