Mental Health How do we hold our MH providers more accountable?

[Jerry Atrick]

After a brief conversation with @deficiT about therapists, I realized a lot of us may have some of the same problems. I told him I once had a therapist who would only meet with me for 10 minutes yet was billing my insurance for a full hour. After a lot of sessions like this, I was beginning to get frustrated but then my therapist suddenly died in his sleep. So I was never able to resolve the issue with him.

In the end, whether it is a therapist or psychiatrist, we pay them for a service. So what do we do when they are no longer fulfilling their obligations as a provider? Sometimes quitting that person and finding a new provider is not a viable option. What can we do as patients to leverage our voices and make sure we are heard?

 

[VerbalTruist]

I will have a serious think on this and come back to it.

 

[gibberish-noise]

quit and don't find a new one??

i jest

 

[gibberish-noise]

In all seriousness, I can't say I have a good answer to this. At the moment I'm about to take treatment for one last half-arsed spin before I bin it for good. Been through the revolving doors enough. Call me cynical. Too many negative experiences to feel hopeful for myself, but I'm sure others will have differing experiences and with the right support (or despite the lack of it) can turn their lives around.

 

[n3ophy7e]

I once had a therapist who would only meet with me for 10 minutes yet was billing my insurance for a full hour.

I once had a psychiatrist like this. It only took me 3 sessions to cotton on to what he was doing though, plus everything he said was absolute rubbish, so I stopped seeing him pretty quickly.

Otherwise I have been pretty damn lucky with MH therapists. I only had one other psychologist who was absolutely useless, but I only had one session with him and knew straight away it wasn't going to work out with him and never went back.

BUT I definitely know and appreciate how common it is for people to struggle with not having access to good therapists, and sometimes not having the ability to switch to someone else (be it due to insurance company reasons, location reasons, financial constraints etc etc.

As VT said, I am going to have a think on this and maybe come back with further comments.

 

[Jerry Atrick]

quit and don't find a new one??

i jest

I know you made this comment in jest but other readers may feel it with less jesting, so I will still address it. About a decade ago I was on a pretty tight income and had Medicare coverage. I could not afford private psychiatrists but qualified for an indigent program at a mental health clinic in my town. At that place, I never had the same psychiatrist for consecutive monthly visits. There was a rotation of 3 of them I believe. When I was a member of that particular clinic, I did not feel I had the chance to change psychiatrists without leaving the program completely. So quitting and finding a new doctor was much easier said than done. I felt trapped for a few years until I got a job that brought private insurance. And with private insurance, the ability to change providers more often.

 

[Jerry Atrick]

In all seriousness, I can't say I have a good answer to this. At the moment I'm about to take treatment for one last half-arsed spin before I bin it for good. Been through the revolving doors enough. Call me cynical. Too many negative experiences to feel hopeful for myself, but I'm sure others will have differing experiences and with the right support (or despite the lack of it) can turn their lives around.

Best of luck on your new journey through the system again. I hope it works out for you. Please keep us posted how you are doing.

 

[Jerry Atrick]

I once had a psychiatrist like this. It only took me 3 sessions to cotton on to what he was doing though, plus everything he said was absolute rubbish, so I stopped seeing him pretty quickly.

Unfortunately, I have grown to cut my psychiatrist more slack than any talk therapist. The reason being, I don't have an hour's worth of material to talk about for him to be able to do his job well. My therapist OTOH owes me an hour of jibber jabber.

Otherwise I have been pretty damn lucky with MH therapists. I only had one other psychologist who was absolutely useless, but I only had one session with him and knew straight away it wasn't going to work out with him and never went back.

Although I have had bad MH experiences, my good ones outweigh the bad ones and I also feel like I've been pretty damn lucky in the long run.

BUT I definitely know and appreciate how common it is for people to struggle with not having access to good therapists, and sometimes not having the ability to switch to someone else (be it due to insurance company reasons, location reasons, financial constraints etc etc.

This is the main thing. I have tried being honest with different providers about certain aspects of my journey, sometimes I got burned and sometimes it accomplished what I wanted to accomplish. I mainly wanted to open a conversation about whether it is okay to talk to a psychiatrist candidly about how we think they are doing. Like, rather than firing them, if we think they have potential, then verbally putting them in their place so to speak.

 

[Jerry Atrick]

Been thinking nonstop about this. I even told my psychiatrist this yesterday but of course he ignored it maybe because he knows it well.

It's so pathetic and pitiful - if you're diabetic you do a simple exam (maybe not even that, just expose your pee to ants) and you learn that you have to reduce your sugar intake and you will be fine, if you have high blood pressure you do a simple exam and try maybe 3 or 4 pills at most and you're good to go, etc. But if you have a "mild" mental health issue bugging you loads you are, almost invariably, going to seek at least five docs, the first four will try to push some shitty drug they get paid to prescribe, and it's a different drug each time and you gotta pay for it and try to figure out why it is not working, and then the fifth actually bothers to listen to you, and then you have to try ten more drugs because it's trial and error - you know exactly how you feel and who you are and which of your reactions and symptoms are off and technology is so advanced even Facebook knows your issues, but it's still trial and error with drugs that often impair your functioning a lot both long and short term and make you an even bigger mess physiologically and psychologically on the long run and you're just expected to suck it up and keep working because otherwise how tf are you paying those expensive bills??? And if you tell your boss you have a mental health issue God forbid you lol. You say you want to get imaging exams done and it's always "lol don't bother you won't find anything" - like, excuse me, maybe I will dude. Fuck off. And if the patient dies of it after years of treatment - it isn't the doctor's fault but rather the patients' . Weak minded piece of shit. /S all you need is help figuring out what is so wrong about you - fine adjustments but nooo, the crazies can't have agency lol they are too DISRUPTIVE for that. I do not believe in mental health anymore - I know my issues are money issues. I don't have power so I display a nice personality and suck things up to avoid trouble and try to get ahead in life (cuz those health bills gotta be paid ...) But I would not have migraines if I took less shit. I would not be bullied for being weird if I punched a couple of fucktards in the face. I wouldn't have to deal with manipulative bastards in my office if I had more free time to plan things out. But that shit takes money too because I overwork my ass ... So there. Of course my brain can't take this anymore. I know it but fucking docs won't even acknowledge that all I have is a money issue and instead push the "you will never feel fine unless you can afford a treatment" discourse obviously Being "neurodivergent" is really the last of my issues. Having to try a lot of drugs because the "basic" ones make me feel like shit but I still gotta find ways to pay the bills and not literally lose my mind is an issue

Thank you for replying. I am sorry you have had so many negative experiences. During the first few years of my journey, it certainly felt like "trial and error" was the only way the doctors would work with me. It was like, if the medication works, you get this diagnosis and if it doesn't work, you get a different diagnosis. Very frustrating to say the least.

Do you mind sharing more about the migraines? Are they caused by something your doctor is prescribing you? Or are they from using or withdrawing from drugs not prescribed to you?

 

[Jerry Atrick]

Aw, thanks, really. Yep, it's exactly this. Worse yet, they don't seem to believe what I have to tell them sometimes. And I am sitting here staring like "yeah, I know being ND sucks, I have been doing this for a while now" lol. I never had the amount of money needed for a proper long treatment and honestly I still don't but I am trying my best now because idk how I will get money from now on, since I miraculously got an okay job but I can't even keep it because of impending dpdr episode and shit. Whoops.

Neither I believe. Wasn't on anythin when I started having them - only really stressed out from a busy-ish routine. But being used to my brain pulling lame tricks on me lol I was like hello darkness my old friend. Never did illicit drugs or alcohol either - I am impaired enough as is and this is exactly why I DESPISE trying meds. I know my brain isn't amazing but I worked damn hard on this.

Since it's pretty clear that I have been impaired for fucking ever and I am pretty sure I have some kind of neurodevelopmental disorder (and at the very least I DO have still undx migraines w aura ...) I decided to seek a neuro and get an MRI and an EEG done. First thing the (expensive ass - way more expensive than imaging exams not even counting the meds ...) psychiatrists had to tell me: "okay, do whatever you want"? Nooo, it was "you think that's gonna help?" Lol. The way they hate the idea that a poor patient wants to get better instead of becoming a drug junkie and ending up in a mental health institution is hilarious. By which I mean criminal

I understand that you want to remain medication-free but I honestly don't see how that is possible considering you are seeking psychiatric help as well as help from a neurologist for the migraines. You seem very self-aware and in tune with what your mind and body tells you. I know the prospect of entering a mental hospital seems scary at first but the experiences one picks up in mental institutions are not that bad. Most people are not in one for longer than a week at a time. Lord knows I've been through more than a few of them.

Yes unfortunately there is a social stigma associated with seeking psychiatric help (psychiatrists, mental hospitals, and medications), but the benefits usually outweigh any perceived negatives in the long run. The only catch is that one has to trust the process in order for it to work. And I'm not saying you have to do any of this. Only saying that it's not as bad as you think. God forbid you find a pill that works and improves your quality of life.

 

[negrogesic]

After a brief conversation with @deficiT about therapists, I realized a lot of us may have some of the same problems. I told him I once had a therapist who would only meet with me for 10 minutes yet was billing my insurance for a full hour. After a lot of sessions like this, I was beginning to get frustrated but then my therapist suddenly died in his sleep. So I was never able to resolve the issue with him.

In the end, whether it is a therapist or psychiatrist, we pay them for a service. So what do we do when they are no longer fulfilling their obligations as a provider? Sometimes quitting that person and finding a new provider is not a viable option. What can we do as patients to leverage our voices and make sure we are heard?

As far as psychiatrists are concerned, these days insurance often only covers medication consultation. Years ago, psychiatrists used to do some degree of psychotherapy, but insurance stopped covering it (probably because evidence of its efficacy doesn't really exist).

And, years ago, psychiatry had a certain allure that brought in bright minds to the field. These days however, psychiatry is one of the least desirable medical specialties, and brings in the lowest performers.

I bet big money that the mean MCAT and licensing exam (USMLE) scores are among the lowest in recently minted psychiatrists.

 

[Jerry Atrick]

As far as psychiatrists are concerned, these days insurance often only covers medication consultation. Years ago, psychiatrists used to do some degree of psychotherapy, but insurance stopped covering it (probably because evidence of its efficacy doesn't really exist).

And, years ago, psychiatry had a certain allure that brought in bright minds to the field. These days however, psychiatry is one of the least desirable medical specialties, and brings in the lowest performers.

I bet big money that the mean MCAT and licensing exam (USMLE) scores are among the lowest in recently minted psychiatrists.

Yeah, it's been a long time since I had a younger psychiatrist. My current one is older and pretty old school. He offers psychotherapy but I prefer to keep my medication maintenance separate from talk therapy.

And I say fuck insurance companies. They only act as middlemen to take money off the top and try to direct our lives in terms of profitability. But I understand how much power the insurance companies have and try to navigate their broken system as best I can.

 

[Jerry Atrick]

Nah meds aren't an issue for me if they work, see. I take painkillers and ergots and such to deal with tougher pain obviously ... But most psychiatric drugs don't really work, I feel. They make you feel things you don't really feel logically which is why I am not into psychotropics in general - I mean, I am much more one for self-improvement and natural solutions for moods ... Or monopharmacy at most for extreme situations. This tendency of polypharmacy and it's always meds that interact with each other and fuck you up in the long run in ways they don't even know yet (congrats - YOU're the experiment!) ... Ugh. But to each their own, right lol? I don't diss people who take meds / drugs therefore I hope they'll respect me too.

Even so I did try a couple of meds, they sucked. Can't count on a hand how many times I felt stuff I wasn't supposed to feel / should be a rare side effect or at least not feel so disabling and I didn't even try that many lol. You are right, I AM quite attuned with my own feelings / sensations - learned to do so to remain alive & rational - so it feels like psychiatric meds just... work TOO MUCH for me. Like I just need a fine adjustment or a push if you will and I take a med and suddenly everything feels different and hard to readjust to because I am like this ... I don't like that so I quit. It's not a bad trait IMO, since it doesn't take a lot to make me feel better (generally, changing my routine or eating habits helps ; or even aromatherapy / chromatherapy / arttherapy etc. ) - it's only bad if they try too hard to get me into meds ... again they work for some people so yeah great for them. Like, enjoy yourself. .. me? Nah I go to psychiatrists when I can't function and always leave less functional lol. I hate "pills for feeling better" because I don't feel better on them is all. Again, if you do - that's nice. It really is. Jus wish they weren't so keen on selling them because they really fuck up some of us.

No worries. Like I said before, the process will not work if one doesn't trust it. I've been prescribed meds that had some crappy side effects that actually went away after a couple months. Here's the thing, I would never have known the side effects went away had I quit immediately before giving the meds a chance to work.

In the psychiatry business, we are the customers and in the end, we should be the ones who have a say not only in what we are prescribed but what dosages as well. If your body is sensitive to medications, then it is up to you to communicate this with your doc and ask for smaller doses than what they would normally give someone your age and weight. I'm not saying you should go take all the meds now. Hopefully just giving some food for thought.

 

[negrogesic]

Had too look it up and yup, psychiatrists test at among the lowest end of the spectrum:

 

[gibberish-noise]

I know you made this comment in jest but other readers may feel it with less jesting, so I will still address it. About a decade ago I was on a pretty tight income and had Medicare coverage. I could not afford private psychiatrists but qualified for an indigent program at a mental health clinic in my town. At that place, I never had the same psychiatrist for consecutive monthly visits. There was a rotation of 3 of them I believe. When I was a member of that particular clinic, I did not feel I had the chance to change psychiatrists without leaving the program completely. So quitting and finding a new doctor was much easier said than done. I felt trapped for a few years until I got a job that brought private insurance. And with private insurance, the ability to change providers more often.

good response, however I think you may have misread it:

quit and *don't* find a new one

 

[Jerry Atrick]

good response, however I think you may have misread it:

Ha! How did I miss that?

 

[Jerry Atrick]

Yes, I know. But I can't afford to risk it, by which I mean my brain - I don't have much going on for me except for it and I know how flawed / "weak" it is (well maybe not my brain but my nerves.. something for sure. ) by nature so eh

Thanks. Nah if docs were this understanding in general I wouldn't have a problem with them. I don't like doctors in general, but psychiatrists ... Are the worst. What bugs me the most is this - we are sane enough to pay for a service but not enough to have agency over it/ourselves (tired of hearing - you sure you felt this? never heard of it etc. I end up throwing scientific articles at them to prove my point, wtf. ) how come? I am really damn tired of being gaslit and whatnot. They know how close to the edge you are so they go ahead and push you, because meds lol. It gets REALLY bad when you are a young woman too. Young women just have this old reputation for being neurotic and shit. Yes I am neurotic just like everyone else, this isn't what I need help with though...?

But I digress lol. Just like I had many bad experiences I am sure others had good experiences - in the end it's just that. But when you have a mental health patient and a psychiatrist it's clear who is in a position of power and no amount of rightful complaining can change that and if you're bad at expressing yourself or communicating because you are tired to your bones of trying they will assume it's a brain issue etc (and I am tired of being misinterpreted ...) so for me, eh, I rather avoid them altogether

That sounds awful and I'm sorry you've had so many negative experiences. Of course it is your right to not seek out psychiatry. Best of luck to you.

 

[gibberish-noise]

Ha! How did I miss that?

Confirmation bias? Sleep deprivation? Attention drift? The world may never know.