How to get help during a mental health crisis?
June 24, 2016 7:18 AM   Subscribe

I'm dealing with a double career/relationship situation that has completely "destroyed" me. I'm eating and sleeping; I have savings for several months, and I'm not going to hurt myself or anyone else. But, I'm nonfunctional, going in circles, suffering terribly, and I want it to stop, and I want to move on with my life.

I have catastrophe insurance with a huge deductible, so paying for weekly therapy would really eat into my savings quickly, but I might have to do so anyway.

When I can talk to someone, it really seems to help. But, I feel like I've drained my parents and friends with basically saying the same things over and over. Their responses are more and more curt, and it's just not fair to them.

So, does anyone have any suggestions for what to do? Group therapy? Sliding scale therapy? I don't know where to begin.

I can handle general suggestions, but I'd be grateful for step-by-step.

I'm currently in a suburb of Chicago. I have access to a car and the city.

posted by zeek321 to Health & Fitness (17 answers total) 7 users marked this as a favorite

St. Joseph's (lakeshore and diversey in the city) has an intensive outpatient program. If you go to their ER, they'll get you in. I recommend the program wholeheartedly.

I wish you luck.
posted by Ms Vegetable at 7:25 AM on June 24, 2016 [1 favorite]

I sympathize lots with how you feel. Been there. I wonder if you are near a family service agency. Here's a link to one with centers in and around Chicago. Typically such agencies offer counseling on a sliding scale. You might also look into nearby universities with counseling centers staffed by grad students--you can see someone for less money bc they are in training--and they are supervised well, so the therapy is good, on the whole. I wish you tons of luck.
posted by sister nunchaku of love and mercy at 7:27 AM on June 24, 2016 [1 favorite]

St. Joseph's (lakeshore and diversey in the city) has an intensive outpatient program.

What happens in one of these?
posted by zeek321 at 7:28 AM on June 24, 2016

I would read "When Things Fall Apart" and I would get one of the apps for depression or anxiety that tracks habits so that you're keeping the basics taking care. I used Daily Feats. If you're not working, I would sign up for a class online at Coursera. I would not randomly be on the internet all day. Have you seen the research on how playing tetris helps with trauma? Play some tetris.

Honestly, finding a good, healthy, qualified, well-boundaried therapist that you connect with is really hard. Then, getting to the point where therapy helps, takes time. I would actually go see a psychiatrist to get evaluated (estimated $300) and get some medication support to get through the acute phase. In my experience it is bad for you on every level to allow yourself to stay in a state of acute distress. So, I would get yourself evaluated.

My psychiatrist describes it as getting a cast. When you have a crisis the medication can serve as a cast while you do some healing so you can then help yourself. I used to be appalled at the idea of medication. Then I learned how bad it is possible to feel and not die.

If you're interested in group therapy the psychology today website lists some.
posted by orsonet at 7:34 AM on June 24, 2016 [3 favorites]

Most intensive psychiatric outpatient programs provide a block of daily 3-5 hour structured treatment that consists of various combinations of group and individual therapy as well as diagnostics and medication and case/services management. The better ones also provide services for comorbid medical issues that impact mental health and/or a person's ability to effect self-care as part of an overall treatment plan. The primary advantage of outpatient psychiatric programs is that you get the more cohesive and directed treatment team modality without the locked doors. Outside of this structure many people end up with multiple treating professionals (ie: GP, psychiatrist, and LCSW) who do not directly interact.
posted by xyzzy at 7:43 AM on June 24, 2016 [4 favorites]

St. Joseph's IOP is a morning-only, outpatient program. It was structured in 3 blocks when I was there. First block is check in with the entire group - what's going on, how do you feel, anything the therapists should know about, stuff like that. Second block was studying about one particular thing - could be art therapy, could be a new coping strategy, could be identifying patterns in thought processes. It depends on the day and who is running the session, what people in the group need, etc. Third block is problem solving. One person in the group presents a problem they're having, the rest of the group brainstorms on how to solve it.

One of the greatest benefits, to me, was not feeling alone. There was a whole group of people who had problems, and we could all help each other. Yes, that sounds hokey. Whatever.
posted by Ms Vegetable at 7:49 AM on June 24, 2016 [1 favorite]

Trying not to thread-sit. Re St. Joseph's IOP, I surprisingly got voicemail and left a brief message. Any guesses as to what that would cost per day?
posted by zeek321 at 7:55 AM on June 24, 2016

Can you get on and buy a plan? It may be cheaper than you think to find one that gets you down to a low copay per visit for therapy and your regular doctor. You may need therapy more than once a week at this point.

Alternatively, you may be able to find a therapist with a sliding scale based in income. Their websites may have this info.

Yes, take the emergency advice above and try to get into see someone asap.

If you share which part of the suburbs, we may be able to give specific therapist recommendations.

Finally, please implement a schedule for yourself in this time. Please go for a half hour walk at the same time of day most days. Try to volunteer a couple days a week for a few hours if you can a mange it.
posted by Kalmya at 7:58 AM on June 24, 2016 [4 favorites]

Sorry, if I were you, and able, the first thing I'd do is get onto and try to get insurance that would cover therapy. Then proceed to get lots of therapy services in the afternoon.
posted by Kalmya at 8:03 AM on June 24, 2016 [1 favorite]

My insurance (gosh I miss Blue Cross) covered all of it. I think it was $4000 the first time I went for maybe 15 sessions? Something like that. Not cheap. But worth it.
posted by Ms Vegetable at 8:16 AM on June 24, 2016

Oh also the voicemail doesn't surprise me - IOP is in the morning, so they're focused on the patients there right now. I think they respond to phone calls in the afternoon.
posted by Ms Vegetable at 8:17 AM on June 24, 2016 [1 favorite]

another option that might be worth a few minutes of your time would be calling the customer service number on your insurance card and asking them what mental health services they would cover, how much the cost would be for you out-of-pocket, and generally what your options are. might help point you in one direction or another!
posted by carlypennylane at 9:31 AM on June 24, 2016 [1 favorite]

Allow me to take a few liberties with my answer by saying that what you should do, is nothing. I don't have any concrete suggestions but I just wanted to tell you that it's okay to be nonfunctional and going in circles. That might sound weird but what I'm trying to say is that with whatever tragedy (ies) that have recently befallen you, you don't need to add to that burden by shaming yourself about not being 'productive'. You say you want to move on with your life, but processing horrible things takes a long time.

You can't just move on from them-- they change you. If you're lucky, processing horrible things will deepen your empathy for others and, on the flip side, increase your ability to feel joy and love, eventually, one day down the road. Maybe you are grieving an unimaginable loss. This can shatter your definition of 'normal' and make you feel like a freak, but you're not. You've just been handed a very large burden at the moment.

I've been in a crisis situation where I wasn't able to access therapy due to the prohibitive costs. I made it through by moving in with my mother and doing nothing for 6 months and then taking my life in a whole different direction by trying new hobbies and meeting new people. But only after my body forced me to take the time to grieve. Grief feels horrible but it can teach you a lot if you let it.
posted by winterportage at 11:05 AM on June 24, 2016 [1 favorite]

You can to someone for free online here:

You can blog or journal to rehash it to your heart's content without imposing on anyone in particular.

My experience: Endless rehashing is often rooted in either exhaustion or OCD tendencies. Improving your hygiene and nutrition may reduce this tendency, as well as your general feeling of being stuck and going nowhere.

Set goals and find metrics to measure. Use ones that are milestone or benchmark related, not deadline related.

This can be things like "It now only takes me six hours after I get up to get showered and fed and dressed so I can go buy groceries instead of eight hours."

Once you have your goals and your metrics in place, learn to keep yourself harmlessly occupied. I call this a policy of bread and circus. Play games. Watch videos. Do things passive that your current energy levels and cognitive function can handle.

Because the odds are really high that fixing your problems involves like five minutes to an hour a day of actively working on the problem, and 23+ hours of laying there exhausted afterwards. So if you did The Thing you need to do that day to move closer to your goals and there is nothing more you can constructively do, the most important and valuable thing you can do is keep yourself entertained so you aren't climbing the walls and aren't tempted to do anything stupid and counterproductive. Then get up the next day and rinse and repeat until you are doing two hours of useful stuff a day, and then three, etc.

This will not be a linear progression. It will be bumpy and you will need to keep tracking your metrics because it will be two steps forward, one step back. And after you get used to doing two hours of useful stuff a day, when you have one of those days where you only manage to be useful for five minutes, you will feel crushed and destroyed and hopeless. And that's when you pull out your metrics and remind yourself that six months ago, you only did five minutes of work every other day and things are still on track and getting better and some days you just need to rest.

And then you go marathon watch movies or marathon play games and try to enjoy it and refuse to feel workaholic guilt.
posted by Michele in California at 12:10 PM on June 24, 2016 [3 favorites]

write about it every day until you run out of stuff to say about it. write down all the circles you are going in, seriously. sign up for and go nuts, it's private. this is if you can't get therapy, or in addition to any therapy you can get.

try to get direct sun, take good care of your physical self, go on walks or runs, sleep enough, eat well, etc. do these things even if you can't job search that day. time passing will help, in the meantime try to take care of yourself as well as you can.

a short term anti-anxiety med Rx or anti-depressant Rx can also help you function if you can't get outpatient therapy. it can take the edge off physical anxiety symptoms and recurring, ruminating thoughts until time has passed enough that you start thinking about other things.
posted by zdravo at 1:09 PM on June 24, 2016 [1 favorite]

There is some useful self-help out there to take the edge off while you try to find a therapist. Reading or re-reading CBT classic Feeling Good, and doing the exercises, can help, even if sometimes the problems they talk about as examples may seem laughably mild. Albert Ellis has a whole bunch of CBT books as well. Get Out Of Your Mind And Into Your Life is another good one from a totally different perspective (more mindfulness-y). It can feel a little elliptical at times, but I think the techniques they teach (defusion, mindfulness, acceptance) are really helpful for learning how to interrupt and release rumination, worry, etc. Finally, I commented before about a method I was reading about that combines exercise and meditation for depression here; you might find that helpful too in the interim, since meditating and running are pretty low-cost interventions.

OK, so in terms of actually finding a therapist, I would run your finance numbers and come up with a number that's what you can afford for therapy right now for around twelve weekly 1-hour sessions. I would then find a list of therapists: sometimes you can find people on Yelp, of all places, but your insurance website may also have listings of professionals you can look through, so I'd start there if you can. Or maybe this listing on Psychology Today Chicago.

I would find a bunch whose blurbs seem moderately appealing. Also check out "modality": CBT/REBT for example is very concrete and focused on specific thoughts and behaviors, ACT/mindfulness is more based on meditation and on changing your relationship to your thoughts, and psychodynamic/psychoanalytic is more free-associative classic "talk therapy" and involves more e.g. delving into patterns of relating to people that you have that you may have picked up in e.g. childhood. Any of these should work if it's a good fit, so if you don't have strong preferences, that's fine. (You may also be surprised at what you end up liking.)

Then, send them the same pretty standard form e-mail giving your name, a small amount of (vague) background into what you need help with (what you wrote here is fine, you can just copy-paste it even), the maximum you can afford to pay per session, and the maximum number of sessions you can afford. Be sure to mention that you're really financially strapped and would be paying from savings. I would then close by saying something like "if you personally can't see me, would you be able to refer me to anyone else who would be able to treat me at this price point?" You may have to send out a few feelers before you get a lead, but in my experience a lot of therapists are willing to move somewhat on price for clients with no/shitty insurance, and even if they can't move quite to the point you need from them, they will at least have some knowledge about what the local lower-cost options are if they can't help you themselves.

Hugs (if wanted) and good luck.

(P.S. Generic SSRIs and SNRIs are also quite affordable, and they have definitely saved my bacon before. I'm not sure they offer a huge time savings over therapy, though, since most of them take several weeks to really kick in, and just like with therapy sometimes the first one you try isn't a fit for whatever reason. But they're certainly an option.)
posted by en forme de poire at 3:04 AM on June 25, 2016 [1 favorite]

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