I'm not crazy. You're the one that's crazy...
June 25, 2011 8:53 AM   Subscribe

Help me navigate Kaiser Permanente's mental health services.

After several years of depression and crippling anxiety, I'm finally starting to accept that I won't just work through everything on my own. As much as I'd like to, I haven't been able to get better simply through sheer willpower. I really think a professional is the only way to go at this point, but I don't know the first thing about psychiatric treatment and I'm frankly terrified at the possibility.

I have Kaiser Permanente insurance through my job, so I expect any help will have to come through that. I haven't actually used the insurance at all yet, but I'm working on getting an appointment for a general physical. I haven't been to a doctor in almost 10 years, so I figure it's probably best to get a check-up before anything else. I've scheduled a couple appointments in the past, only to be cancelled last minute (Yay anxiety!), but I'm really hoping to keep the next one (scheduled for about a month from now). After that though I'm not sure where to start. Within the KP network, is it better to talk to my regular doctor or should I reach out to the insurance system (wow, that sounds dystopian…) directly? Apparently they have a line specifically for mental health, but it really seems more for emergencies than anything else. But just thinking about bringing it up during my normal doctor visit frightens me. I'm not sure which is worse in the long run.

A lot of the actual insurance anxiety about everything stems (probably irrationally) from the fact that my health insurance is through my employer, and I can't afford to pay for it on my own. Despite everything else, I've actually been doing pretty well at my job and I don't want anything from my medical history coming back to bite me. My first boss at the company was fired after a "mental health sabbatical", so I don't want to jeopardize my job by dealing with my personal problems.

Random notes: I live in LA, so anyone with specific knowledge of Los Angeles health services is appreciated. I'm, of course, especially interested in people who've gone through this whole deal and lived to tell the tale. Thanks!
posted by anonymous to Health & Fitness (7 answers total) 3 users marked this as a favorite
I had a good experience with the psych services from the KP where I used to live (sorry, not California). I already had seen psychs under previous insurers, so I didn't have the anxiety you describe about initiating that conversation with a new GP. The general-purpose customer service phone line was very helpful for me, and if you call them directly they will have better details on how you can get started (as opposed to you having to ask your doctor, which it sounds like you want to avoid). One nice thing about KP was the ability to contact any of my Drs via their email system, so if I had concerns about a medication change I didn't have to call or make an appointment to reach them. I hope that is a little helpful... best of luck!
posted by wowbobwow at 9:41 AM on June 25, 2011

You don't need to go through your doctor. You can make an appointment directly through Kaiser MH. If I remember correctly, they keep the records completely separate from your medical record if you just go for counseling/therapy. (That won't be the case if you get a prescription, obviously.)

That was important to me because, although I only saw a Kaiser counselor once (and for a specific interpersonal-relations problem), I didn't want that following me on my medical record the next time I tried to get health insurance.
posted by mudpuppie at 10:45 AM on June 25, 2011

I used to work at Kaiser Psychiatry in Northern California. Back then, at least, you didn't have to go through medical to make an appointment, although you could. If you mention it to your primary care doc, he or she will order tests that could rule out physical causes of anxiety. The doc could certainly issue a referral, but you don't (or didn't) need one.

Each Kaiser is different in terms of what they offer. Kaisers up here (San Francisco) emphasize regular group therapy with occasional individual sessions. Chances are you'll call them, they'll schedule an intake, and then come to an agreement with you about what services you'll be getting based on your needs and on what they've got to offer. Sometimes people have an aversion to groups, which is too bad, as they can be immensely helpful.

Anxiety is very treatable, so good for you for pursuing treatment!
posted by jasper411 at 11:14 AM on June 25, 2011

One thing that tends to happen often in the Kaiser mental health system is that weekly appointments are difficult to get. They might have you going every other week or once a month, because they overload their therapists' caseloads to serve as many people as possible (while somewhat compromising the quality of care).

I am a therapist; when I was working in a private practice (in L.A.), MANY of my clients were private-pay but had Kaiser and were frustrated with the Kaiser mental health services available to them. When you use private-pay mental health services, therapists are 1) often open to giving you sliding scale rates if you're unable to afford the standard fee, and 2) not billing insurance, which means nothing in your record that will follow you to the next time you have to apply for insurance when insurance companies are still allowed to charge whatever they want for people with "pre-existing conditions" (they won't deny you, but they will set your rate at whatever they like if it seems like you might actually use your benefits).

All that said, based on how I understand insurance companies and mental health (you have to have a diagnosis that's "severe enough" that the insurance company will pay, so a less ethical therapist may overdiagnose you; and you are subject to whatever that therapist reports to the insurance company about your treatment), I would not ever use my insurance to see a therapist.
posted by so_gracefully at 11:44 AM on June 25, 2011 [4 favorites]

First of all, feeling overwhelmed is often the depression itself. Pushing yourself to reach out for help is the first step to overcome it. Please do. I'm about to describe an imperfect system, but know this: it CAN help you.

My experience, from the subscriber side, is with Kaiser Northern California. The psych dept does its own scheduling, and its records are walled off from other depts for privacy reasons. Whereas if you make the request through your regular doctor, it's in the general system. With your concern for privacy, I would absolutely call the psych dept # and lay out your concern directly including the employer access. When I made much more trivial inquiry, they gave a detailed account of how they protect mental health records' privacy.

Scheduling an appt for non-urgent issues (ordinary stress, grief, couples counseling, etc) typically has come with a wait of 2-3 months. There apparently is no such thing as getting a standard weekly session. Instead, their scheduling system releases dates in a month block at a time, just two months ahead, and it's catch-as-catch-can. So slots fill up quickly, then you have to wait until the start of the month for another shot if you miss out. Sometimes it results in weird stuff like two weeks in a row followed by 7 weeks until the session after.

Because the longest wait is for the initial appt, trying out a couple different therapists to find the best fit is not a terribly viable option. So if you have any preferences, tell the scheduler now. They do try to accommodate.

Depression is not a non-urgent issue. When you call, be candid about your state. Those service do have a shorter wait. Treatment for mental illness (depression, anxiety, trauma, addiction, etc) seems to get tracked toward group therapy in many cases. Initially I was unenthusiastic about this, but it did prove helpful and the co-pay was definitely cheaper than individual counseling.

There's a psych urgent care triage hotline. 24/7 someone will get back to you, within, um, maybe a couple hours to a day. If they determine the patient's need is urgent, they'll get you in fast. Like, same day or within maximum of a day or two. Then the psychiatrist at that appt has magical powers to get the patient immediately into accelerated treatment tracks that no one's ever mentioned before.

There are, I'm sure, greater levels of urgency/treatment as well (suicidal, psychotic break, etc). Most of what they offer isn't advertised; it unfolds. Overall, the system works best as the need becomes more acute and urgent. For you, it should work well.

Whether you call the urgent care or regular departmental number, no one will shame you for selecting the wrong one. It's their job to know which you need to be talking to, not yours. Your only responsibility is to be explicit about your situation so they can channel you to the best resources.

Keep the appt. with your regular doctor, but don't wait for it. The first psych appt is just general eval anyway. You absolutely can have that physical afterward. The therapist will have immediate access to any new info that might affect your treatment plan. Trust me, your time will not have been wasted by getting the ball rolling now.

Call today. Do. There's a lot of relief out there waiting for you.

Best wishes!
posted by nakedcodemonkey at 12:14 PM on June 25, 2011 [2 favorites]

I spent the first quarter century of my life as a Kaiser member in SoCal. :)

It might take awhile to get an appointment, so I'd call up and make an appointment with the mental health department at whatever clinic's most convenient. I've only been to the mental health clinics in Norwalk and Sunset/Vermont, and that was quite awhile ago. They were friendly places and I had good experiences with the therapists.

Best wishes. :)
posted by luckynerd at 3:22 PM on June 25, 2011

In the meantime, there are classes you could attend. On their website, log in, then under the Health & Wellness tab across the top, click Member Programs and Classes. On the left, go down to Healthy Program Resource Directory.

Also, in the meantime before even the first class, it looks like they've launched some new digital coaching, healthy lifestyles tools thing, with a track called Overcoming Depression. It seems like it might be interesting.
posted by salvia at 12:33 AM on June 27, 2011

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