Why is there no such thing as urgent care for depression?
April 9, 2014 1:53 PM Subscribe
My partner is trying to seek medication for increasingly bad depression and can't get in to see anyone anywhere until late next month. Advice, suggestions? Location Madison, WI. We are more than willing to travel, but we'd want it to be for a psychiatrist/psychiatric NP, not another talk therapist.
My partner has had traumatic experiences with mental health treatment in the past, so just getting them to agree that it would be worth it to try again was a struggle. Yesterday they went to their first appointment with a therapist after about two months of increasingly deep depression. The therapist refused to refer my partner to psychiatric help without further talk therapy appointments over the next several weeks. My partner is interested in pursuing talk therapy and specifically CBT, but is having a really tough time right now and has previously observed me benefitting greatly from medication in a similar situation. My thought was to get them in to see a psychiatrist and go from there, but it turns out step one is more challenging than I expected. Our primary health-care provider (not the same as the therapist) is booked over a month out, and tells us that area hospitals are only taking patients who are on the hospital's own insurance plan.
Are other options available besides inpatient programs? Do you know of specific places that might have openings sooner? For various reasons, we do believe that my partner should see someone with mental-health-specific training rather than a GP. As I said, we're wiling to travel for someone who has appointments sooner rather than later. Cost isn't an issue; our insurance is quite generous in this regard, for all the good that's doing.
My partner is scared that the general insistence that no one is available unless one is actively suicidal/homicidal will end up being something of a self-fulfilling prophecy, and obviously they don't want it to get to that point. They have felt this depressed about six times in the past and have managed it in a variety of self-destructive ways, so are very frustrated that this time, when they're trying to do things "right", they keep getting rebuffed. Overall, this whole process seems to be making things worse, and is doing nothing to help the initial situation.
[Semi-anon because my usual account is findable. Please e-mail evasivecare via gmail if you'd like to be too.]
My partner has had traumatic experiences with mental health treatment in the past, so just getting them to agree that it would be worth it to try again was a struggle. Yesterday they went to their first appointment with a therapist after about two months of increasingly deep depression. The therapist refused to refer my partner to psychiatric help without further talk therapy appointments over the next several weeks. My partner is interested in pursuing talk therapy and specifically CBT, but is having a really tough time right now and has previously observed me benefitting greatly from medication in a similar situation. My thought was to get them in to see a psychiatrist and go from there, but it turns out step one is more challenging than I expected. Our primary health-care provider (not the same as the therapist) is booked over a month out, and tells us that area hospitals are only taking patients who are on the hospital's own insurance plan.
Are other options available besides inpatient programs? Do you know of specific places that might have openings sooner? For various reasons, we do believe that my partner should see someone with mental-health-specific training rather than a GP. As I said, we're wiling to travel for someone who has appointments sooner rather than later. Cost isn't an issue; our insurance is quite generous in this regard, for all the good that's doing.
My partner is scared that the general insistence that no one is available unless one is actively suicidal/homicidal will end up being something of a self-fulfilling prophecy, and obviously they don't want it to get to that point. They have felt this depressed about six times in the past and have managed it in a variety of self-destructive ways, so are very frustrated that this time, when they're trying to do things "right", they keep getting rebuffed. Overall, this whole process seems to be making things worse, and is doing nothing to help the initial situation.
[Semi-anon because my usual account is findable. Please e-mail evasivecare via gmail if you'd like to be too.]
If I were you, I would try two tactics.
Depression Advocacy Groups who may be able to point you in a better direction.
It also seems like you are currently seeking a psychopharmocologist, who can diagnose and dispense medications based upon symptoms. I have my own personal views on this, but in this vein you can search for these local to your area. I know they are prevalent in NY, but there is one in WI on this list.
Of course, I have no idea if these people are any good, and obviously, if the situation gets too desperate, a hospital is likely the unpleasant way to go.
posted by Debaser626 at 2:07 PM on April 9, 2014 [1 favorite]
Depression Advocacy Groups who may be able to point you in a better direction.
It also seems like you are currently seeking a psychopharmocologist, who can diagnose and dispense medications based upon symptoms. I have my own personal views on this, but in this vein you can search for these local to your area. I know they are prevalent in NY, but there is one in WI on this list.
Of course, I have no idea if these people are any good, and obviously, if the situation gets too desperate, a hospital is likely the unpleasant way to go.
posted by Debaser626 at 2:07 PM on April 9, 2014 [1 favorite]
I'm sorry you're dealing with this. I know you're trying to take care of your spouse but I would encourage you to be sure that your own needs are also being met during this difficult time. It's hard to take care of someone else when you're having a hard time yourself.
You said that money is not a concern - what about time? I know you need to get an appointment ASAP but when my GP has said he's too busy, I've just gone early in the morning so I'm the first person there when the doors open and they have made time to see me. It's not ideal and it might not work but it's an option. Bring a book and some snacks and prepare to wait a while. Prepare for the appointment - make a list of symptoms and how long your partner has been experiencing them, things that your partner has tried that haven't worked, medical history - you said this has happened before, what happened then, etc. When you get in the door, you are all business and you want an action plan and a way to reconnect if it doesn't work.
I know that you don't want to see your GP for this specifically but your GP should be able to help you find a specialist. Your GP is an ally - get them involved. Ditto your insurance provider - I would just call them, ask for a list of names of possibilities and just call until you find someone. Apologies if you've already done this. The other possibly-lame-but-maybe-not idea is to try the University of Wisconsin. Do they have a medical school? I live near a major university with a medical school and they have one building that just has *all* of the doctors. It was great because when I thought I had one thing wrong but it turned out it was something else, I just went downstairs instead of across town.
Also, keep cheering your partner on. My partner literally says to me, this is a stressful situation and I am proud of you for handling it well. It may sound condescending but it's not and I appreciate it. You both have a problem. You're working together to solve it. You can do it. You cheer on your partner, I'll cheer you on. I think it's really great that you're trying to help your partner out and your partner is lucky to have you. Good luck and keep trying.
posted by kat518 at 2:07 PM on April 9, 2014 [4 favorites]
You said that money is not a concern - what about time? I know you need to get an appointment ASAP but when my GP has said he's too busy, I've just gone early in the morning so I'm the first person there when the doors open and they have made time to see me. It's not ideal and it might not work but it's an option. Bring a book and some snacks and prepare to wait a while. Prepare for the appointment - make a list of symptoms and how long your partner has been experiencing them, things that your partner has tried that haven't worked, medical history - you said this has happened before, what happened then, etc. When you get in the door, you are all business and you want an action plan and a way to reconnect if it doesn't work.
I know that you don't want to see your GP for this specifically but your GP should be able to help you find a specialist. Your GP is an ally - get them involved. Ditto your insurance provider - I would just call them, ask for a list of names of possibilities and just call until you find someone. Apologies if you've already done this. The other possibly-lame-but-maybe-not idea is to try the University of Wisconsin. Do they have a medical school? I live near a major university with a medical school and they have one building that just has *all* of the doctors. It was great because when I thought I had one thing wrong but it turned out it was something else, I just went downstairs instead of across town.
Also, keep cheering your partner on. My partner literally says to me, this is a stressful situation and I am proud of you for handling it well. It may sound condescending but it's not and I appreciate it. You both have a problem. You're working together to solve it. You can do it. You cheer on your partner, I'll cheer you on. I think it's really great that you're trying to help your partner out and your partner is lucky to have you. Good luck and keep trying.
posted by kat518 at 2:07 PM on April 9, 2014 [4 favorites]
I got in to see my psychiatric NP pretty quickly. She's in Brookfield, right off I-94, so not too far for you. Cornerstone Counseling
posted by desjardins at 2:09 PM on April 9, 2014
posted by desjardins at 2:09 PM on April 9, 2014
Don't bother calling anyone in the Aurora network, they'll make you go through some bullshit intake session even if you're currently on medication. Just trying to save you some phone calls.
posted by desjardins at 2:15 PM on April 9, 2014
posted by desjardins at 2:15 PM on April 9, 2014
Sometimes going through a crisis mental health center can be a better experience than just going to the emergency room, and they will ultimately refer you to the emergency room if they judge that the best path. However, they may also just be able to break through the bullshit and get you the appointments you need. For your area, these folks seem to provide crisis mental health services.
posted by hydropsyche at 2:18 PM on April 9, 2014 [1 favorite]
posted by hydropsyche at 2:18 PM on April 9, 2014 [1 favorite]
Something to think about is that most antidepressants take a while to act (1-3 months). Ativan is fast-acting, but it and other benzodiazepines are sedatives used for treatment of anxiety. So it is likely that in terms of the depression, even if your partner were on anti-depressants now, it would be talk therapy that would be doing the work for a while.
So, in addition to continuing to explore avenues for psychiatric care (2nd ER crisis response), it might be an idea to continue with therapy for now, both for therapeutic value and to keep that referral process going. (Either with this therapist or another, if that can be done. It would be good to impress the severity of impairment onto this therapist again, if you have to stick with them.)
Also, see if your PCP can put you on a waiting list. Call every morning, by 9 am, to see if there's been a cancellation that day. You might get lucky with a spot or with the receptionist eventually giving in and making one for you.
As an alternative - St. John's Wort has shown mixed results in terms of efficacy (one study, which used a particular concentration, showed better-than-placebo results for mild-moderate depression; I don't know if what you'd find locally would bear any relationship to that formulation or others that have been tested), but if you can't get referred soon, it might be worth a try.
my views on this are different too, but if you want pharmaceutical help, that is how I would go about it
posted by cotton dress sock at 2:31 PM on April 9, 2014 [1 favorite]
So, in addition to continuing to explore avenues for psychiatric care (2nd ER crisis response), it might be an idea to continue with therapy for now, both for therapeutic value and to keep that referral process going. (Either with this therapist or another, if that can be done. It would be good to impress the severity of impairment onto this therapist again, if you have to stick with them.)
Also, see if your PCP can put you on a waiting list. Call every morning, by 9 am, to see if there's been a cancellation that day. You might get lucky with a spot or with the receptionist eventually giving in and making one for you.
As an alternative - St. John's Wort has shown mixed results in terms of efficacy (one study, which used a particular concentration, showed better-than-placebo results for mild-moderate depression; I don't know if what you'd find locally would bear any relationship to that formulation or others that have been tested), but if you can't get referred soon, it might be worth a try.
my views on this are different too, but if you want pharmaceutical help, that is how I would go about it
posted by cotton dress sock at 2:31 PM on April 9, 2014 [1 favorite]
Even with quite good insurance coverage, finding good, responsive psychiatric care in network can prove--in my experience--to be frustrating at best, and sometimes a downright nightmare. So if you're willing to pay out of pocket for an initial session, you can look outside your network and probably find someone who is both (a) better; and (b) available sooner. It'll probably cost $200-300 for a first-time visit and half that for follow-up medication management visits, but if you do have someone in-network who will have an opening in a month or two you can switch over to that provider in the long run.
This may also be beneficial to your partner insofar as (again, in my experience), psychiatrists who don't take insurance give you more of their time, are more flexible/responsive outside of visits, and have less of a feeling of just being a "pill mill" with crowded waiting rooms and too many patients to keep track of.
posted by drlith at 2:52 PM on April 9, 2014 [1 favorite]
This may also be beneficial to your partner insofar as (again, in my experience), psychiatrists who don't take insurance give you more of their time, are more flexible/responsive outside of visits, and have less of a feeling of just being a "pill mill" with crowded waiting rooms and too many patients to keep track of.
posted by drlith at 2:52 PM on April 9, 2014 [1 favorite]
Response by poster: Thank you all for your responses thus far. I do appreciate hearing that I'm not wrong to be frustrated by this, since so many of the people we've been speaking to act like a month is a completely reasonable amount of time to suffer before even discussing options. Personally I'm doing alright thus far, though having to keep talking my partner through/into life tasks is wearing. The answers on the other recent question like this freak me out a bit because maybe I'm being too complacent in thinking this can just wait for an appointment.
If we go to the ER or otherwise insist this is an emergency, will they actually provide treatment without my partner needing to be an imminent threat to someone? My partner is worried that if they come off as being "too bad" they'll be committed involuntarily. All of my perfectly rational arguments about how that can't actually legally happen haven't helped -- even though my partner agrees with everything I say, they're still scared. However, I do think I could coax them to the ER if that's actually a viable option.
Unfortunately, Journey Mental Health already told me earlier in this process (when things started getting bad) that they wouldn't help my partner because we have insurance -- again, unless we were talking serious risk of harm. They punted me back to the PCP, who in turn offered the referral to the therapist who doesn't like drugs. At the time at least, I couldn't find any other non-suicide-related crisis lines.
Our PCP is a large group practice and the GPs there won't see any mental health patients since (theoretically) that's handled by the counseling/psychiatric staff. Obviously that system has broken down, but the receptionists are holding firm that either my partner waits in line with everyone else, or it's an emergency and we go to the ER. A long conversation with my partner's PCP case manager today ended with explicit confirmation that there are no available short-term resources for someone who is not suicidal/homicidal. (I am strongly tempted to lie to the receptionist about the purpose of the appointment and then see if the GP actually turns us away in person, though that would probably just compound the problem.)
Our concern about working strictly with a GP, be it at the PCP or elsewhere, is that during a childhood episode of depression/antisocial behavior that was later diagnosed as being ASD-related, my partner was given Prozac and (according to the therapist from yesterday) that may have triggered a manic episode. Both because of the experience itself and this possible interpretation, we would ideally like someone who really knows what they're talking about, or least has good access to such a person. Does that seem off the mark? Should GPs be given more credit to not just blindly write "depressed person" scripts?
In any case, we can certainly keep pestering the mental health side of the PCP; I've already called my psychiatric NP there to see if there's anything she can do, though she's confirmed that they really are that booked. I would agree that is seems like a couple hundred bucks would go a long way — and we'd spend it! that's pretty much what the ER would cost anyway — we just have not been able to make any headway with new-patient appointments, and receptionists keep getting squirrely as soon as I say "urgent". The idea of specifically seeking out for someone who doesn't take insurance is interesting, and I'll look into that more as well as the NP in Brookfield (thanks for the hint about Aurora too, desjardins; the intake interviews without any progress are really taking it out of my partner).
posted by jabbersocky at 3:54 PM on April 9, 2014
If we go to the ER or otherwise insist this is an emergency, will they actually provide treatment without my partner needing to be an imminent threat to someone? My partner is worried that if they come off as being "too bad" they'll be committed involuntarily. All of my perfectly rational arguments about how that can't actually legally happen haven't helped -- even though my partner agrees with everything I say, they're still scared. However, I do think I could coax them to the ER if that's actually a viable option.
Unfortunately, Journey Mental Health already told me earlier in this process (when things started getting bad) that they wouldn't help my partner because we have insurance -- again, unless we were talking serious risk of harm. They punted me back to the PCP, who in turn offered the referral to the therapist who doesn't like drugs. At the time at least, I couldn't find any other non-suicide-related crisis lines.
Our PCP is a large group practice and the GPs there won't see any mental health patients since (theoretically) that's handled by the counseling/psychiatric staff. Obviously that system has broken down, but the receptionists are holding firm that either my partner waits in line with everyone else, or it's an emergency and we go to the ER. A long conversation with my partner's PCP case manager today ended with explicit confirmation that there are no available short-term resources for someone who is not suicidal/homicidal. (I am strongly tempted to lie to the receptionist about the purpose of the appointment and then see if the GP actually turns us away in person, though that would probably just compound the problem.)
Our concern about working strictly with a GP, be it at the PCP or elsewhere, is that during a childhood episode of depression/antisocial behavior that was later diagnosed as being ASD-related, my partner was given Prozac and (according to the therapist from yesterday) that may have triggered a manic episode. Both because of the experience itself and this possible interpretation, we would ideally like someone who really knows what they're talking about, or least has good access to such a person. Does that seem off the mark? Should GPs be given more credit to not just blindly write "depressed person" scripts?
In any case, we can certainly keep pestering the mental health side of the PCP; I've already called my psychiatric NP there to see if there's anything she can do, though she's confirmed that they really are that booked. I would agree that is seems like a couple hundred bucks would go a long way — and we'd spend it! that's pretty much what the ER would cost anyway — we just have not been able to make any headway with new-patient appointments, and receptionists keep getting squirrely as soon as I say "urgent". The idea of specifically seeking out for someone who doesn't take insurance is interesting, and I'll look into that more as well as the NP in Brookfield (thanks for the hint about Aurora too, desjardins; the intake interviews without any progress are really taking it out of my partner).
posted by jabbersocky at 3:54 PM on April 9, 2014
Having gone through an incredibly terrible period last year, I suggest reaching out to your nurses. I did this, mostly out of frustration for having to wait for an appointment (which I felt I might not be around to take after such a wait) and because they were readily accessible (more so than a doctor). Through speaking with a nurse, I was able to get an appointment pretty much the very next day. YMMV, but all of the nurses I've ever interacted with have always acted as my advocate and push for earlier appointments or try to squeeze me in just long enough to see a doctor and get a prescription.
I wouldn't worry about being involuntarily committed - even at the height of my depressive episode last year, no one gave any indication that they would ship me off somewhere. You can certainly convey the terrible place you're in, without making people worry you're an immediate threat to yourself or others. I started the conversation with my nurses by simply being honest - I was in a terrible place, and I felt it was getting worse. I couldn't eat. I couldn't sleep. The rumination was non-stop and anxiety was so high I couldn't even drive anymore. I ended it by saying I knew something was wrong, but I didn't know how to fix it and that I just really needed help.
Also, don't be afraid to see a GP (that's who I've been seeing). When I was younger, I was given a prescription for an anti-depressant, which then threw me into a manic episode. I do not fault the GP for this - there's no way to know how you're going to respond to any given medication. Additionally, undiagnosed mood disorders can cause anti-depressants to trigger mania in some people (such as those suffering from bipolar). And treating depression with medications is VERY hit and miss since those medications work in different ways and on different neurotransmitters. Some block receptors so that the brain is flooded with 'feel good' chemicals. Some provide key neurotransmitter chemicals that may be absent. Cycling through meds is, unfortunately, just something you have to deal with - you try a lot of different meds until you find the one that works right for you. So I wouldn't discount a GP based on this. A GP will be able to see you sooner than a specialist can and would be a good way to at least get your foot in the door.
posted by stubbehtail at 4:19 PM on April 9, 2014 [1 favorite]
I wouldn't worry about being involuntarily committed - even at the height of my depressive episode last year, no one gave any indication that they would ship me off somewhere. You can certainly convey the terrible place you're in, without making people worry you're an immediate threat to yourself or others. I started the conversation with my nurses by simply being honest - I was in a terrible place, and I felt it was getting worse. I couldn't eat. I couldn't sleep. The rumination was non-stop and anxiety was so high I couldn't even drive anymore. I ended it by saying I knew something was wrong, but I didn't know how to fix it and that I just really needed help.
Also, don't be afraid to see a GP (that's who I've been seeing). When I was younger, I was given a prescription for an anti-depressant, which then threw me into a manic episode. I do not fault the GP for this - there's no way to know how you're going to respond to any given medication. Additionally, undiagnosed mood disorders can cause anti-depressants to trigger mania in some people (such as those suffering from bipolar). And treating depression with medications is VERY hit and miss since those medications work in different ways and on different neurotransmitters. Some block receptors so that the brain is flooded with 'feel good' chemicals. Some provide key neurotransmitter chemicals that may be absent. Cycling through meds is, unfortunately, just something you have to deal with - you try a lot of different meds until you find the one that works right for you. So I wouldn't discount a GP based on this. A GP will be able to see you sooner than a specialist can and would be a good way to at least get your foot in the door.
posted by stubbehtail at 4:19 PM on April 9, 2014 [1 favorite]
"My partner is worried that if they come off as being "too bad" they'll be committed involuntarily"
There's absolutely nothing wrong with that happening. Three days of regular meals and dispensed drugs in a controlled environment can be extremely helpful.
If you're in the US, your state *may* not let you own guns for a few years. That's the worst thing that could happen.
posted by colin_l at 4:28 PM on April 9, 2014
There's absolutely nothing wrong with that happening. Three days of regular meals and dispensed drugs in a controlled environment can be extremely helpful.
If you're in the US, your state *may* not let you own guns for a few years. That's the worst thing that could happen.
posted by colin_l at 4:28 PM on April 9, 2014
That sucks and I'm sorry. If your partner needs general life help or someone to talk to, I tried some website called three cups of tea (something like that?) where a non-medical person just listened to me vent and it was actually nice. It shouldn't be a therapy substitute but just hearing someone else listen and affirm my feelings was helpful.
Regarding your partner's childhood experience with Prozac, this might be the wrong answer but I don't think I'd mention it. SSRIs work totally differently on children than on adults. This also depends on whether you mean child as in 12 years old or 17 years and 11 months but that's a thought.
Fwiw, my GP writes the prescription for my antidepressants. I tried seeing a mental health provider, they put me on something that was useless, I went back to the drugs I knew and liked.
What about contacting a group like NAMI?
posted by kat518 at 4:35 PM on April 9, 2014
Regarding your partner's childhood experience with Prozac, this might be the wrong answer but I don't think I'd mention it. SSRIs work totally differently on children than on adults. This also depends on whether you mean child as in 12 years old or 17 years and 11 months but that's a thought.
Fwiw, my GP writes the prescription for my antidepressants. I tried seeing a mental health provider, they put me on something that was useless, I went back to the drugs I knew and liked.
What about contacting a group like NAMI?
posted by kat518 at 4:35 PM on April 9, 2014
Speaking as someone in a similar situation:
The ER is your absolute best bet. Being involuntarily committed is not a bad thing. A few days of medication and regular meals, 24/7 support, and most importantly, a complete break from all the depressive triggers of the outside world can work wonders.
Plus, with that diagnosis and discharge papers in hand, your PCP will have a bit more of a kick in the ass to actually do something.
Bear in mind I'm Canadian so I have no idea how this all meshes with your insane insurance system. MeMail/email me if you want to talk more privately.
Oh, and Ativan is an anti-anxiety med that will do pretty much nothing for depression, and like all benzodiazepenes (e.g. Klonopin, Valium) can be extremely habit-forming. Anti-depression meds usually take 6-12 weeks to reach peak efficacy.
In the meantime, continue talk therapy. Get as much sunlight and physical exercise as your partner can possibly stand. Eat as healthy as possible--lots and lots and lots of green vegetables and minimal use of processed food products.
posted by feckless fecal fear mongering at 4:49 PM on April 9, 2014 [2 favorites]
The ER is your absolute best bet. Being involuntarily committed is not a bad thing. A few days of medication and regular meals, 24/7 support, and most importantly, a complete break from all the depressive triggers of the outside world can work wonders.
Plus, with that diagnosis and discharge papers in hand, your PCP will have a bit more of a kick in the ass to actually do something.
Bear in mind I'm Canadian so I have no idea how this all meshes with your insane insurance system. MeMail/email me if you want to talk more privately.
Oh, and Ativan is an anti-anxiety med that will do pretty much nothing for depression, and like all benzodiazepenes (e.g. Klonopin, Valium) can be extremely habit-forming. Anti-depression meds usually take 6-12 weeks to reach peak efficacy.
In the meantime, continue talk therapy. Get as much sunlight and physical exercise as your partner can possibly stand. Eat as healthy as possible--lots and lots and lots of green vegetables and minimal use of processed food products.
posted by feckless fecal fear mongering at 4:49 PM on April 9, 2014 [2 favorites]
I see kat518 mentioned them, but if you haven't contacted NAMI Dane, you probably should. This is probably about as comprehensive a list of local options as exists. They have support groups, including one for family and friends.
I think most of the advice above is good. Yes, drugs can be very helpful, but they take a while to really make a difference, and I wouldn't predicate my judgement on a treatment plan on whether I got them right away. If your partner is so anxious that they do feel they need "something" immediately, then the ER is probably the best bet and involuntary commitment isn't the worst thing in the world right now.
my partner was given Prozac and (according to the therapist from yesterday) that may have triggered a manic episode
That seems like sufficient reason to reject a prescription for Prozac, but it's possible this could have been caused by any SSRI. The real issue here is whether it led to suicidal ideation and/or outward-directed violence of any kind. But all you need is to understand that this isn't an exact science, most people get better with OR without drugs, the success rate of various therapies is about 1/3 no matter what the therapy, and being a self-advocate as a patient is extremely important. "OK, that didn't work for me. What other options do I have?" is a perfectly valid approach to this issue. That is to say that regardless of expertise an iterative approach to therapies, talk, group, lifestyle changes, or drugs, is going to be the norm.
Your partner is extremely lucky to have someone of your understanding in their life. Good luck.
posted by dhartung at 5:21 PM on April 9, 2014 [1 favorite]
I think most of the advice above is good. Yes, drugs can be very helpful, but they take a while to really make a difference, and I wouldn't predicate my judgement on a treatment plan on whether I got them right away. If your partner is so anxious that they do feel they need "something" immediately, then the ER is probably the best bet and involuntary commitment isn't the worst thing in the world right now.
my partner was given Prozac and (according to the therapist from yesterday) that may have triggered a manic episode
That seems like sufficient reason to reject a prescription for Prozac, but it's possible this could have been caused by any SSRI. The real issue here is whether it led to suicidal ideation and/or outward-directed violence of any kind. But all you need is to understand that this isn't an exact science, most people get better with OR without drugs, the success rate of various therapies is about 1/3 no matter what the therapy, and being a self-advocate as a patient is extremely important. "OK, that didn't work for me. What other options do I have?" is a perfectly valid approach to this issue. That is to say that regardless of expertise an iterative approach to therapies, talk, group, lifestyle changes, or drugs, is going to be the norm.
Your partner is extremely lucky to have someone of your understanding in their life. Good luck.
posted by dhartung at 5:21 PM on April 9, 2014 [1 favorite]
Many insurance plans in the US have contingencies for behavioral health crisis situations. Many insurance plans have a nurse helpline. If yours does, there will be information on this on your member card. Contacting these people can be very helpful.
Check your card or member handbook and call the nurse helpline or member line. Explain that your partner is having a behavioral health (aka mental health) crisis. They will likely keep you on the line while they get a case manager on the line and have folks standing by to do an intake.
This will also make it easier after discharge, as they will have your full case from end to end.
posted by mochapickle at 5:22 PM on April 9, 2014
Check your card or member handbook and call the nurse helpline or member line. Explain that your partner is having a behavioral health (aka mental health) crisis. They will likely keep you on the line while they get a case manager on the line and have folks standing by to do an intake.
This will also make it easier after discharge, as they will have your full case from end to end.
posted by mochapickle at 5:22 PM on April 9, 2014
If you have some money to spend that is not coming from insurance, maybe consider ketamine therapy. There are other places that offer it too. It's supposed to work very quickly, like within a day. I mean, do some more research, obviously, but I'm just mentioning it as a possibility that you may not have considered yet. Personally, I'm quite interested to find out what other psychedelics may do for depression.
posted by the big lizard at 5:47 PM on April 9, 2014
posted by the big lizard at 5:47 PM on April 9, 2014
This is just a shot in the dark, but does your partner have any type of affiliation with UW-Madison that would allow them to use University Health Services (even if you have to pay out of pocket?) It has been a few years, but when I was a student there I had a friend with an with urgent, but non-emergency mental health issue that UHS handled very well in a very timely fashion.
posted by mjcon at 7:21 PM on April 9, 2014
posted by mjcon at 7:21 PM on April 9, 2014
Call your GP's office (try right when they open, then try again at 9:15 if you can't get through, after all the "right when they open" people have been handled) and ask to speak with a nurse. "Hi, I'm a patient of Dr. Somebody, and I need to speak with a nurse." Don't talk to reception. ("What about?" "My health." "Can you be more specific?" "No. I need to talk to the nurse to figure out if I need to come see the doctor.") They may take your number and have the nurse call you back, or they may put you through to leave a message on the nurse line.
When you speak with the nurse, say (with urgency and upset in your voice), "My partner is having a worsening mental health crisis, his therapist is totally unhelpful, and we need to talk to somebody who can help us TODAY. It's okay if we have to pay out-of-pocket or drive an hour out of town, but we really, really need to see someone TODAY or at the very latest, tomorrow." You tell the nurse, when she asks, "He's not actively suicidal, but he's really anxious, depressed, and overwhelmed, and our inability to get him appropriate psychiatric care is making him freak out even more. His depression's at a level where he's having to take time off work/where he's going to bed when he gets home and not walking the dog/playing with the kids/where he's failing two classes." (You know, something that shows the depression is having a serious impact on his quality of life NOW. This is one of the things nurses want to know before they pull strings: direct and serious/major impact on quality of daily life right now.) You say, "I know our other option is the emergency room, and I really don't want to do that because it's inefficient and I know it'll be even more stress for my partner, but if we can't get SOMEONE to help us today, that's probably what we're going to have to do."
I called my GP's office with a similar situation after my on-and-off therapist couldn't fit me in and I was in a big honkin' crisis, and basically just cried on the nurse line that my therapist couldn't see me and I was FREAKIN OUT and really needed to see someone and the nurses started working the phones, found a guy who agreed to see me that day on his lunch hour, arranged the transfer of relevant medical records, etc., and called me back and told me where to go at what time. They did everything else. I walked into the appointment and the doctor had already been briefed by the nurses on the phone and already knew a lot about what was going on.
But yeah, insist on speaking with a nurse -- someone with some authority over MEDICAL decisions, not just scheduling decisions -- and be clear that if you can't see someone in the next 48 hours, you're going to have to go to the ER. They can probably find SOME doctor or practice who can see you immediately, or direct you to appropriate community mental health services, or give you other ideas/options short of the ER.
posted by Eyebrows McGee at 7:58 PM on April 9, 2014 [8 favorites]
When you speak with the nurse, say (with urgency and upset in your voice), "My partner is having a worsening mental health crisis, his therapist is totally unhelpful, and we need to talk to somebody who can help us TODAY. It's okay if we have to pay out-of-pocket or drive an hour out of town, but we really, really need to see someone TODAY or at the very latest, tomorrow." You tell the nurse, when she asks, "He's not actively suicidal, but he's really anxious, depressed, and overwhelmed, and our inability to get him appropriate psychiatric care is making him freak out even more. His depression's at a level where he's having to take time off work/where he's going to bed when he gets home and not walking the dog/playing with the kids/where he's failing two classes." (You know, something that shows the depression is having a serious impact on his quality of life NOW. This is one of the things nurses want to know before they pull strings: direct and serious/major impact on quality of daily life right now.) You say, "I know our other option is the emergency room, and I really don't want to do that because it's inefficient and I know it'll be even more stress for my partner, but if we can't get SOMEONE to help us today, that's probably what we're going to have to do."
I called my GP's office with a similar situation after my on-and-off therapist couldn't fit me in and I was in a big honkin' crisis, and basically just cried on the nurse line that my therapist couldn't see me and I was FREAKIN OUT and really needed to see someone and the nurses started working the phones, found a guy who agreed to see me that day on his lunch hour, arranged the transfer of relevant medical records, etc., and called me back and told me where to go at what time. They did everything else. I walked into the appointment and the doctor had already been briefed by the nurses on the phone and already knew a lot about what was going on.
But yeah, insist on speaking with a nurse -- someone with some authority over MEDICAL decisions, not just scheduling decisions -- and be clear that if you can't see someone in the next 48 hours, you're going to have to go to the ER. They can probably find SOME doctor or practice who can see you immediately, or direct you to appropriate community mental health services, or give you other ideas/options short of the ER.
posted by Eyebrows McGee at 7:58 PM on April 9, 2014 [8 favorites]
So, have you tried going through your primary care doc? That's going to be much cheaper and likely more fruitful than going to the ER. Your primary care doc can prescribe meds -- and they might be able to get you an appointment with someone sooner. I mean, it's worth trying. Call them first thing tomorrow and ask for a sick visit.
posted by bluedaisy at 8:24 PM on April 9, 2014
posted by bluedaisy at 8:24 PM on April 9, 2014
Response by poster: Eyebrows McGee, I love your script. I had a more subdued conversation with the NP earlier today, and clearly I need to step things up tomorrow. It's been kind of nagging at me that my partner isn't very big on emotional affect in the best of times and so may not be hitting most people's "crisis" checklists. Me, I can clearly see that this is going nowhere good and will handle the apparently-necessary freaking out.
University Health Services (UHS) is our PCP.* I've also had very good experiences with them in the past and truth be told they are handling this "well", just not quite the way my partner was hoping. My partner doesn't generally assign as much value to having someone to talk to as others might, so has mostly been agitated by having to have these long intimate conversations with so many strangers. I think that once there is a clear trajectory for how talk therapy will go, things will be different; right now it feels like everyone's just saying "come back later and we'll chat more". My partner sees medication as an evidence-based methodology that almost can't help but do something, whereas talk therapy could continue indefinitely without progress. That they are expressing this dichotomy so starkly is a symptom of their depression and I don't know that it's possible to fully break out of it right now.
Until this happened, I hadn't realized how lucky I was in getting in to see both a therapist and the psychiatric NP so quickly before. I think I oversold that experience in my effort to convince my partner that therapy didn't have to be as awful as it was when they were young. If the conversation tomorrow with the NP doesn't pan out, we'll start working through the lists of resources and/or seriously considering the ER option. It was good to be reminded that inpatient isn't necessarily a bad outcome, though I sincerely doubt I'd make any progress on talking my partner past their phobia without things getting much worse.
I really, really appreciate the links and advice from everyone. Thank you. The sheer amount of information is somewhat overwhelming but that's a much better position to be in than feeling like we're walking around town futilely pounding on windows for attention.
*For posterity: UHS only sees students and their partners/dependents, and then only if said partners/dependents are enrolled with the Student Health Insurance Plan. SHIP is fantastic if you qualify for it but don't bother calling UHS if you don't.
posted by jabbersocky at 9:25 PM on April 9, 2014 [2 favorites]
University Health Services (UHS) is our PCP.* I've also had very good experiences with them in the past and truth be told they are handling this "well", just not quite the way my partner was hoping. My partner doesn't generally assign as much value to having someone to talk to as others might, so has mostly been agitated by having to have these long intimate conversations with so many strangers. I think that once there is a clear trajectory for how talk therapy will go, things will be different; right now it feels like everyone's just saying "come back later and we'll chat more". My partner sees medication as an evidence-based methodology that almost can't help but do something, whereas talk therapy could continue indefinitely without progress. That they are expressing this dichotomy so starkly is a symptom of their depression and I don't know that it's possible to fully break out of it right now.
Until this happened, I hadn't realized how lucky I was in getting in to see both a therapist and the psychiatric NP so quickly before. I think I oversold that experience in my effort to convince my partner that therapy didn't have to be as awful as it was when they were young. If the conversation tomorrow with the NP doesn't pan out, we'll start working through the lists of resources and/or seriously considering the ER option. It was good to be reminded that inpatient isn't necessarily a bad outcome, though I sincerely doubt I'd make any progress on talking my partner past their phobia without things getting much worse.
I really, really appreciate the links and advice from everyone. Thank you. The sheer amount of information is somewhat overwhelming but that's a much better position to be in than feeling like we're walking around town futilely pounding on windows for attention.
*For posterity: UHS only sees students and their partners/dependents, and then only if said partners/dependents are enrolled with the Student Health Insurance Plan. SHIP is fantastic if you qualify for it but don't bother calling UHS if you don't.
posted by jabbersocky at 9:25 PM on April 9, 2014 [2 favorites]
You could also go to a walk in clinic in a nice neighborhood near a psychiatric program where you covet a referral. They'll put you on drugs in a walk in clinic.
posted by crazycanuck at 9:44 PM on April 9, 2014 [1 favorite]
posted by crazycanuck at 9:44 PM on April 9, 2014 [1 favorite]
You can't get into to university health services at more than a month out? That's awful. But, yeah, I'd just find the cash and call every GP and psychiatrist around, ask them what their out-of-pocket rate is and when they can get you in. I pay $75 a visit to see someone every three months who I never have to wait more than a few days to see, and I don't think even most GPs blink at the notion of handing out antidepressants.
posted by Sequence at 10:49 PM on April 9, 2014 [1 favorite]
posted by Sequence at 10:49 PM on April 9, 2014 [1 favorite]
My partner sees medication as an evidence-based methodology that almost can't help but do something, whereas talk therapy could continue indefinitely without progress. That they are expressing this dichotomy so starkly is a symptom of their depression and I don't know that it's possible to fully break out of it right now.
This is tricky. You're probably right about his black and white thinking, but also, he wouldn't be the first person to feel they've come away with limited benefit from therapy (for whatever reason), and he's right, when you're in a real moment, the intake process feels pretty alienating and doesn't inspire confidence. Hopefully, he will be able to move quickly past intake into actual therapy.
As dhartung said, anti-depressants are a crapshoot. No psychiatrist can offer precise predictions about how one or another drug will work. They can make guesses, based on previous experiences with other members of the drug class, and then it's trial and error*. But, if that's what your partner strongly feels will work and he's resistant to the idea of counselling, that's fair enough and that's the hook you've got to work with.
One thing about psychological and psychiatric services is that, for reasons you might imagine, no-shows are not unheard of. If the office or medical staff insist on being bullish about scheduled appointments without a sufficient-to-them sense of severity (which might, yes, mean "immediate risk of harm to self or others", which could well also mean an ER situation), being available for last-minute cancellations (seriously, calling every morning) would help, as far as your PCP goes.
*In my own care, my providers agreed that it was very possible that side effects experienced in one drug might easily be seen again with drugs of the same class, and that I could try another and see how it was. There are just a lot of unknowns. For those willing to try, the key, other than having a provider with good knowledge of the drugs themselves, is good and consistent monitoring - regular follow-ups, good record-keeping, ease of access (i.e. appointment availability and proximity - you don't want to have to drive an hour if you can avoid it). If you are not confident you could get that through your PCP, perhaps paying out-of-pocket is a good idea.
I wonder though, if he's persuaded by evidence, whether it might be worth presenting the argument for exercise. I know it can sound insulting to someone who wants to be taken seriously and needs serious help. But there's mounting support for an important role for exercise in therapy, with at least initial ideas about the mechanisms that might facilitate its (observable) effect in many. If he could be persuaded to engage a bit with some of the research and try it, perhaps it could help him get to feeling a little better, sooner.
posted by cotton dress sock at 11:04 PM on April 9, 2014 [1 favorite]
This is tricky. You're probably right about his black and white thinking, but also, he wouldn't be the first person to feel they've come away with limited benefit from therapy (for whatever reason), and he's right, when you're in a real moment, the intake process feels pretty alienating and doesn't inspire confidence. Hopefully, he will be able to move quickly past intake into actual therapy.
As dhartung said, anti-depressants are a crapshoot. No psychiatrist can offer precise predictions about how one or another drug will work. They can make guesses, based on previous experiences with other members of the drug class, and then it's trial and error*. But, if that's what your partner strongly feels will work and he's resistant to the idea of counselling, that's fair enough and that's the hook you've got to work with.
One thing about psychological and psychiatric services is that, for reasons you might imagine, no-shows are not unheard of. If the office or medical staff insist on being bullish about scheduled appointments without a sufficient-to-them sense of severity (which might, yes, mean "immediate risk of harm to self or others", which could well also mean an ER situation), being available for last-minute cancellations (seriously, calling every morning) would help, as far as your PCP goes.
*In my own care, my providers agreed that it was very possible that side effects experienced in one drug might easily be seen again with drugs of the same class, and that I could try another and see how it was. There are just a lot of unknowns. For those willing to try, the key, other than having a provider with good knowledge of the drugs themselves, is good and consistent monitoring - regular follow-ups, good record-keeping, ease of access (i.e. appointment availability and proximity - you don't want to have to drive an hour if you can avoid it). If you are not confident you could get that through your PCP, perhaps paying out-of-pocket is a good idea.
I wonder though, if he's persuaded by evidence, whether it might be worth presenting the argument for exercise. I know it can sound insulting to someone who wants to be taken seriously and needs serious help. But there's mounting support for an important role for exercise in therapy, with at least initial ideas about the mechanisms that might facilitate its (observable) effect in many. If he could be persuaded to engage a bit with some of the research and try it, perhaps it could help him get to feeling a little better, sooner.
posted by cotton dress sock at 11:04 PM on April 9, 2014 [1 favorite]
The therapist refused to refer my partner to psychiatric help without further talk therapy appointments over the next several weeks.
WTF. No, no, get a new therapist ASAP; it's not up to them. You don't need a referral to see a psychiatrist, just call them and make an appointment. You might need a referral (probably from a PCP, not a therapist!) for it to be in-network on your insurance, especially if you have an HMO, but that doesn't mean you can't just call a shrink and make an appointment all by your own self. You don't need to be seeing a therapist at all.
posted by Violet Hour at 11:19 PM on April 9, 2014
WTF. No, no, get a new therapist ASAP; it's not up to them. You don't need a referral to see a psychiatrist, just call them and make an appointment. You might need a referral (probably from a PCP, not a therapist!) for it to be in-network on your insurance, especially if you have an HMO, but that doesn't mean you can't just call a shrink and make an appointment all by your own self. You don't need to be seeing a therapist at all.
posted by Violet Hour at 11:19 PM on April 9, 2014
Response by poster: I wonder though, if he's persuaded by evidence, whether it might be worth presenting the argument for exercise.
Ah, sorry, must have forgotten that earlier: my partner is all over the exercise and good food. Typically it's because they genuinely enjoy those things; lately it's by rote dedication to Science. Their increasing sense that things can't go on like this is heavily influenced by not getting what they used to out of physical activity.
posted by jabbersocky at 11:58 PM on April 9, 2014
Ah, sorry, must have forgotten that earlier: my partner is all over the exercise and good food. Typically it's because they genuinely enjoy those things; lately it's by rote dedication to Science. Their increasing sense that things can't go on like this is heavily influenced by not getting what they used to out of physical activity.
posted by jabbersocky at 11:58 PM on April 9, 2014
Check your Memail.
posted by professor plum with a rope at 1:19 AM on April 10, 2014
posted by professor plum with a rope at 1:19 AM on April 10, 2014
I've had similar trouble in gaining access to the system; I think nearly everyone who has had an acute mental health crisis can relate. Unfortunately, short of picking a few psychiatrists in town and calling every day to seek a cancellation (and being ready to drop everything and go in when they have one), your options probably are wait, or ER.
But just to add on about the ER option - it is crummy, but probably not as bad as your partner fears. First of all, if they are evaluated in the ER and the people there determine that they are a threat to themselves, in all likelihood they will not issue a 72-hour hold if your partner agrees to go inpatient voluntarily. I've had the misfortune of being taken to the ER for mental health reasons a couple of times in my adult life, and each time I was basically given the option of signing myself in voluntarily or being legally compelled. Signing yourself in is the mental health equivalent of staying the hospital for a few days for observation, and will not affect his/her legal rights at a future date. Yes, it can be very scary, and I recommend investigating where he or she would likely land if they went inpatient from that ER to try and find the nicest place among your available options, but it's not life-ruining. It's also not very effective, but it does tend to fast-track getting access to outpatient appointments.
However, it's also entirely possible that he or she could get enrolled in a partial hospitalization program. Those are GREAT options for people who are in acute crisis but not actively suicidal. People often don't know about partial hospitalization until they're tracked into it as a step-down from inpatient, but insurance will sometimes cover it independently of an inpatient hospitalization. That would give your partner 6ish hours a day of medical attention and therapeutic activity/assistance with daily functioning in a setting with people who know what they are doing, and it would probably give you a bit of a reprieve, without the stress of spending the night at the hospital.
posted by bowtiesarecool at 6:09 AM on April 10, 2014
But just to add on about the ER option - it is crummy, but probably not as bad as your partner fears. First of all, if they are evaluated in the ER and the people there determine that they are a threat to themselves, in all likelihood they will not issue a 72-hour hold if your partner agrees to go inpatient voluntarily. I've had the misfortune of being taken to the ER for mental health reasons a couple of times in my adult life, and each time I was basically given the option of signing myself in voluntarily or being legally compelled. Signing yourself in is the mental health equivalent of staying the hospital for a few days for observation, and will not affect his/her legal rights at a future date. Yes, it can be very scary, and I recommend investigating where he or she would likely land if they went inpatient from that ER to try and find the nicest place among your available options, but it's not life-ruining. It's also not very effective, but it does tend to fast-track getting access to outpatient appointments.
However, it's also entirely possible that he or she could get enrolled in a partial hospitalization program. Those are GREAT options for people who are in acute crisis but not actively suicidal. People often don't know about partial hospitalization until they're tracked into it as a step-down from inpatient, but insurance will sometimes cover it independently of an inpatient hospitalization. That would give your partner 6ish hours a day of medical attention and therapeutic activity/assistance with daily functioning in a setting with people who know what they are doing, and it would probably give you a bit of a reprieve, without the stress of spending the night at the hospital.
posted by bowtiesarecool at 6:09 AM on April 10, 2014
Many GPs will prescribe depression meds. Ours does. Also, can make a referral to a psychiatrist if need be.
Do look into a hospital option. These can be life changing and amazing!
posted by Ruthless Bunny at 9:50 AM on April 10, 2014
Do look into a hospital option. These can be life changing and amazing!
posted by Ruthless Bunny at 9:50 AM on April 10, 2014
I'm just here to nth the er option. I was having a severe bout of depression. Due to past issues with alcohol abuse and self harm, my therapist strongly advised that I take a long weekend and get myself committed. They were able to put me on higher doses of meds then my psychiatrist would have been able to do. Plus, I was in a safe place with other similar folks and didn't have to "pretend" that things were okay when they were not. Also, all of the doctors and nurses that I met with understood that I was checking myself in because I was concerned for my health and worried that self-harm was becoming very attractive. I was not involuntarily committed because I clearly wanted to be there. I let them know that the evidence was I brought myself to an ER to be hospitalized rather than continue to battle my demons on my own.
It sounds like you have a lot of really great suggestions here. I just wanted to add my voice to the chorus that psychiatric wards do not have to be terrible and frightening experiences.
Take care of yourselves.
posted by thankyouforyourconsideration at 2:00 PM on April 10, 2014
It sounds like you have a lot of really great suggestions here. I just wanted to add my voice to the chorus that psychiatric wards do not have to be terrible and frightening experiences.
Take care of yourselves.
posted by thankyouforyourconsideration at 2:00 PM on April 10, 2014
This thread is closed to new comments.
Sometimes with doctors you need to push, and don't take no for an answer. You as the partner might be the one who has to push, because someone struggling with depression may not be able to do it themselves. It's super frustrating - you have moments when you overcome the depression/anxiety of making the appointment, make the phone call, and then are shot down.
Call the primary care office, say it's extremely urgent and that you need one of the slots that they keep open for emergencies. They have these. Call the therapist and explain the urgency of the situation as well. If your partner has not signed a HIPPA, the therapist won't be able to discuss your partner's situation directly with you, but can certainly listen to your concerns. Maybe you can get your partner in for daily visits for the next week or two?
posted by radioamy at 1:58 PM on April 9, 2014