How important is having same psychiatrist for longer time?

Discussion in 'Parent Emeritus' started by SuZir, Oct 14, 2014.

  1. SuZir

    SuZir Well-Known Member

    difficult child continues to get slowly better and so the issue of what to do after hospitalisation arises. If nothing drastic happens, they are likely releasing him from hospital in few days after they have first poked and prodded him head to toe few more times to make sure there is no hidden neurological illness.

    With physical symptoms the after care plan is clear, he will continue out patient in the place he is right now. Rehab continues with the same physical and occupational therapists it starts with now that he is inpatient, also the treating neurologist will be the same.

    Now the psychiatric side is different. He is currently treated by the hospitals psychiatric consulting department that is there to treat psychiatric issues with somatic patients. After release he will be referred to either our county's mental health clinic, neighbouring small town hospital's outpatient clinic or even the University hospitals psychiatric hospital's outpatient clinic depending from diagnoses and how specialised treatment they think he needs. It is also possible that he may have a stay at the psychiatric ward or day hospital (outpatient program where you are at the hospital during the work days and go home for nights) after release from neuro and before getting home, but that depends on how he is mentally after neuro is done with him.

    That is what the public side has to offer, but we also have a private option.

    To put it short, public side offers all the really hard core and expensive treatments, but can be crowded, providers are likely to change, you often have to wait, it's often very inflexible, you often don't have much to choose from and so on. Private side offers flexibility, lot to choose from and so on in lighter level of care cases. Same doctors often work in both sides.

    Till now difficult child has been treated by private side psychiatrist. He likes her, but she is couple hundred miles away in the city difficult child is not likely to go back to. It is time to change provider. If difficult child is offered something more intensive like day hospital from the public side, that is of course the best plan, but if not we have to choose between public and private. Of course his choice, but he can't afford private side, we can. We can't even make him continue with his treatment after he gets out of hospital, but if he wants to come home to us, and he currently really doesn't have any other place to stay, that is something we demand.

    If difficult child is not ready to retire from sport, which I highly doubt, he will likely continue transient lifestyle. Private options in mental health care would give him stability for longer time. Going with public route would mean changing providers all the time with every move or staying resident in our county and having hard time access the care. Of course one can change from the public to private or back again in any time.

    Just now, difficult child being so tired and listless as he is, he is likely to do whatever we say him to do. And, after very short consideration, we take that as an opportunity with husband. We are not going to sit back and wait for him to make decisions and call for appointments and so on. When released from the hospital he will have a ready made plan to public side and for the short term that is likely to be easiest and even best treatment available. But changing him to private side right from the hospital would likely give him much more continuity of care in long term. I'm not sure how high we should value that.
     
    Last edited: Feb 1, 2015
  2. pasajes4

    pasajes4 Well-Known Member

    Continued prayers.....I hope that you are able to find some peace for yourself.
     
  3. SuZir

    SuZir Well-Known Member

    Thank you, I really do appreciate that.


    Honestly, right now that isn't too high in our list. We discussed about this with husband, when we drove back home at Sunday. We are very aware that having difficult child back home to recover will be hard and stressful for us all. He will not be easy to live with, but instead will likely be extremely destructing to harmony of our household.

    We just considered it briefly and decided that we are not yet spent, that there was still quite a few sleepless nights and room for battle scars left in us and our son is worth every one of them. If we get lucky, this will be short term arrangement, if not, we have to sit down some time in future and consider, how much battle we still have left and is the arrangement still in best interest of difficult child either.

    But as of right now we are willingly making our home a battle field and going for it eyes wide open.
     
    Last edited: Feb 1, 2015
  4. dstc_99

    dstc_99 Well-Known Member

    My mother has gone back and forth between therapists and psychiatrists for many years. She finally settled in with one a while back and has stayed with them for a while now. I'm not sure how good they are but the suicide attempts have stopped. On the other hand she is now an alcoholic?

    So from my experience both have been good and bad. When I was in highschool and college my mom was with the same therapist for years. I couldn't stand the lady. My mom never improved and in fact was worse than ever during those years. She was hospitalized multiple times and as soon as she would get out she would run right back to this lady. It was useless. Combine the lack of communication with the lack of a good therapist on the outside and life was an neverending merry go round of hospitalizations and psycho turmoil.The only way I ever got my mom to move on was that the therapist died.

    The biggest issue was that the doctors didn't share information well. The hospital providers didn't really correspond with her civilian providers. They would put her on a medication combo and then the other doctor would pull her off. It got to the point it was ridiculous. Imagine being someone who was molested for years and beaten and God only know what else and then you have to tell the story over and over and over to each new therapist? While I guess it helps you learn to talk about it but it also causes you to relive the trauma.

    OK now to the point of this story. I would try to avoid changing doctors frequently and switching back and forth. The info doesn't flow well. Also don't find a therapist and stick with them if they aren't helping. If he doesn't like the doctor or he isn't seeing any benefits don't be shy about moving on.
     
  5. SuZir

    SuZir Well-Known Member

    Thank you for the insight dstc.

    With difficult child at this point we are thinking options for psychiatrist. Finding a new therapist will be another ball game. His former therapist was a good fit, but also in that other city over three hours away. When difficult child moved out from there, the intensive rehabilitating therapy stopped and difficult child has had online appointments to him for much less intensive supportive therapy after that. While it has helped difficult child to keep his nose above water till now, it is clear, that to actual to get better, he would need more intensive therapy. But of course first he will have to get to good enough shape to actually do the work rehabilitative therapy requires. So for the short term the best solution is likely go with meetings with the psychiatric nurse in public side clinic where he ends up referred. They tend to be the most experienced in supporting patients after acute mental crisis and helping them to get more stable (in our system the supportive and rehabilitating psychotherapy are clearly distinct things, partly because different government entities foot the bills for them, first is in the end paid by counties, second by state.) When difficult child is in good enough shape to get back to rehabilitating therapy, he will be in good enough shape to make his own decisions about the provider and till he is, he is likely to be in bad enough state that he will stay home and be on sick leave, so no issues with using local public mental health clinic.

    Your point about information transferring is really good. Inside the public system medical records of course transfer, but with private side one has to make sure they transfer themselves. And then of course there is an issue with doctors actually reading those records... In private side we also have few big, national clinics that have offices in almost every bigger city. Inside those records of course also transfer. Unfortunately difficult child's former psychiatrist worked for smaller, local clinic in private side. If she was working for one of these chains, it would be easier to find a new provider closer to us from that chain.

    For difficult child it is difficult to trust and difficult to talk about some of the most difficult things he has experienced. I'm not even sure, if he has ever talked to anyone about what really happened in the 'incident.' Maybe to his former therapist, but not likely to anyone else. Having to go around talking about it, even the bare bones of it, is not something he would likely do. In this time we have known about it, he has actually never even used appropriate words to described it, just "they messed with me" etc. He also tends to downplay his symptoms a lot.
     
    Last edited: Feb 1, 2015
  6. DammitJanet

    DammitJanet Well-Known Member Staff Member

    I have mostly had the same psychiatrist since 2000. In fact he was the psychiatrist who dxd Cory with bipolar at age 13. Now we both go to him. The only time I had to take a break from his was when I lost insurance for two years. That was awful because I had to go to see one at a public mental health clinic and that guy was awful.

    In my opinion, if you can get him into both a psychiatrist and a therapist that he likes and trusts and which he can see long enough to build that needed relationship with, well that is important. I had a therapist who I loved (only decent one I ever saw) and I had to stop seeing her due to insurance and I simply cannot find another one I am able to trust again. I have given up.
     
  7. SuZir

    SuZir Well-Known Member

    Thanks, Janet!

    This starts to look like very frustrating process. Clinics are clearly cherry picking and difficult child ain't no cherry, so to say.
     
  8. Signorina

    Signorina Guest

    Suzir- I just wanted to let you know I care and I too was stung by cherry picking . I was stunned when I tried to find a therapist willing to accept difficult child for counseling when he was 16. I had no idea it would be so hard. I researched doctors, got referrals and called only to have the gatekeeper/receptionist interrogate me about difficult child's issues and then reject my difficult child as a patient. Or tell me the next available appointment was 2 months out. It was devastating and I felt so "judged". I told his story over and over again and I was wrung out. What I thought would be a careful process of finding the perfect doctor for difficult child turned into me going though the long list of docs who accepted our insurance in alphabetical order. The doctor that he ended up with was "Dr.T" - after I called and was rejected by every dr from "A" thru "S."

    It's really hard emotionally - please make sure to take care of yourself.
     
  9. SuZir

    SuZir Well-Known Member

    Yeah, I have used few hours to making calls and this is very evident.

    I do get that these private clinics get their bread from employers who are law required to offer certain services in private side for their employees, and many offer little more; and their butter comes from parents of young children, who need a doctor after hours for small ailments and don't feel like waiting in ER for even hours with child with the ear infection or just a cold and little fever (we have law guaranteed paid sick leaves and even paid leaves to take care of our sick young kids, but of course many employers want the doctors note to verify the sickness/sick child.) I understand, that they do not want druggies or disorderly people to their lobbies.

    I understand well why almost every psychiatrist in these clinics tell straight out that they will either not prescribe benzos at all (the most common drug of choice for our drug addicts) or not after one visit or at least that they will not re-prescribe other doctor's prescriptions of anything, and that is certainly not a problem, but it really seems, that they also really do cherry pick based on demographics and diagnoses. If I don't get "Sorry, can't help you" right after the '21-year-old male'-part, it comes after 'PTSD and dissociative' or in the latest after 'self-harm.' And I'm not even stupid enough to mention anything about addictions...

    I already found this so futile, that I changed tactics and called difficult child's godmother to ask how to get around this. Had to tell here bit more than difficult child would had maybe liked me to tell, but she could maybe help getting around the gatekeepers. While she as a pathologist only works on public side, she has lots of friends and old medication school buddies working in these clinics, also psychiatrists, and her current husband (not a psychiatrist either but a endocrinologist) is part of administration of one of the big ones. She promised to ask around and said that she is fairly sure she can get difficult child around the gatekeepers by giving personal guarantee that difficult child showers regularly and knows how to behave indoors.

    Of course waiting lists especially for more renowned ones are long, but they should release difficult child from hospital with diagnosis and medication for now and also referral to public side to continue the treatment right after, so we do have time to wait for longer term solution to psychiatrist issue. difficult child also has a year and half funding left for his rehabilitating therapy, so he doesn't need a new paper work from psychiatrist for that.

    Very, very few psychiatrists around here do much at all counselling (and those who do, do it at public side) so what we are looking now is more the medication management.

    Of course same, or worse, will likely be true, when he starts to look for new therapist for rehabilitating therapy. Self-harmers are not popular patients...
     
    Last edited: Feb 1, 2015
  10. InsaneCdn

    InsaneCdn Well-Known Member

    In our experience, continuity of psychiatrists and tdocs is even more important than continuity of family docs. We've been bounced around... and every bounce has been a problem. The periods where our team was stable, tended to produce more stability in difficult child.

    That said... it's hard to find!
     
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