It shouldn’t be this hard

Long-time readers know that I battle Depression.  Those of you who are new and would like to learn more can catch up on previous posts about that here.

I was inspired to write today because Kimberly at All Work and no Play Make Mom Go Something Something is celebrating a mental health awareness day with Bell of Canada by sharing her story.  If you’re a Bell Canada customer, tweet with #BellLetsTalk and Bell Canada will make a $0.05 donation.  If you’re not Canadian, do it anyway in solidarity. 🙂

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Today I want to talk about how difficult it can be to find a good psychiatrist and/or counselor when one is attempting to manage one’s mental illness.

Specifically, I want to rant about my last shrink (I use “shrink” lovingly, not pejoratively), whom I had to fire.

I’ve been doing pretty well the last couple of years, so I would only see Dr T every three months or so to perform “medication management” — that is, he would talk to me for ten minutes to determine if my current medication and dosage were still appropriate.

My health insurance covers such visits, however, this guy doesn’t take my insurance.  I would pay cash for each visit and, at first, I assumed I’d be submitting my receipts for said payments to my insurance company for reimbursement.  However, the front desk staff at this office seems completely incapable of providing me with an invoice/receipt that clearly stated the necessary data (DSM code, physician, date, cost), so I was never able to actually apply for reimbursement.  I don’t know if it was an issue of their billing software being really terrible (which, being in medical informatics I can actually imagine to be the case), human incompetence, or some mixture of the two.  What I DO know is that if I wasn’t very fortunate to be able to afford these visits on my own, I’d be up shit creek.

Luckily for me that is just logistics.  The more annoying part is that Dr T is an ass.

He’d ask me a question, and then tell me he didn’t want to hear it when I gave him the answer saying, “I don’t need to hear all that.”  I guess I took too long to explain.

When I got pregnant and indicated I was happy that I was lucky enough that my third trimester would be in winter he said, “There’s that obsessive compulsive you again,” with a snide smirk.  And I said “What?”  He said “All your over-planning and trying to control!”  And I, someone who’d already been through one miscarriage (and unbeknownst to me would experience another not a day later after this visit) said “I didn’t PLAN that… we don’t care WHEN we get pregnant, just that we do and have a live birth.  I’m just happy at how the timing turned out.” After that he didn’t say anything.  Prior to that visit, he’d never indicated that he saw any OCD tendencies in me — Depression, Anxiety, PTSD, sure, but not OCD*.  This was total news to me.  I don’t know to this day if he really thought I have OCD or not, he never mentioned it again.

This guy drove me nuts.  I would find myself getting stressed out about seeing him.  But I went to him anyway, because finding a new shrink (at least around here) is a LOT of work, and without him, I wouldn’t have my meds (he would write a scrip just long enough to last me to my next visit**).

The last time I saw him was after the miscarriage of Bambino.  By that visit, it was already a couple of months post-loss and I (amazingly and gratefully) was in a pretty good place.  Dr.  T kept me talking though, about Bambino — kept asking for details.  I suppose (hope?) he was looking for signs that I might have worsening symptoms or something.  After continually reassuring him that I wasn’t about ready to kill myself, he finally let me go (with a new prescription for my same med/dosage).  When I got to the front desk to pay for my visit I was told that this one was MORE EXPENSIVE since it wasn’t just “meds management”.  The ass had the BALLS*** to take advantage of a bad situation to soak me for more cash.

I got home from that visit and realized with dawning clarity that I didn’t need to put up with his shit any more.  Check out this post to see more about the fantastic feeling one gets when one realizes one can break up with one’s partner/doctor/whatever.

However, with my new-found sense of freedom and relief I also experienced the dread of trying to find a new shrink.  First problem?  My prescription would be up in a week.  Luckily my primary care provider (an AWESOME woman) was willing to prescribe for me until I could find a new provider (though only in two-month increments which is its own pain in the ass).

And one might think that two months would be enough time to find a new shrink… but that is just not the case.  This time around, I thought I would take my time and try to find a GOOD provider instead of a provider I could get quickly (which was how I ended up with Dr. T).  I’d love a provider that takes my insurance, that has good reviews on physician rating sites, and better yet, comes recommended from my PCP or a friend.  This is a TALL order.

Firstly, MANY MANY shrinks/counselors/therapists do not take insurance.  At all.  Those that do tend to take only a select few.  I think I’ve only had one out of about 10 providers over my lifetime who took my insurance.

Next – there aren’t a lot of online reviews of mental health providers.  There’s just still too much stigma – so no-one talks about it.  Unlike with something like gall-bladder surgery, one doesn’t just pop on facebook and ask “Hey peeps, who’s got a good shrink to recommend for Depression, Anxiety, and PTSD?”

My PCP’s office has a list of providers, but of those, only one group that I called was: a) within a half-hour drive; b)  accepting new patients.  When I called that group, the first new-patient appointment they had was SIX MONTHS IN THE FUTURE.  Yeah.  And that’s not unusual.  At least, around here, where good providers are apparently very highly in demand.

So I made that appointment.  Then a few months later, realized that it was smack in the middle of an out-of-town vacation we were planning.  When I called to reschedule, the next available appointment was in another FOUR MONTHS.  Yeah.

Meanwhile, I called other providers.  At least one wasn’t practicing any more, and the provider he referred me to never returned my calls.  Two other providers never returned my calls.

Oh, and then I had a baby.  Yes, in the meantime while I was waiting for my appointment, I’d become pregnant (yay!).  On maternity leave, the provider’s office called and left me a message (on a work line that I wasn’t monitoring at the time, my bad for giving that number instead of my home number) that they had to reschedule my appointment.  Oy.  I missed the voicemail and they ended up sending me a letter to let me know.

I’m just SO DAMN LUCKY that my demon brain chemistry has stayed quiescent during pregnancy and now in the post-partum danger zone.  This could have gone VERY wrong.

So I STILL don’t have a provider.  It just shouldn’t be this hard, people.  If I were actually in a Depressed slide right now, there’s no way I think I’d have the energy to deal and keep looking for someone good.  I would either settle for someone mediocre or bad, but available, or not find someone at all and let my meds lapse.

Having a mental illness should be like having Diabetes, or any other chronic medical condition.  Providers should be readily available, take insurance, and it shouldn’t be embarrassing to ask those around us for help with finding a provider, or just support.

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*I have nothing against OCD, or people who have it.  If I have it, then I want to be informed and then discuss treatment options – not have it referred to obliquely with an implicit value judgment attached.

**One assumes this is a system designed to discourage drug-seeking behaviors.  While I can understand this, and to a certain extent support it, it does put patients in a bit of a headlock and a quandary when one wants to switch providers.  This is the only provider who did this to me.  Past providers, acknowledging that my meds were maintenance and not likely to change any time soon would give me a year-long prescription.  Also, the meds I take (Wellbutrin) are hardly a controlled substance.

***I was going to use the word “temerity” here, but “BALLS” was just so much more satisfying.  BALLS BALLS BALLS!