Mental health services are such shit in this country

[Deleted]

I have a friend who is struggling, and damn is it hard to find her a mental health specialist who is taking new patients and who takes insurance. I tried calling the clinic I went to when I lived in her area, and they now only see patients who have a referral from a primary care physician within their own hospital system. WTF? This is so not helpful.

I will say that this is why some of the, "If you are struggling, reach out!" stuff after Kate Spade's and Tony Bourdain's deaths is bullshit. It's not that I don't want people to reach out, but then what? I can't prescribe meds. I am not qualified to provide therapy. I am trying to make phone calls for her and find her something short of going to the ER because she's in a dark place but not actively suicidal. We'd like to keep it from getting to that point.

I'm going to keep researching and fighting for her, but ugh, I just needed to vent about how it shouldn't be this much work for someone who is already struggling to find help.

[chilerellanos]

Preach!

I have a lot of things to say but I’m still at work after being here for 14 hours.

I’ll try to remember to come back to this once I’ve had some sleep.

[georgeglass]

Agreed.

PDQ

My BIL just went through a manic episode that resulted in at least 3 emergency psychiatric holds in 3 different cities. He was shown incredible kindness by many people, but there was no way for him to adequately receive care. His parents are bending over backwards, pulling every string, and offering every lifeline possible, and that's just not the case for so, so many people for a variety of reasons.

I'm sorry for your friend.

[wambam]

I gave up trying to find a psychiatrist. There are just NONE in my area accepting new patients and that don't work in a hospital. Fortunately, I started seeing a DO as my PCP and he is really helpful managing my depression.

ETA: My mom used every connection she could think of to get me into the psychiatrist I saw in HS. Then my parents paid him $200 a visit because he didn't accept insurance. I am incredibly fortunate that my parents could afford my treatment. I don't say this lightly, but I believe I would've died without him. He no longer practices. 

[katieinthecity]

Yup yup yup. In 14-plus years of I've never found a good psychiatrist who took my insurance AND had availability. I saw some duds who met both criteria but the good ones I've seen I've paid out of network costs. And half the time I don't manage the paperwork to get any reimbursement (thanks to you know, the conditions I'm being treated for). It's exhausting and demoralizing. I've struggled to get in front of someone more times than I can count, and I'm usually pretty high functioning.

[noradog]

Jun 29, 2018 8:11:00 GMT -5 katieinthecity said:

Yup yup yup. In 14-plus years of I've never found a good psychiatrist who took my insurance AND had availability. I saw some duds who met both criteria but the good ones I've seen I've paid out of network costs. And half the time I don't manage the paperwork to get any reimbursement (thanks to you know, the conditions I'm being treated for). It's exhausting and demoralizing. I've struggled to get in front of someone more times than I can count, and I'm usually pretty high functioning.

Liked because it is so so true.  The paperwork to get reimbursed overwhelms me every single time

[mskitkat]

Truth. It took my sister a year to find someone who would see her. My sister is well off and able to afford to pay out of pocket, and she STILL couldn’t find anyone accepting new patients.

[walterismydog]

Just here to commiserate.

It’s been a lifelong struggle to find good help. I’ve pretty much given up on doctors.

This country is so sick in so many ways. It’s hard not to get bogged down in everything that is wrong.

[Deleted]

And my friend lives in one of the biggest metro areas in the country with three medical schools. I can't even imagine how bad services are in small towns and rural areas.

[aliciabella]

I recommend people to go crisis- which are located in most hospitals. They can get people an appointment much easier than on their own. They will know which places/people take her insurance and complete the pre-cert if required.

Good luck. I know how difficult and bullshit navigating the system is. I wish her the best.

[Velar Fricative]

I'm so sorry for your friend.

Reading the above posts makes me wonder - what is the problem with mental health treatment in this country? Is it that there's a shortage of professionals? If so, why is there a shortage - is the field too stigmatized because we still don't consider mental health "the same" as physical health, or is it just due to an overall shortage in medical professionals for other reasons (e.g. the state of healthcare and insurance in this country, etc.)? It's appalling, and even more appalling when you consider how everyone yells "but we have a mental health crisis!!!" anytime there is gun violence and yet those same people crying out about this crisis have no desire to pay for healthcare that would enable everyone to receive the treatment they need and deserve.

I know I went off on a tangent, but reading the stories here just makes me so angry on behalf of anyone who needs help.

[seeyalater52]

True. Fucking. Story. I am also in a major metro area (I am between TWO fairly major metro areas) and I cannot find a therapist who takes my insurance and has hours that work for people who work 9-5, or who can work on a moderately flexible workday scheduled (during lunch, at 4pm, at 9 or 10am etc.)

We also need a referral, although it doesn't have to be from a specific system.

Plus even with excellent health insurance our co-pays are $35 a visit which is a pretty hefty monthly expense for weekly appointments.

I've been looking for 8 months and am on like 25 waitlists.

[tealblue]

Ditto. I’m trying to help my sister get her preschool aged son diagnosed with anything. They are on Medicaid and keep getting denied because there is no “diagnosis” but they can’t get approved to get a diagnosis and can’t afford to pay oop for one and then Medicaid won’t pay for the treatment. It’s so hard.

[Deleted]

She's going to be able to get in with a primary doc today to get the referral process started. So that's something.

I think that my being willing to just call places and try to find out if they had openings helped motivate her to call her family doctor. So if you have anyone who is struggling, that is an easy thing you can do to help - just start calling places.

[seeyalater52]

Jun 29, 2018 8:29:12 GMT -5 Velar Fricative said:

I'm so sorry for your friend.

Reading the above posts makes me wonder - what is the problem with mental health treatment in this country? Is it that there's a shortage of professionals? If so, why is there a shortage - is the field too stigmatized because we still don't consider mental health "the same" as physical health, or is it just due to an overall shortage in medical professionals for other reasons (e.g. the state of healthcare and insurance in this country, etc.)? It's appalling, and even more appalling when you consider how everyone yells "but we have a mental health crisis!!!" anytime there is gun violence and yet those same people crying out about this crisis have no desire to pay for healthcare that would enable everyone to receive the treatment they need and deserve.

I know I went off on a tangent, but reading the stories here just makes me so angry on behalf of anyone who needs help.

There is a major shortage of mental health professionals (especially psychiatrists, but also therapists) who take insurance coverage. Reimbursement is a huge pain in the ass, and reimbursement rates for mental health are particularly low which incentivises self-pay, which is typically somewhat expensive (upwards of $100 a visit). All of this is amplified if someone has Medicaid coverage instead of private insurance because the reimbursement rates are even lower. 

Therapists who aren't in private practice make shit money and are usually licensed professionals with masters degrees (so not super cheap training), so that is also a big disincentive to going into the field and to staying in accessible clinic environments. 

It's a complicated and multifaceted problem. 

Edited for clarity. 

[pitta12]

It is a disgrace. One thing to look into is if your health plan has telemedicine some of those vendors have counseling and psychiatric visits. Not ideal, of course, but it’s a decent option for areas where access to care is a problem.

[erbear]

Yup. We make it so damn hard to admit we are struggling (buck up. you're fine. things are worse ...), then when we finally do, it's damn near impossible to get the help you need as quickly as you need it without breaking the bank. The system fails over and over again.

I hope your friend gets what she needs, @angryharpy

[yentl]

Jun 29, 2018 8:36:38 GMT -5 seeyalater52 said:

Jun 29, 2018 8:29:12 GMT -5 Velar Fricative said:

There is a major shortage of mental health professionals (especially psychiatrists, but also therapists) who take insurance coverage. Reimbursement is a huge pain in the ass, and reimbursement rates for mental health are particularly low. All of this is amplified if someone has Medicaid coverage instead of private insurance. 

Therapists who aren't in private practice make shit money and are usually licensed professionals with masters degrees (so not super cheap training), so that is also a big disincentive to going into the field and to staying in accessible clinic environments. 

It's a complicated and multifaceted problem. 

QFT. I also want to add that as a private practice therapist who does take insurance, my reimbursement from them is usually about 50-60% of what I could charge for private pay. For psychiatrists, there is an even more dramatic difference. There's sometimes very little incentive to accept insurance as a provider. I do it because of my own personal beliefs around healthcare being accessible, etc. But every insurance snag I hit makes me question those beliefs. Also, because I'm a provider who accepts insurance and sees clients in the evening, I'm nearly always at capacity. Most of the therapists I know who take insurance don't have openings either and some are actually leaving insurance panels because of these issues.

[jreeds]

Jun 29, 2018 8:17:50 GMT -5 jeaniebueller said:

Agreed. There are also so few child psychiatrists available that its impossible to get an intake and if you do, you have to travel many hours away.

Yes. We have finally managed to get DS into services with a child psychiatrist and behavioral therapist after a long wait. And we ONLY got in because we're willing to drive an hour and do mid day appointments. Once an after school appointment slot opens we can shift to that but everywhere we have tried up til now has been solidly booked. Not even touching the cost of the appts. This entire system is broken and not set up in a way to be easy to navigate for patients at all.

[tiramisu]

When we (therapists, especially master's level) work in agencies or clinics, we're paid rather shittily. If you're in private practice and taking insurance, you're having to set aside a chunk of time for insurance billing. Sometimes reimbursement can take months, even over a year, from what I've heard from others.

We have to do so many hours of experience at extremely low pay (less than $30,000/year at one place I was hoping to get in, less than $40,000 at the place I finally got in, both in a VHCOL area) and then when we get licensed the raise isn't usually enough. Agencies do at least offer other benefits, but that keeps a lot of therapists out of the private practice arena, or they then do it only part time, on the side of their agency job.

Some government agencies also haven't considered all masters-level clinicians to be able to do thing others can do, which also complicates things. Honestly, the way things are set up, people who need help are losing out and the clinicians are losing out and burning out.

[hopecounts]

Yes, we drive over an hour and pay out of pocket for DD's psych.
He is worth it and I am just so glad and lucky we are in a position to be able to do that.
He is amazing and has helped so so much but I do think about how many need care and can't manage OOP or travel to find someone taking patients who is a good fit.

[atexan]

I will echo what all of the other providers here have said.

PDQ

poof

[vamoose]

Obviously a bit different, but we were on a waitlist for a YEAR to get in with a child psychiatrist, despite weekly follow ups looking for cancellations, and we drive 30 minutes for his therapy each week to go to the one child therapist accepting new patients that accepts our insurance that I could find within an hour radius after spending probably 10-12 hours on the phone with insurance and making a zillion phone calls. And we live in a densely populated area. My kid has ADHD, so less of a crisis situation, but he was totally out of control and becoming depressed (at age 7) and these are the same people someone with a more pressing issue would need to find and reach. It was eye opening.

[downtoearth]

Jun 29, 2018 8:03:53 GMT -5 @angryharpy said:

I'm going to keep researching and fighting for her, but ugh, I just needed to vent about how it shouldn't be this much work for someone who is already struggling to find help.

Hugs and thoughts for your friend... you hit the nail on the head - so much work to maneuver our mental health field AND so little payment or understanding of how to get it paid.

[Deleted]

So my friend has an appointment and a network of people helping her, including her boss.

But I just got an email that the daughter of a couple I know from church just died. She’s about my age. The email doesn’t say, but I suspect based on the language of the email that it was suicide. FUCK. FUCK FUCK FUCK.

Go hug your people.

[Velar Fricative]

I'm so sorry, @angryharpy.

[pugz]

@angryharpy I'm so sorry

I'm so glad you are helping your friend. I did this for a friend last summer/fall after she was fired and her anxiety sent her into a tailspin. I found resources for her and while she didn't use them, she found comfort in knowing they were there and that I was in her corner. She eventually went to a primary care physician and got on medication. Even doing that was hard because she was scared to be fat shamed by a provider. Getting into a psych would have taken longer.

[NomadicMama]

Jun 29, 2018 8:11:00 GMT -5 katieinthecity said:

Yup yup yup. In 14-plus years of I've never found a good psychiatrist who took my insurance AND had availability. I saw some duds who met both criteria but the good ones I've seen I've paid out of network costs. And half the time I don't manage the paperwork to get any reimbursement (thanks to you know, the conditions I'm being treated for). It's exhausting and demoralizing. I've struggled to get in front of someone more times than I can count, and I'm usually pretty high functioning.

I don’t post here but I saw this thread…

I’m in the very same situation. We pay out of pocket for my psychiatrist. I’m thankful that he’s worth it (and that we can afford it). Over the past 20 years, I’ve seen some horrible psychiatrists. It is frustrating.

What I find so hard is once I’ve worked up the energy/courage to call to try to schedule an appointment, the door is often shut in my face or the hoops are too many for someone in a fragile place to manage. One time, I went to the clinic to try to set up an appointment and I ended up bawling in a conference room while the clinic manager worked to help me out.

I can’t speak beyond my personal experience, but in Germany, I had to petition a psychiatrist to see me. He saw me twice and then said that what I needed was beyond his scope of work (depression and ADHD). And then he offered me gummi bears (no joke!). I’m not sure how other countries manage their mental health services, but my guess is that many people struggle all over.

[wildrice]

It is such a joke. I had a friend who was actively suicidal a few year back and it was damn near impossible to get them to keep her and treat her, even though she almost killed herself twice (actually landed herself in the hospital, once where she wasn't breathing and didn't even wake up for a few days).

I will also echo what others have said about providers being scarce due to their own financial issues. My H is almost done with his PhD in counseling psychology, and it's such a fucking joke what these people need to do to get the degree and then make crappy money once it's over. We're moving halfway across the country next week so that my H can make 25k per year on an internship to finish his PhD. This is after several years of making around that much as a grad student. He has almost 100k in loans from the couple of years where he didn't have full funding, and they are gaining interest daily while we wait for him to finish his program. I have to quit my job (thank goodness we don't have kids who need to switch schools) to go on this internship, we have to pay out of pocket on our own to move ourselves there (and to find the internship to begin with - probably cost at least $1500 out of own pockets for that too) and when it's done he'll be lucky to make a good income if he stays in counseling. He's seriously considering going into research instead, not only because of finances but also because counseling is a really tough job to do day in and day out. He's lucky he found and married me while he was in school because he'd be in a lot worse financial shape if my income didn't subsidize his schooling. It's all a giant load of BS in my opinion and I can't blame anyone for not choosing this route.

[spindle92]

@angryharpy, I just want to say Thank you.

I was your friend several years ago and a woman with a heart of gold stepped in and made several phone calls and somehow, she was able to get me into a psychiatrist the next day. To this day I think of her as my guardian angel because without her doing that for me, I have no idea where I would be today.

So again, thank you!