Help me navigate the basics of the mental health system
February 18, 2014 12:08 PM   Subscribe

My only real experience with mental health practitioners was a brief stint with my free university counseling where I tried one or two medications for anxiety and depression. They didn't do anything for me and I became disheartened and left the idea behind for the past few years. Having gotten health insurance for the first time a few months ago and after some recent introspection, I've found myself interested in possibly trying some anti-anxiety/depression medication again, as well as some sort of ongoing psychotherapy.

I have to admit, I'm a little overwhelmed and I'm pretty embarrassed by my complete lack of knowledge on the subject at 27 which has kept me from really seeking out answers thus far. Or I go online and panic at the volume of information and shut down.

How does this all work, anyway? What is a typical session with a psychiatrist look like? And therapist? Do I go to a psychiatrist, get medication, and then independently find a therapist? Will I be referred to one? How can I find a therapist that will cater to my needs (I don't think the 'talking to a wall' type talk therapy would work for more, I'm much more action/solution-oriented)? How do I even find good ones, other than relying on ZocDoc stars?

And insurance-wise, I'm having some trouble finding an answer in my plan to the basics. Is therapy typically covered under major health insurance plans (Oxford plan H, for reference)? I'm assuming psychiatry is treated as a normal doctor's visit. I've tried looking on their site under the gigantic list of things covered, but can't find a definitive answer. If it is covered, how often is typical - weekly, monthly? How do I even start?

posted by gregoryg to Health & Fitness (5 answers total) 5 users marked this as a favorite
Best answer: So, there's no right or normal way of going about this. There isn't some magical guide book, and you should totally not feel embarrassed.

I think the kind of therapy you are looking for is probably CBT (Cognitive Behavioral). This type of therapy focuses on sort of action items and mental practices to work on to improve your mental health situation. It's action oriented and a lot less of the analyzing your relationship with your mother kind of thing. It's worked tremendously well for a lot of people and it's efficacy has been demonstrated in the scientific community.

Now, some CBT therapists are just therapists, in which case you'll have to go to one of those for therapy (whatever time schedule you like/need - once a week, once every two weeks, whatever), and see a Psychiatrist or Mental Health Nurse Practitioner (folks who can prescribe meds) separately (usually much less frequently. Maybe once every month or so to start out, and then check-ins once every 3-6 months depending). I would say this is a really common set-up.

But you can also find MHNPs and Psychiatrists who are trained in the type of therapy you find helpful, in which case you only need to see one person. This is what I do and it works for me because I like to talk about the medical/neurological aspects a lot and I really like my psychiatrist.

As far as insurance goes, you need to just call them. Plans are so different. Call them and ask about your mental health coverage. My understanding is that most plans must cover mental health these days, but the details vary. But for many providers, it works similarly to a doctor visit. You meet your deductible, you pay a co-pay per visit, and your insurance picks up the rest. But you'll need to just call and ask to make sure. In the same phone call, ask to be referred to a Psychiatrist or MHNP to start. Your insurance will have a list of in-network providers they can refer you to. Then make an appointment and you're set.

I know making the initial phone call can seem really impossible, but it won't get any easier. It's the one big step you just got to muster the courage to do. Best of luck.
posted by Lutoslawski at 12:20 PM on February 18, 2014 [3 favorites]

Best answer: The most most important thing is that you figure out what you want out of therapy.

Not feel so depressed?
Better relationships?
Cope with anxiety?
Overcome history of trauma & abuse?

And figure out how will you know when you've reached your goals.

You'll have a LTR?
You'll be able to assert yourself to people without crumbling?
No more depression?
You can make large life-decisions with confidence?

As for a therapist, all I can say is check around, don't sit with the first person you meet. Like anything, you ask: have you dealt with this type of problem before, have you successfully helped other clients? What is your style / method?

You want to feel comfortable with the person you're going to talk in depth with. You don't need anyone's permission to say "eh not for me" if you don't feel comfortable.
posted by St. Peepsburg at 12:51 PM on February 18, 2014

Best answer: After far too many years in the mental health system, my best advice would be:

(1) call your insurance company to find out what mental health coverage they have and the specifics

(2) if you need psychiatric care (doctor), in my experience, a private psychiatrist with his/her own office is far preferable to a psychiatrist at a mental health center/clinic. The reason for this is that you typically get longer sessions with more personal care. This approach may be more expensive and/or less available. YMMV.

(3) if you go route (2), then you will have to choose your own therapist most likely at another location. The advantage of going to a mental health center/clinic is the idea of "managed care" or "continuity of care". In other words, they can make an appointment for you to see a psychiatrist, a therapist, a case manager (if necessary), all in the same location. The downside to going to a mental health center/clinic IME is that the doctors and staff are often overworked, overbooked, and understaffed, not to mention having to wait for quite a while for an appointment.

Ask if anyone you know can refer you to a good practitioner. Word of mouth references can be really helpful.

There is no "easy" way to find a great psychiatrist and/or therapist. A lot of it is trial and error. I hate to use this analogy, but it's a lot like dating. It's a numbers game. Sometimes you get lucky, but often you have to keep looking until you find someone that you click with.

But like Lutoslawski said, you gotta call to find out.
posted by strelitzia at 1:11 PM on February 18, 2014

Best answer: I agree that your first step should be to call your insurance provider to find out about coverage for therapy. In general, I think many plans provide for a limited number of sessions per year, and then after that there may be an appeals process/prior authorization involved. This is all highly variable from plan to plan, though. Usually psychiatrists (assuming you're going for med visits) will be considered specialists, so you would have the same copay as if you were going to a dermatologist, and the limitations on number of visits per year would not apply the way they do for therapy. You really need to get in touch with your insurance company to figure out the details of this.

There are a couple complications that may come up. More mental health practitioners these days are going the private pay route, so depending on the area, you may have to search to find someone who will take your insurance. Also make sure you find out whether they are considered in network or out of network. If you are having issues finding someone who can take your insurance or your insurance is balking at covering therapy, you can always look into therapists who offer sliding scales.

Assuming you have a primary care physician you're comfortable with, one step may be to set up an appointment with them, explain your situation, and ask them for referral to a psychiatrist. Depending on your specific issues and their personal policies, they also might offer to start you on some kind of meds while you work on setting things up with a psychiatrist. Again, depending on where you live, you might have to call around a bit to find a psychiatrist who is open to new patients/doesn't have a 6 month waiting list.

In terms of finding a therapist, you could either do that first, concurrently, or after you find a psychiatrist. If you do find a psychiatrist you like, you can always ask them if they can refer you to someone for talk therapy. You could also use the psychology today find a therapist tool. Although I think this tool may be specifically for mental health clinicians who are social workers, here is another search engine that lets you specify things like insurance/age group/specialty/etc. It's totally okay (and often recommended) to shop around a bit for a therapist.

It is really critical that you have someone who you trust and are comfortable with. With that being said, based on your description, it sounds like you might prefer working with someone who has more of a CBT (Cognitive Behavioral Therapy) orientation.

As far as frequency of visits, I would say it's common to see a therapist once a week, and a psychiatrist anywhere from weekly/biweekly when you're experimenting with different meds, to every couple months once you get stabilized, but this all highly variable.

I'm offering these as hopefully helpful guidelines, but really, there's no right or wrong way to do this. The most important thing is just to get started on this as soon as possible so that you can get the help you need.
posted by litera scripta manet at 1:48 PM on February 18, 2014

I should add that my answer is US specific. If you're in another country, like the UK, it's probably a very different process.
posted by litera scripta manet at 1:50 PM on February 18, 2014

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