I really need mental health resources in Portland, OR.
September 16, 2014 8:05 PM   Subscribe

My anxiety has flared up recently, to the point where I am reluctant to leave my house unless absolutely necessary. This weekend, I checked myself into urgent care after having five panic attacks in 12 hours. The health care providers there were less than helpful, and I feel like I've hit a wall in terms of figuring out how to get the help that I need.

I was diagnosed with generalized anxiety disorder a few years ago, and spent a few months trying out various SSRI's with little success. Eventually, my doctor prescribed me Xanax to take as needed, which worked fine for a few months, at which point things sort of mellowed out. (I now have a different doctor in a different state with different health insurance-- I now have Kaiser.)

The last few months have brought about several major life changes, some of which have been quite unpleasant. When my anxiety first started increasing, I got a referral from Kaiser to do a mental health evaluation, which consisted of a 30 minute phone interview. I told the evaluator that I would prefer to see a psychiatrist for therapy and medication, as my instinct is that I need both. The evaluator laughed at me and said, "Psychiatrists don't do their own counseling anymore." (Is that true? I don't think that that's true.) She then gave me an option of three counselors, all of whom work only during traditional business hours. I also work during traditional business hours, with absolutely no flexibility in my work schedule. I told her that, and she said they don't contract with any counselors who work evenings or weekends.

When I went to urgent care this weekend, the nurse who initially spoke to me asked me what was happening, I told her I was having back-to-back panic attacks, and she said to me, "oh, yeah, that's probably because of the supermoon." Great.

When I finally saw the doctor, she gave me a dozen Xanax to help me get through the next few days, and tried to re-refer me to the mental health evaluation system. I told her my previous experience, and she nodded and said that the system is tricky to navigate.

Exacerbating this issue is the fact that doctors are a big anxiety trigger for me, and so trying to muddle my way through this without any help is really frustrating and discouraging.

I don't know what my next steps should be. I don't know how to get the help that I need.

Any Portland-specific resources would be really appreciated, as well as any general advice about how to be a better advocate, since it seems lI've been pretty ineffective thus far.
posted by anonymous to Health & Fitness (12 answers total) 6 users marked this as a favorite
Some psychiatrists do therapy too. I have one and she does both for me, but I also see a social worker because I am that much of a mess that I need all the help I can get.

Sounds like you have had some terrible experiences, I have too. Just like with romantic relationships you have to kiss some frogs before you find your prince. So keep at it. Go to the NAMI website or from a landline call 211 for help finding services. Call a suicide hotline when you are having a panic attack, they will have resources, but more importantly the numbers for resources that are cost effective for your situation. If you do not have insurance google "free mental health care in Portland, if you haven't already. Also, join support groups for those that deal with anxiety. Those can be found on the NAMI site or may appear on a meet up.com type site. Search for treaters that do Cognitive behavioral therapy or dialectical behavior therapy. It helps.

With regard to the work issue, you could ask for accommodation through Human resources and the Office of Equal Opportunity. There you should be able to advocate for the hour or two off that you need thanks to the Americans with Disabilities Act. See if you can get a Primary care of internist physician to fill out the paperwork for intermittent FMLA leave so that your job is protected while you pursue the accommodations.

Finally I definitely feel for you. It is tough looking for help while you are under distress. There are people that can help you. They are out there. Just because one or more people have said no, or you have not got on well with others, does not mean that you should give up. You are worth it, you need to fight for yourself. This will make you stronger. Anxiety is the worse, because it is so paralyzing. you can do it. me mail me with questions about the legal, ADA, Family medical legal act, etc that I mentioned above. I will respond. You can also email me at scaryordangerous@gmail.com
posted by Jewel98 at 8:34 PM on September 16, 2014 [1 favorite]

Kaiser is the absolute worst for mental health. I jumped through all their hoops to get an appointment with someone but they won't let me see her on any kind of regular basis, and even that one appointment was given grudgingly.

All of which is to say that you might be better served finding someone outside of Kaiser who works on a sliding scale fee. I don't have any recommendations unfortunately, but I wanted to post that in case anyone else might have non-Kaiser referrals for you.

Good luck.
posted by rabbitrabbit at 8:53 PM on September 16, 2014 [3 favorites]

I think both the William Temple House and Lifeworks NW provide fairly cheap therapy. It is also my impression that Kaiser can do things in an inflexible manner. What about seeing a Kaiser psychiatrist for a prescription and then going to an affordable therapist for the talking part?
posted by feets at 8:56 PM on September 16, 2014

Also, this guy is tremendously nice and has a sliding scale. And if you didn't click with him he is well connected and could hook you up with someone else. I'm sorry this is so hard! Keep at it and I hope you find calm soon. Dr Ed Versteeg
posted by feets at 8:59 PM on September 16, 2014

Your insurance, according to your insurance company, only covers therapists who work during business hours. So if you're unable to get accommodations from your employer, your option would be to look for therapists who do work evenings or weekends and pay out of pocket.

There are psychiatrists who do therapy as well, but it doesn't sound like your health insurance covers any, according to your insurance company. Psychiatrists are very expensive for therapy, so while you can pay out of pocket for therapy from a psychiatrist, it may not make sense. And finding a psychiatrist who does therapy outside regular business hours is going to add a complication.

I would recommend finding a psychiatrist through your health insurance and having them manage your medications, and finding a therapist and paying out of pocket. There's a list of low-fee clinics here (PDF, scroll down to page five). If you can afford more per session, Psychology Today's Therapist Finder is a good resource.
posted by jaguar at 9:04 PM on September 16, 2014

I believe you can get linked up with very low-cost therapy through OHSU, which might be worth exploring.

Beyond that, I second the notion that Kaiser's mental health coverage and care is not good, and probably not well set up to meet your needs. If you can get a doctor to prescribe medication in the Kaiser system and a therapist that's outside and more flexible that's likely to be a better option. That's what I do, anyhow.
posted by Kpele at 9:09 PM on September 16, 2014

And from what you've outlined, it doesn't sound like you're being a bad advocate for yourself and more like your scheduling constraints don't work with the inflexible Kaiser system. It may be helpful to realize that fighting harder probably won't actually get you what you envision in terms of care (psychiatrist providing therapy as well as med management, on evenings or weekends), and to instead focus on what's possible rather than what would be perfect.
posted by jaguar at 9:16 PM on September 16, 2014

Also, if you are female, please get your hormones checked, and your thyroid. There are several real life conditions that can present with panic attacks, and some doctors just slap the GAD diagnoses on you because they can't figure it out. It's normal to get these sort of features if you are going through perimenopause, for instance, and it's not a mental illness, it's a physical cause. And yes, stress can make it worse. Exercise is the key in any case, walking or other cardio, it does help. And make sure you get your Vitamin D and other mineral levels tested, potassium, magnesium, etc.
posted by Marie Mon Dieu at 9:34 PM on September 16, 2014 [2 favorites]

Portland has a protected sick time ordinance. Unless you have been at your job less than 90 days, you are legally entitled to some time off to go to a psychiatrist.
posted by aniola at 12:50 AM on September 17, 2014

Just wanted to reiterate that you need to find help outside of the Kaiser system. The push back you are experiencing is because of the way the Kaiser system is set up.

They have cut most of their mental health services and now only provide classes for managing basic mental health issues. You may find those helpful if you haven't been through the material before, so I'd recommend taking advantage of that since it's covered.

I've had Kaiser 'insurance' for years and have had the same experiences you describe. You will not find the care you need through Kaiser. If you are looking for a list of Psychiatric resources and are having a hard time finding them online, call a non-Kaiser hospital and ask them to tell you what's resources they know about in the area. Call every number they give you. Ask each office about rates and sliding scales and availability, then ask them for other offices that you can call.

Once you hit the medication combo that works for you then you can stop visits with the psychiatrist you find and move the maintenance and RX duties back into Kaiser. That way at least the psychiatric care is a finite cost.
posted by grizzly at 6:59 AM on September 17, 2014

Kaiser just got a write up regarding their abysmal mental health care, plus I have a couple of friends who work there who say the article doesn't EVEN touch the dysfunction there.

I would go outside their system and just find someone on a sliding scale (which, I think, is most people.)
posted by small_ruminant at 7:43 AM on September 17, 2014

I agree about looking for therapy outside of Kaiser. The behavioral health center by me has *massive* turnover and is incredibly uncommunicative, which makes dealing with them for therapy extremely frustrating. I also personally haven't had any luck with their therapists, which probably shouldn't be a surprise because they give you no way to learn about the therapists on staff (specialties, etc) beforehand. (Though all the therapists seem to be LCSWs, and can't prescribe). I tried the behavioral health center out initially but gave up and looked elsewhere. The process sounds similar to what you're dealing with.

Kaiser's CBT classes are fairly good, though, if you want to try that out (they're pretty standardized across medical centers and regions, it seems like). At my medical center, they offer some on nights/weekends, so hopefully they would work better for your schedule, too. I also don't think that there's a copay (maybe that's just in some circumstances/for some classes, though?).

For the psychiatrist and prescriptions, I would go through Kaiser to take advantage of the relatively low cost and ease of access. You can also communicate with your psychiatrist via email (on the Kaiser site), so if you need any changes to the medication, she'll probably be fairly responsive. As far as I know, you just need to get a referral to the psychiatrist through the evaluator (I think you probably got one?), and then you have one appointment with the psychiatrist in order for her to decide what medications to give you, and possibly a follow-up if things don't go well (though you might deal with that via email, too). So even though the psychiatrist is probably going to be working the same 9-5, M-F schedule as everyone else at the center, hopefully that won't be as much of a scheduling issue.

Be aware, though, that Kaiser seems to rely really heavily on generics rather than brand-name drugs (for all drugs, not just psychiatric drugs). I'm not sure whether you can get brand-name drugs if you request them specifically, but personally, I've always received generics from Kaiser no matter what the issue.
posted by rue72 at 8:22 AM on September 17, 2014

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