I have a major axe to grind. That's right, "I'm mad as heckl and I'm not gonna' take it anymore!" Well, not to worry, I'm not gonna' flip out. But somehow I aim to do something about it. Maybe you can help. Okay, okay...here's what fried my bacon. And, no, that isn't me in the pic.
I got paged late this morning to assess a patient who's been having a tough time with anxiety and panic. So I get there and begin to work with this very nice 29-year-old woman who'd been an anxiety sufferer since she was 13. And, of course, depression had made an appearance, as well.
Not really part of my point here, but I always find meds interesting. She'd been treated over the years with a number of antidepressants and benzodiazepines. She's currently prescribed alprazolam (Xanax), .25mg PRN TID (as needed, 3x/day). She told me she typically takes two tablets per day. And for the past month she's been taking 20mg/day of paroxetine (Paxil). Her meds are prescribed by her primary care physician (PCP).
Okay, now for what really chaps my fanny. The woman had an appointment earlier this morning with her PCP in an effort to secure a paroxetine refill. See, the doc had only prescribed 30 days worth and she'd run out. And if you've experienced selective serotonin reuptake inhibitor (SSRI) withdrawal, especially from paroxetine, you'll know why she wanted a refill. Not to mention her anxiety and panic had been nasty as of late.
So does the doc take care of his patient by giving her a refill? By the way, whether or not you or I think paroxetine is good medicine is irrelevant here. Nope...he tells her to report as a walk-in to the behavioral health intake department at the hospital just across the street (where I assessed her), telling her she could receive counseling and meds services there. Oh, and before I forget...God forbid the doc give her a prescription for maybe ten days worth of paroxetine while she finds another source.
Sadly, when I looked at the referral, the doc had written a department/program that hadn't existed in years. Worse yet, though an assessment could certainly be provided free of charge, the facility doesn't even provide the kind of care the doc promised. And that meant I was going to have to refer her elsewhere. Two places, in fact...one for counseling and one for meds. Just what an acutely anxious person needs, isn't it?
And just for the record, the woman told me when she presented, acutely anxious, to the doc's office a month or so ago, she had to wait three hours before seeing him. And she knew at one point he was in the back eating lunch.
Is this an outrage, or what? I guarantee this doc had no interest in retaining this woman as a patient. And I'll double guarantee his disinterest was fueled by the fact that he couldn't deal with the complexity of an anxiety case and the reality that the woman's health care coverage was through Medicaid.
So he "streeted" her, even giving her a carelessly considered and written referral.
I share your outrage and have spent many frustrated days in the past trying to get good mental health care for a family member. I remember one day, a number of years ago, this family member went to our local ER (the hospital has a mental health department) because of out of control bipolar symptoms, including hallucinations and severe depression. He was told by the attending physician that he was having a psychotic episode and these normally went away after a few days. He was told to go home and check with the local mental health center the next day. (He was also on Medicaid). To make it worse, the next day the mental health center told him there was a month wait for an intake appointment and they also sent him home.
Luckily, this family member is doing okay at this point in his life, but he still struggles and still fights the medical community to get effective treatment.
It is a shame that those who need mental health the most are denied it because they do not have private insurance. But it is their condition that often prevents them from having full time jobs and access to private insurance. Medicaid patients are so often looked down upon.
Although there are many mental health practitioners (such as yourself) that genuinely care about patients and want to do all they can to help, there are also those that simply push patients aside.
We have a crisis oriented mental health system. We will treat, briefly, those people in crisis, get them stable and then abandon them. I have seen this happen time and time again.
I hope that sites such as these will open people's eyes, give information so that people will better understand that mental illness is just that, an illness, and that those suffering each day should be afforded the same medical treatment as those suffering from physical illness. (But then, we don't always take such good care of those with physical illness and don't have insurance either).
Let me know what you plan to do to fight this injustice.
Eileen
Hi Eileen...
What a well-considered and expressed post. Absolutely, health care in this country is out of control. Sadly, most think of the "medical" side of the fence when it's discussed. But, as you point out, the "mental/medical" (and it truly is medical) side of the fence is in even greater disrepair. No doubt, mental health care, especially if you don't have private insurance, is crisis based. Though I will say continuation of care is at least attempted. Problem is when mood stabilizing and antipsychotic meds are required it can, yes, take weeks to see a psychiatrist at, say, a county or non-profit facility. And, of course, the presenting issue quickly slides down hill and the E.R./psych admission cycle starts all over again. I'm not as concerned about the availability of counseling and case management for these patients. I can tell you the agency I work for has plenty of room for new clients. But it's the psychotropic piece that causes so many problems. I've found NAMI to be quite active in these matters. Well worth a stop by their site at nami.org.