I have two questions related to my mental health.

February 1, 2013 4:22 PM

I'm 24, and I live in the suburbs a half-hour north of Boston. I'm about to get health insurance that includes mental care. I don't know how the private healthcare system works. How should I get a mental-health diagnosis? What doctors and therapists in the area could help me with whatever problems I may have? Details inside.

If there are previous AskMes on these questions, please link me to them. I realize a lot of people post similar things here.

I'm unfamiliar with private healthcare because I was covered under my father's military plan. After I aged out of that, I didn't get insurance. It was too expensive. I spent a year temping, and then I got hired permanently at the place I was working, which is how I now have insurance.

I don't know whether I have depression, social anxiety, attention-deficit disorder, or any other mental issue. I know that I often have hours-long periods of self-hatred. I know that I'm insecure: The other day, I attended an improv-comedy show in which some troupemates from college performed, but I didn't talk to them afterward, because I felt unworthy of their company. Sometimes I spend hours on the internet, going from site to site, learning nothing and feeling agitated for no identifiable reason. I've always procrastinated and I've always been lazy. I don't have any ambitions driving me onward.

The insecurity is to some degree justified: I pay rent, but I live with my parents; I have no close friends; I have no romantic or sexual history; my job doesn't offer much opportunity to learn new skills or rise in the corporate structure; I haven't cultivated any talents; I'm not even academically accomplished. A lot of teachers cut me a lot of slack over the years. I graduated from college in September, not in May.

I'm this guy. I even work in payroll.

Obviously, I'm glad that I have a job at all, and that I have enough extra money to drive to town to see comedy shows, even after paying more toward my student loans than I need to. Obviously, many of my problems are of my own making.

Still, I often feel so bad about my situation that I can't move myself to do better. I'm using Health Month to keep myself on an exercise regime, and I'm doing well, but that's about it.

Money is an object, but I don't think it's so bad that I couldn't scrimp here, scrimp there, and get mental care that way.

Thanks for reading this far.

posted by Rustic Etruscan to health & fitness (8 answers total)

Go to your primary healthcare provider (regular M.D. or whatever your plan has designated as your primary healthcare provider) and ask for a recommendation for a psychiatrist. Simple as that. If you think talk therapy would be beneficial, call your insurance company and ask if/how they would cover that. You're already over most of the hurdles by having insurance, now is the time to investigate what is covered.

I wish you the best.
posted by kamikazegopher at 4:42 PM on February 1

I would expect that you could go to your usual doctor and ask him for a referral, but in my case (in a different New England state, a few years ago) I was also able to just call a "Behavioral Health" number on the back of my insurance card, explain my situation, and be approved for x number of mental health visits in that calendar year, which was then extended after feedback to the insurance company from the therapist. There was a directory of mental health providers on the insurance company's web site.

Don't be afraid to "shop around" and try out different therapists or psychiatrists until you find one you're most comfortable with. I was actually able to find a book about selecting a therapist at my local public library.

Good luck. For my part, from your posts here you seem like a pretty cool guy.

Oh, one other thought - if you're interested in trying out anti-depressants, any licensed physician can actually prescribe any medication; a friend of mine was given a prescription for Prozac by his podiatrist. But it's better to be working with and monitored by a specialist, of course.
posted by XMLicious at 4:44 PM on February 1

If you are feeling like you could use some mental-health help, you should definitely seek it out. Many of us have issues to sort out, especially in our 20s, and it's great that you're taking steps to get help.

Your private insurance card should have an 800 number on it that you can call to ask about the details of benefits. You should find out whether you need a referral to a mental health services provider (often you don't), how much the co-pay is, how many visits are covered per year, and whether the year starts with the calendar year or some other time (like if your coverage started in June, does the year "reset" in June.)

If I were in your shoes, I'd seek out a good therapist and consider medication later, if necessary. The best way to find a therapist is by referrals from people who are happy with their therapists, but there are other ways to find a good one. I like the listings on psychologytoday.com, which let you sort geographically and by insurance accepted. It's a good idea, if you can, to schedule initial meetings with two or three therapists who sound promising and then make a decision about who you will see on a continuing basis.
posted by unreadyhero at 4:46 PM on February 1 [1 favorite]

One thing to keep in mind is that if you've had a lapse in coverage (it sounds like you have) there may be a waiting period for pre existing conditions on your policy. I would assume coming into a new plan your insurer would consider this pre-existing even if you haven't been treated before. I'm not used to group plan laws, so maybe another mefite can chime in.
posted by Bunglegirl at 5:16 PM on February 1

One great thing about Boston is that we have tons of universities. So back when money was a little tighter and I finally got health insurance (such a relief!), I did just what folks above mentioned. I looked at my benefits and chose a primary care physician (PCP) at a large local practice associated with the Cambridge Hospital. She wasn't accepting new patients when I called, but the primary care office was able to connect me to a doctor who was (so don't get discouraged!).

I talked to my PCP about wanting therapy - I thought I knew why, but they still asked a lot of questions, which was great because that gave them a better picture than my (skewed, it turned out) view. They referred me to the psychiatry department, which asked me more questions and suggested a therapist on-site. I went once and Hated it - it was exactly what I didn't want at that point (try deep breathing!). I didn't go back. But I did get up my nerve to go back to the pyschiatry department. They asked more questions, prescribed me Prozac (I never took it, but that's ok), and referred me to a different therapist who was exactly what I Did want (let's talk about why you feel unworthy), although I hadn't known that before. As a bonus, she was still in training, and thus very affordable. She was also always willing to work with me to make it so I could afford therapy, even when I went twice a week, even when her rates got a lot higher. It was worth Every Penny.

So this long-winded personal story is to tell you that you don't have to self-diagnose. You just know that your mental health is affecting your functioning, and that's all you need to know. You can go through a primary care doctor or an acquaintance recommendation or psychologytoday.com. You can try working with a practice that has students. Mostly, I just urge you to persist, because you are totally right to think that things can be So Much better. And you deserve all that good stuff!
posted by ldthomps at 6:24 PM on February 1 [1 favorite]

I have a good relationship with my primary care physician and I just said, I'm depressed, I want to try Wellbutrin and he wrote me a scrip. I encourage you to talk to your PCP about what you're feeling and ask for the names of some people who might be able to help. You can just call the 800 number. I like to ask my PCP things like that because I'm more comfortable getting a recommendation that just trying whoever but YMMV.

Do you have an HMO or PPO? I have a PPO so I can just see a specialist whenever I want but you might want to check first if you have an HMO just to be sure your doc is in network and covered. Good luck and keep trying if the first diagnosis, doctor or drugs don't feel right.
posted by kat518 at 7:51 PM on February 1

I like the idea of calling that 800 number on the back of your insurance card.

If you're willing to come into Boston, another place to begin is Boston University's Center for Anxiety and Related Disorders. They do all sorts of therapy but also full neuropsychological testing.
posted by kinetic at 4:22 AM on February 2

The big hurdle for a lot of people is "where do I start?" Your insurance is an excellent place to start but that puts a big burden of "how do I pick someone out of a list of providers that are in my insurance network?" on you.

A good service to help with this in Massachusetts is http://therapymatcher.org/ A friend successfully used this service just to get started. He was able to find someone to talk to initially who was then able to point him to a psychiatrist for more specific things like meds/diagnosis. He no longer even sees the initial therapist but it was very helpful to get him going.

You don't need to have hours-long periods of self-hatred. You can get out of this. You deserve to feel better.
posted by bobobox at 9:30 AM on February 3