Need urgent mental health care
March 24, 2014 7:22 PM   Subscribe

My wife needs urgent mental health care, but we don't seem to have any good options. Can you offer some advice?

My wife has struggled with depression for most of her adult life and generally manages it well with medication. She's been seeing a GP for her meds, and recently switched drugs because of some side-effects. The new meds aren't working (despite giving them plenty of time), and she's now stuck in a major depressive episode. Not suicidal, but unable to work.

She needs to see somebody ASAP, but the only options we've found are either waiting a month for the first available psychiatrist appointment (via referral from the GP or doctors we've called), or immediately checking into a five-day, 25-hour outpatient program. The month-long wait is out of the question, and the outpatient program seems to be overkill.

Surely, there has to be a middle ground. She has mediocre BCBS insurance, and we're in southeast Tennessee.
posted by anonymous to Health & Fitness (26 answers total) 1 user marked this as a favorite
Urgent care will see you about this. They're just going to try the next medication on the list, but they will do it.
posted by Lyn Never at 7:25 PM on March 24, 2014 [1 favorite]

Try calling 2-1-1. They are on call with community resources. Best wishes.
posted by michellenoel at 7:26 PM on March 24, 2014

Do either of you have an Employee Assistance Program ("EAP") through your workplace? They usually have an 800 number you can call and answer some questions, and the nice operator will be able to set you up with a service provider (they often provide legal help, therapists, addiction help). The idea of EAPs being that you or your spouse (these programs often cover spouses) will work better if you're able to get quick help fixing problems of that kind in your life.
posted by LobsterMitten at 7:26 PM on March 24, 2014 [7 favorites]

Can she go back to her GP and get a prescription for a new medication? Either what she was on before, or something new?
posted by MadamM at 7:34 PM on March 24, 2014 [1 favorite]

Does her insurance require a referral to see a psychiatrist? If not, just keep calling all the pdocs listed through her insurance. Or, if a referral is needed, call all pdocs listed, see who has something available asap, then call the GP and ask for a referral to that pdoc.
posted by KogeLiz at 7:34 PM on March 24, 2014

If your wife was suicidal she wouldn't qualify for the outpatient program, she'd have to go inpatient. She's disabled enough by her depression that she cannot work - I urge you to rethink whether an intensive program is overkill. It's tough to fix psychiatric problems that serious in weekly appointments.
posted by treehorn+bunny at 7:35 PM on March 24, 2014 [41 favorites]

Have you tried Zocdoc or DocAsap? This situation is exactly the problem that they're trying to solve.
posted by comradechu at 7:41 PM on March 24, 2014 [3 favorites]

25 hours over five days doesn't really sound like that much -- I would assume it's aiming to be a cross of intensive counseling and getting stabilised medication-wise, and would hopefully end with some sort of follow-up in place? From here, from the limited 'can't work' description, that option sounds like a great one.
posted by kmennie at 7:50 PM on March 24, 2014 [8 favorites]

Forgive if this is too obvious, but some people sometimes forget that there are out-of-network rates under their insurance, and that sometimes even if there isn't great care available in-network, there's often a lot more people you could call if you're willing to pay a bit more. And for that matter, just to see somebody, like, I pay cash $75/visit to see my psychiatrist. So maybe try just looking at who else is in your area and how much that would actually cost?
posted by Sequence at 7:56 PM on March 24, 2014

I am going to suggest that you listen to Treehorn+Bunny. I have dealt with sick family members, and I know it can seem normal to you, but you are not qualified to deal with this at home. I don't care what you think, this is an illness as severe as someone having a heart attack or a blood pressure issue, it is not something you can get another pill for and make it all right immediately. Please, for your wife's sake, take it seriously and get her the help she needs, not the help you think she needs. Depression is not a walk in the park, it is an ongoing issue that sometimes does need intensive care, no matter what your personal opinion about it may be. I have dealt with too many family members with this illness, and it is an illness, to try and tell you to brush it aside to see a doc in a month.

Please get your wife the care she needs, and put your personal prejudices aside. I know it is difficult, but you have to step in and make the decision, because she cannot do it for herself. I wish you both well.
posted by Marie Mon Dieu at 8:11 PM on March 24, 2014 [5 favorites]

I have struggled with depression for my entire adult life -- 20 years now. During law school, ten years ago, I was misdiagnosed bipolar, and given bipolar drugs. But after three years on lamictal and other drugs it was apparent that the condition was major depression, not bipolarity. I have not taken any medications in more than 5 years. Instead I rely on talk therapy, group therapy, journaling, meditation, friends, exercise, diet and prayer (I'm not Christian but I pray a lot). Your wife needs people to talk to about her depression more than she needs drugs. I know this is a controversial stance but I spent a decade on antidepressants and they just made me aggressive/irritable as well as depressed -- thus giving rise to the bipolar diagnosis. Here's a site for Mood Disorder Support Groups in Tennessee -- these will include depression, anxiety, bipolarity and other mood disorders:

I wish you both the very best of luck. Thank you for taking care of your wife. I don't have to tell you how much she needs your love right now. I will say a non-Christian prayer for you both.
posted by i'magirl at 8:13 PM on March 24, 2014 [1 favorite]

Not suicidal, but unable to work.

This reminds me of a line my mother used to use: "Hot metal looks just like cold metal right up until you burn yourself." Suicidality is not something that can typically be neatly delineated. If it's a serious enough episode that she can't work, it is most prudent to treat it as a potentially life threatening emergency.

Maybe take another look at the IOP, is all I'm saying.
posted by PMdixon at 8:24 PM on March 24, 2014 [10 favorites]

I'm sure you've thought of this, but just in case: have you considered seeing a psychologist immediately? Just in case there's less of a wait. It could help, no?

Also, I'm not sure about this, but maybe a psychologist could refer you to a psychiatrist or suggest a medication for your regular physician to consider? I realize that finding a psychologist and hoping for a referral from that person to an in-network psychiatrist could be tricky.... maybe call the psychiatrists available and see if they take urgent referrals from any specific psychologists, and then get in to see one of those psychologists.

I'm not an expert on any of this, just trying to think outside the box.
posted by amtho at 8:27 PM on March 24, 2014

Many places have mental health crisis lines you can call. The people there will be able to talk to you or your wife and provide immediate emotional support, and also connect you with appropriate resources local to you. I encourage you to call.

Tennessee Mental Health Crisis Lines

Toll-Free Adult Statewide Crisis Telephone Line: 1-855-CRISIS-1 or (1-855-274-7471)

Also: please take care of yourself. This is undoubtedly very hard on you as a primary support for your wife. Seek support for yourself in whatever form you can. Best wishes.

P.S. One of the benefits of calling in outside support is that you can ask them to recommend a course of action, based on your situation and the resources they will know about. For primary support persons it can feel like there is an obligation to somehow know what to do and to pick the right path, and with so much at stake the pressure of not making the wrong move can be unbearable. One of the best gifts you can give yourself is to say "I am going to ask an expert for help and allow their recommendations to guide my decision, and by doing so I will know have done the right thing", thus relieving yourself of this pressure.
posted by PercussivePaul at 8:35 PM on March 24, 2014 [4 favorites]

Can her GP make some phone calls to get her in to see someone outpatient sooner? Doctors tend to be very persuasive with other doctors.
posted by radioamy at 8:42 PM on March 24, 2014

My husband has also dealt with severe depression for most of his adult life and has struggled to get effective help. I have, at times, effectively been his carer. From my perspective, I would jump at the outpatient program. Your partner will, at the very least, be cared for and safe and, best case scenario, pick up some valuable life skills to help see her through to her psychiatrist’s appointment. Worst case scenario, it’s boring, she does some art therapy or something. If she hates it, she can always quit, right? But I would give it a go.

As far as seeing a psych sooner than a month, we had a three month wait, during which time my husband became very, very ill. I phoned their office, explained the situation and asked to be put on an emergency waiting list. I also asked his psychologist to phone the psychiatrist, and wrote a letter to psychiatrist myself outlining my concerns. They called in a few days with an appointment (someone had cancelled) and we were able to get him help much, much faster than might otherwise have been possible. I would really urge you to push for this. People cancel *all* the time and if the office knows you will drop everything to be at any appointment they give you and your wife, they will, hopefully, give you that spot.

I would just caution too, that just because she’s not saying she’s suicidal, doesn’t mean you should tick that off your list of things to worry about. I’m not saying you should go overboard or be paranoid, and of course you know your wife better than anyone on the internet, but if she is ill enough that she can’t work, and her meds are not working… that’s the start of a very very bad place. Please don’t underestimate how bad this might be, or how much help and support (not just meds) she might need to get back on track. ECT and hopsitalisation might be overkill at this point. An intensive outpatient program is probably not.
posted by t0astie at 9:10 PM on March 24, 2014 [2 favorites]

Unfortunately I don't know the first thing about getting an appointment, but I will say, in the interim, if your wife feels she needs to be able to speak to a trained, neutral third party, that the Contact Helpline of TN is a fantastic resource (and they may actually have some advice for this situation as well, wouldn't hurt for you to give them a ring as well.) They're not therapists and it's definitely no substitute for a medication adjustment, but it can be a helpful coping tool that's reliably there every day for as long as she would like to use it.
posted by WidgetAlley at 9:15 PM on March 24, 2014

Are there any APRN(Advanced Practice Registered Nurse)/Psychologists available in your area? That seems to me a very helpful combination of counseling therapy with prescribing capabilities. Wishing you and your wife the best.
posted by spamandkimchi at 12:47 AM on March 25, 2014

Outpatient is great -- it's there day after day, you talk with people who know whereof they speak, if they are keyed into a good shrink than she can begin again the long slog toward medicinal armistice with this stuff.

As far as her getting off the meds -- it's nice when some people get off the meds. Problem is that they can extrapolate their experience as yours. You don't need that.

If I had high blood pressure, and was on the medication, and then I see "Hey, I don't need to take this shit, I'm all better now." So they'll chunk the meds into the dumpster and then their blood pressure shoots up through the roof again.

It is awfully disspiriting to have to slog through finding the right meds stew that works for you. Took me years. But I'm awfully glad I hung in with it.

I wish you both the very best of luck. Keep at it; the right medications are out there, I promise.
posted by dancestoblue at 1:26 AM on March 25, 2014 [1 favorite]

Has she tried Wellbutrin yet? It works much faster than most antidepressants.
posted by Jacqueline at 4:51 AM on March 25, 2014

Do the outpatient program. It sounds perfect for her situation.

It's not overkill, and it may be one of the best experiences she'll ever have.
posted by Ruthless Bunny at 5:32 AM on March 25, 2014 [4 favorites]

Please get her to the outpatient program. I've been to one twice, and it was life-changing. I am not exaggerating.
posted by Ms Vegetable at 6:25 AM on March 25, 2014 [3 favorites]

The outpatient program doesn't sound like overkill at all.

I have watched friends struggle with depression and every time it seems like you should just be able to manage it, you just need to get through this moment. Like there's a silver bullet that will make everything normal again.

There isn't.

There is a new reality, and the reality is that together she needs to prioritize mental health. The best analogy I can offer is that after years of carrying messenger bags full of groceries and talking on a flip phone held to my ear by my shoulder and working on a laptop, my neck became a huge problem. I remember saying at some point "but I've always done these things" and my doctor (actually, my tui na practitioner, who was the only helpful health care provider during that mess, but I digress) said "Uh, yeah. And you did it so many times that now you have a problem and you can't do it any more." By which I mean that mental health builds up, too. Drugs stop working because your brain chemistry gets accustomed to them. I'm not an expert by any means, but it doesn't seem crazy that having managed successfully with drugs for years, she now needs to add some additional practices to her arsenal.

Let go of the idea that she just needs a proverbial shot in the arm to get back to normal. Take advantage of the opportunity to really focus on getting better. Five days of outpatient work is nothing. Do it.
posted by amandabee at 6:26 AM on March 25, 2014 [2 favorites]

I should also add to the chorus : I did an IOP and it permanently (so far) improved my ability to manage my mental health issues.
posted by PMdixon at 8:09 AM on March 25, 2014 [1 favorite]

Here to be another advocate for the IOP. It's better to overkill than underestimate when it comes to depression. I did a similar program, and like PMdixon it changed my life.
posted by k8oglyph at 8:59 AM on March 25, 2014 [1 favorite]

I think the outpatient program might be exactly what she needs.

Why do you think it's overkill? What sort of middle ground would you be looking for? This sounds to be designed to be the middle ground between run-of-the-mill treatment and hospitalization.
posted by RainyJay at 7:55 PM on March 25, 2014

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