Which mental health provider - religious but speedy or nicer but slow?
May 12, 2019 11:03 PM   Subscribe

I could use some advice/input on some mental health providers I’m figuring out…. one is weirdly religious but more helpful, the other is annoying and bureaucratic but might be a good fit, and I’m having a hard time deciding what to do.

I’m currently going through the process of getting diagnosed with ADHD, and thanks to some shenanigans on the part of the local health conglomerate I was working with to start, it’s been particularly drawn out. Without getting too far into the weeds, the current situation is that I currently hold two sets of appointments for testing, but am not sure what to keep.

The first is with an outside-of-my-conglomerate (but still in-network) provider I was referred to when a within-conglomerate psychiatrist appointment was cancelled due to (I think?) not having the correct referral. However, I didn’t realize until I started filling out paperwork that they wear their religion on their sleeve (Ichthys fish replacing a period in their logo, various mentions of their strong Christian values, my testing contact providing Bible quotes on their page). I don’t have a huge problem with their existence or anything, but I am not religious personally, and am a bit wary of psychological counseling for issues I have coming from someplace religious/potentially conservative when I generally have fairly liberal/heathenistic values. On top of that, if I were to be prescribed ADHD medication, I’d be subject to random drug testing from a lab of my choice, which while not a current problem, feels very invasive to me. However, my intake appointment went well and did not touch on religion at all, and they seemed much more helpful and proactive in setting up appointments for me, which was a refreshing change from being dicked around by my health system’s call center.

The second is with a psychologist who is within my current health network. We clicked fairly well - he recognized the hoodie I was wearing and we chatted a bit about video games and Kumail Nanjiani - but his availability is much less, and setting up mental health appointments within the health network has been a real PITA in the past. And the first appointment I have for actual testing is after I would know results from the weirdly religious place, and I wouldn’t have actual results until a month later, at a point in my life where I feel overwhelmed on a near-daily basis and just want to know one way or another and find help.

So I’m stuck between a place that seems more easy to get results from, but gives me off-putting and controlling vibes; and somebody that meshes well in our first hour, but going with might be more difficult to deal with longer-term. My presumption is that my health insurance will be okay with multiple intake appointments but multiple testing appointments back-to-back will cause problems.

One possibility I have considered is to continue the testing with the first provider, and once I have an answer, avoid their therapists/psychologists; possibly allowing myself to see their psychiatrist, until I find another. (This would involve possibly consenting to an initial drug test to start on medication, which I’d pass, so it's not a huge deal.) This feels okay to me, because testing and prescribing medication don't seem to have as much room for values I oppose to sneak in as counseling/therapy. I do wonder if the friction + my ease of falling into complacence makes this a bad idea, though.

Or, perhaps I am just being too impatient and I should hold out for the longer appointment with the psychologist that clicked better, even though appointments require long waits and battling against bureaucracy and failed referrals?

A third option might be to abandon both systems and look for another; though at this point given I already have testing appointments set up, that seems excessive. Or maybe my assumption that I can't do two of these tests is wrong and I should just go ahead and leave both appointments set up in case something goes wrong with the first provider.

I realize that there might not be a 100% right answer here, especially given the limited information folks have. But I’m also just going around in circles in my head given the limited experience I have dealing with mental health providers, so any input folks have on the above questions would be welcome :)
posted by anonymous to Health & Fitness (13 answers total)
My suggestion would be to continue at the first place at least until you have a diagnosis/evaluation/paperwork, and find somewhere else if the fit starts becoming a pressing issue for you.

Lots of people have had lots of different experiences, but my own experience (as a US-based person with an ADHD diagnosis that stemmed from a lot of testing and evaluation as an adult—full IQ thing, questionnaires sent to my parents, etc.) is that since I've had it, and had a history of taking the medication, it's been very easy to find a place to continue treatment whenever I move around or my insurance changes. At first I carried their big report about my dumb brain with me whenever I went to see a new pyschiatrist, but honestly nobody has actually asked me for it.

I don't think I've actually spoken to the psychologist who evaluated/tested me since I received his evaluation. It was just a one-time thing.
posted by Polycarp at 11:12 PM on May 12

I would absolutely not go to the first clinic. I would cancel the appointment with them, keep the appointment with the place where you clicked, and keep looking for a place that you feel will understand you and help you ASAP. Keep the urgency when looking for help with your mental health, but don’t accept substandard care. The drug testing IS invasive and suggests your treatment can be linked to their judgement of whether or not you deserve it.

Getting treatment for mental health can be scary and requires bravery and trust. I would prioritise working with people I feel good about over just about anything else, because bad or misleading treatment can set you back.

I wouldn’t even get a test through the first place. Tests for mental health disorders can sometimes be misinterpreted and or miscommunicated. It’s not like a chemical blood test done in a lab, so you have to have confidence in the people doing the testing!

Good for you for seeking help! I hope you find very good care and your journey is bright and helpful. You deserve that!
posted by pazazygeek at 11:34 PM on May 12 [14 favorites]

Agreed that the testing is not exactly objective (there are different kinds of tests around, for one thing, that don't all seem based on the same understanding of ADHD). So I personally wouldn't go to the first place because I'd wonder why they saw fit to include their religious values in a health care enterprise, and whether those values inform their diagnoses and treatment to any extent.

I would look into whether a third option exists, because why not, and otherwise go to the second one for the first stages and keep looking for a more convenient option to switch to. Or see how much a private evaluation costs and whether I could afford it (probably more realistic if you're not in the US?)

Depending on where you live, is there any chance your GP can diagnose/prescribe for you?
posted by trig at 12:24 AM on May 13 [1 favorite]

The initial niceness is part of the con, avoid the Christian themed place. You do not want them having any control over you, and the drug testing thing sounds ominous.
posted by Meatbomb at 1:57 AM on May 13 [10 favorites]

I've had bad experiences with religious providers and would be asking alot of questions (do they treat medications as a last resort option, do they expect spiritual participation, etc) especially with the overt religious advertisement. I would fear that they would recommend alternative to medication even if the testing came back with the ADHD diagnosis, and that the drug testing is a delay. (This is my unchartible opinion. I have recieved counseling through religious organizations in the past (not medications) and had one phemonial therapist and one who just wanted to pray my PTSD away, so it is possible to recieve good care but I feel like when it goes wrong it goes very very very wrong.

I've heard of drug testing for pain management, but not for stimulents, mostly because stimulents leave your body really quickly anyway, and it's not necessary to take them every day. Check with your insurance, your insurance might not cover the drug test, so it could be out of pocket for you.
posted by AlexiaSky at 2:39 AM on May 13 [2 favorites]

From what a friend of the family friend who was love bombed into an evangelical cult(a fellow member) has been posting on fb, medical treatment for mental health is discouraged and substituted with prayer. Nthing avoid.
posted by brujita at 5:16 AM on May 13 [4 favorites]

I wouldn’t necessarily have a problem with the Christian place, depending on the area of the country you’re in, it’s not a huge red flag on its own. My mental health provider right now is Christian, and it only came up because I brought up my own belief one day and since it’s important to me, she started incorporating it. But never replacing actual science with prayer. However.... the drug testing seems weird and invasive to me. You’re getting ADHD meds, not going to addiction recovery. So I’m not sure why they think that’s even in the realm of being appropriate. That’s the red flag to me.
posted by katypickle at 5:24 AM on May 13 [3 favorites]

I’d be subject to random drug testing from a lab of my choice

Check with your insurance and make sure they actually cover this. It is not always considered to be medically necessary and therefore may be a thing you actually have to pay out-of-pocket.
posted by Sequence at 5:33 AM on May 13 [5 favorites]

On top of that, if I were to be prescribed ADHD medication, I’d be subject to random drug testing from a lab of my choice,

NO NO NO NO NO. This is not standard of care or anywhere close. Hard pass.

I'd just go to a psychiatrist directly, TBH. Extended testing is a bit of a con; it's not really evidence based or objective.
posted by internet fraud detective squad, station number 9 at 5:38 AM on May 13 [6 favorites]

Religion in psychiatric care is the reddest of red flags. This place could be ok- it could also be a cult-y "pray-away-the-ADHD" nightmare. The drug testing also seems super-sketch. AVOID
posted by Homo neanderthalensis at 8:45 AM on May 13 [3 favorites]

I should add, I don't think the drug testing thing is necessarily religious; I had a previous psychiatrist do it who was not a part of that kind of a practice at all. The random drug test thing started with opiates, and in some places at least is legally required for that, and some doctors seem to have decided it's a great idea to extend to other regularly-diverted substances? I don't like it, as a practice; it's only that it's not just them.

But, privacy aside, it can easily cost hundreds of dollars extra to have medically-unnecessary labs done, and that's where I'd 100% go with the other practice over the potential for surprise lab fees. Make sure you know how much of that cost is on you--whether it'll be covered, whether it will be paid out by your FSA or whatever if you have one, whether it'll apply towards your deductible, all that.
posted by Sequence at 9:23 AM on May 13

The random drug test thing started with opiates, and in some places at least is legally required for that, and some doctors seem to have decided it's a great idea to extend to other regularly-diverted substances? I don't like it, as a practice; it's only that it's not just them.

Right, and expanding on this, this is because unethical (and, frankly, abusive) clinical practices are standard when clinicians are dealing with those people. Seeing your ADHD patients as "those people,"---meaning members of a subaltern class of drug users who one is entitled to subject to invasive procedures for no clinical purpose---is a huge red flag. (Seeing anyone as "those people" is a huge red flag but that's neither here nor there.)
posted by internet fraud detective squad, station number 9 at 10:19 AM on May 13 [5 favorites]

tl:dr Opinion: Christians might seem super nice, but I don't trust their judgement when my sanity and life are on the line, and I recommend that you don't either. The drug testing thing is bad too. Speed is not better, even if you are miserable, because the stakes are that high.

You deserve better than suspicious Christians.

The more I think about it, the more scared I am for you. But it could be paranoia, and I am not always right. Sometimes, I'm even wrong. Also I wrote this completely out of order, so the flow is odd. Sorry. But from what you said, it sounds like your subconscious doesn't like the Christian place, no matter how much you want to get this process going.

THERE IS NO OBJECTIVE DIAGNOSTIC TEST FOR ADHD. There are evaluations, but it is a diagnosis based on interview and observation, which is generally confirmed by a person's reaction to medication. This is important because there is at least one diagnosis that fits a lot of the presentation of ADHD, is less risky for a practitioner to make, and it is hard to get rid of once it is on your record.


If anyone says it, then you're treated for that first. Every future practitioner will have to consider it even if they're 99% sure that you have ADHD. The drugs for bipolar are not nice, but they're sure strong. Mostly mood stabilizers and antipsychotics. Lots of side effects, and it sucks to be on them almost as much as it does to taper off of them. But hey, they're more FDA and DEA friendly than stimulants!

Assuming that you're in the US, in the current political situation with the right to refuse a patient health care or treatment if the religious beliefs of the practitioner somehow disagree now being officially endorsed, can you honestly say that you want the openly Christian place to be the one that decides this for you?

Do you want to let people who think that bible quotes and an icthys logo are good and reasonable advertising for the treatment of mental illness in 2019 have this kind of power over your care?

Signed, a person with ADHD who has walked the painful and time-consuming wrong bipolar dx path with a good practitioner, and who is currently helping a friend with ADHD who is having to come off of an inappropriately prescribed antipsychotic, and may still have a couple of mood stabilizers and another miserable drug to go before their new psych will actually treat for ADHD, who was treated at a couple of clinics that sound a lot like that Christian place. Including the drug testing. This was a policy the last clinic used punitively when my friend's coverage changed, so my friend would have had to pay several hundred dollars out of pocket for a battery of drug tests to get a refill written for a prescription that if abruptly discontinued at the dose my friend was taking would have caused incredibly bad withdrawl, and the fallout would have ruined my friend's life. It didn't go that far, but it easily could have.
posted by monopas at 9:21 PM on May 13 [1 favorite]

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