The mental health system is going to break me

It's time. I am not looking for flags or stars, just open ears.

A brief background on myself. I am 34, almost 35 and live here in Illinois. I have been a therapist for 3 years and outside of performing talk therapy, I have worked almost solely in the emergency mental healthcare world and although I haven't been doing it for decades, the system and yes some of the clients are breaking me. Rather than go to the rants section I decided to take a breath and post it here as it is a MASSIVE medical/mental health issue that runs from top to bottom.

So I am going to make this not-so-short essay from a personal and professional perspective.

Now I realize that to many of you this will be no surprise. Some other will simply gloss over it and not care. My hope is that this third group will be someone who has a bit of eye opening to see what destruction the mental health system is and has become.

the Personal

Not only am I a therapist, I gladly admit to being a patient as well. I have bipolar disorder and generalized anxiety disorder. Now before anyone asks, yes I do have legitimate bipolar (you'll see why I wrote this in a moment). I am fortunate enough to be one of the lucky few that medications work for with no side effects. Now all you researchers may look back and say "Kyo! You've championed psychtropics before." Yes that is 100% and I sit on the throne of my own hypocrisy. I did not lie to anyone because up until recently I truly believed my position. Make no mistake; I still believe there are thousands and thousands of people who legitimately need psychotropic medications. People with severe bipolar, severe schizophrenia or schizoaffective disorder and so on. Some people simply cannot function outside of their medication regimen and to them I say “I hope this works for you.”

So time for some honesty…something I am becoming less and less afraid of these days. Because in the end, who cares if you know I have issues. If I can use those issues to bring to light a problem then I will sacrifice.

BTW this doesn’t make me a martyr or savior…I’d just tired of the system

I was diagnosed bipolar as a teenager. I had severe swings of depression that crushed me daily followed by weeks of unrestrained power and invincibility. I would put myself into debt on wild spending sprees and so forth. Then I would cool off and things would be alright. Then the cycle…

So why tell you all this? Because I want you to know first-hand my experience with treatment. I did not start seeking real treatment until I was about 28 years old. I was having weekly emotion-induced migraines and I was an utter mess.

Now follow me on this…

At the time I was 28 and had well over a decade’s worth of severe mental illness.

Take a guess how long my psychiatrist saw me before deciding to put me on a pill (which I will go over in a second)

7 minutes. My psychiatrist gave me 7 minutes of her time and placed me on Lithium…lithium…I am not telling you this story from the 60’s where lithium was the wonder drug. I am telling you this from the 90’s when other options existed. I was always told in graduate school that in the court of bipolar disorder, Depakote is like a bb gun and lithium is like a howitzer. But even if we look beyond that (which btw I am happily on Depakote and it is working for me) I come right back to the 7 minutes.

I was seen for seven minutes, diagnosed instantly and prescribed a regimen for drug therapy. No looking into what caused my bipolar (chemical, social, abuse whatever). Now I realize a psychiatrist these days don’t often do therapy and that’s fine…but no attempt whatsoever was made. It was literally, take this lithium at so-and-so intervals and see me in a month for a blood test.

That was it…now flash forward to 2014 (about 6 weeks ago) For a stretch of time, I could not afford to take meds and when I was in the military, I evened out or hid my bipolar pretty damn well. Eventually I caved, the military treated me…poorly…and then moved me out of the Air Force. I don’t disagree with that to be honest. I wouldn’t necessarily want a 2W2 who was bipolar either…but the point was, I continued to be treated as a disease…given 7 minutes and a new med. Zyprexa. All at once, my migraines stopped and my moods quickly stabilized….until I left the military and could no longer afford it. Then back to mania and depression again.
Fortunately, as a VA patient in a great hospital, I am getting medicated as needed, stabilized and seeing a therapist but it took over a decade to find a good connection. I am proud to say I am quite healthy these days on Depakote and seeing a therapist.

Notice anything? Yep…I left out my anxiety…and did so for a reason. I wanted to tackle the impersonal nature of mental healthcare first.
To save some time, let’s just say right off the bat that y anxiety was devastating and remained so for almost 20 years. Care to know how they treated that? Xanax and Ativan. I’ll save you a google search. They are known addictive benzo’s that temporarily lessen anxiety and yes they are effective as hell…until you keep taking them daily and you build up tolerance and now have to take two at a time or three or become addicted. That’s the magic word folks.

Following an accident in the military, I was placed on Vicodin and Valium for almost a year. I became an addict. I am happy to say I have been clean for years but here comes the rub. In the VA system I have self-identified as a narcotics addict and am only given Oxycodone/Oxycontin during extreme situations of pain. Otherwise I am not allowed addictive substances. Upone explaining that I had severe anxiety, three….THREE doctors offered to give me 120 Ativan…one hundred….and twenty….to an addict…who sat in their office and literally said “I AM AN ADDICT”

Wrap yourselves around that for a moment…three separate doctors giving me, bipolar, anxious and a pill addict, an extreme amount of Ativan or Xanax…yeah they were going to give me my choice of poisons…

Again, I am happy to report that I am now very stable, on a good solid med that does work, seeing a therapist, eating better, exercising, using acupuncture, massage and meditation…((we’ll get back to this list of treatments in a moment)) because it’s now my segue to the professional



The Professional
Since my time in the military shadowing PTSD clients, I have had a massive desire to treat and do therapy. Another tidbit of honesty. I am not scientifically smart or motivated enough to be a doctor and besides, I much prefer talking to people and having cathartic experiences with them. Hell one of my teenagers I used to treat, we used to laugh and joke, but then when we got serious, she made remarkable recovery. So yes I love the field I chose.

The problem is I am not currently a clinical therapist, I am only a licensed therapist. Once I become clinical (after a certain amount of hours working) I can work on my own and start my own practice. More on that in a second…

Currently I work as a contractor to the two local hospitals in my city. I come in and assess clients in emergency crises and make a determination of whether or not to hospitalize them. Now is where my real burnout begins. I did this work for two years as an intern and do it now professionally.

My statement is as follows…

THE MENTAL HEALTHCARE SYSTEM IS DESTROYED

I get at best 15-30 minutes to assess someone and I have the challenge of making a determination for THEIR lives about how to treat them. All the while I have a backlog of 3 other clients to see and assess. It’s a numbers game. I get paid hourly, but the company I work for makes money on numbers so they chain me to the bed rail and force feed my clients because each “pretty little client” I see equals money to them. I’ve seen how much they charge insurance per client and it’s astounding.

Anyway, in this short 15 minutes I take over their lives and there are multiple problems in this system.

Time for break down...I’ll make a pathetic attempt to approach solutions for each.

1. Family members – if you ever had to ask me what my biggest problem with mental health crises is, I would say family members. They range from clueless parents who want to put their kid away for months to siblings who have a seriously dangerous mental illness and is an extreme danger to themselves and wants to just have them pop pills. Parents and friends especially are the biggest problem. I had a lady bring her 72 year old friend to my ER and tell me straight up..”She WILL stay on a psych ward…I was suicidal and I know the signs.” “Oh ok, well ma’am, you are not a professional and that’s not how this works. You don’t get to demand things”

OK I didn’t actually say it but I felt it. Turns out this woman was fine and just depressed over life stress…not suicidal. Then there are the parents who have a misbehaving child who is a “terror” and “dangerous” and needs to be hospitalized for months…translation “I am tired and want my kid put away’

Ok I get it. It must be terribly hard to deal with rough and tumble kids…but no not every kid is ADHD because they act out. Two weeks ago I assessed a 5 year old girl who had a penchant for “violence” and the parents were scared to be in the house with her. I am telling you I couldn’t have kicked a field goal with this girl and broken the NFL longest FG record…This little girl who appeared to me to have no propensity towards violence was being brought to me to hospitalize. 5 years old…let that sink in
After my own personal research, I talked to this girl’s therapist who told me the parents just don’t want to deal with her and she has never been violent. The solution is quite simple…education. But nobody wants to pay for parental and familial education…it’s much easier to sweep under the rug and hospitalize these people than it is to educate. Thing is, if we educated, we’d eliminate so many of these issues and make life better for our clients. But there is no money in it. There is however lots of money in Zoloft and Prozac…ok that was exhausting….time for problem 2

2. Frequent flyers – this is a terrible term and I am sorry but I will not pretend they don’t exist. Frequent flyers and manipulators are the bane of my existence. I have two males who no kidding come to the ER twice a day, every day, every week to be hospitalized. They literally want someone to take care of them nonstop. And that’s the tip of the iceberg. I have dozens of clients who make daily trips to the ER for meds so much so that some have gotten arrested for abusing the system. Now this is a serious problem and the solution for this is more challenging than the parental solution. But there is, in my opinion, a solution. Community resource centers like the one we ‘used’ to have was heaven-sent. These centers would work daily with frequent ER-goers to help them navigate their lives, benefits and education. The process was one of “let’s help improve your life.” So what happened to this beloved system? Budget cuts that led to deletion of these systems. The solution IMO is to take money out of these waste-bins and pump it into proper healthcare and community systems. Take over the problem, and treat it with a solution. Why don’t’ we do this? I already said it so say it with me…”there’s no money in it.”

3. The decaying mental health system – Ive been preaching education to you and that comes into play here. I have seen a rapid and noticeable increase in shutting down clinics and hospitals. I will admit now, some people REALLY do need to be hospitalized to stabilize themselves. But there is simply no room. I have a list of over 40 hospitals I can utilize and yet each day I get “at capacity.” And even when I do hospitalize someone who really needs it, they get those magical 7 minutes I talked about and a new medication. Then they get told they are fine and booted. I mean it’s simply ridiculous. Nobody cares because we’ve lowered ourselves to a standard where we throw pills at a problem. The solution here leads to my conclusion…I know this is a long thread…

The final solution IMO is holistic and comprehensive healthcare. We need to get to a standard where we talk with clients and actually listen. I am just as guilty these days due to my time restrictions and my burn out. I just can’t give my clients the proper time of day because all I can think of is “I have 3 more hours and 4 more clients to see.” It sickens me to the point where even a lengthy vacation wouldn’t solve my issues. We need a massive change and we need it now.
Ultimately we need to approach these issues with holistic, client-centered care. Instead of always throwing a pill at someone, let’s have them see a psychiatrist, counselor, community resource and *GASP* maybe even some natural work ups. In short, let’s tackle the problem not just call someone a disease, give them 7 minutes and Seroquel and tell them “see you in a month”

But then…”there’s no money in it…”

Thanks for reading

Thank you for such comprahensive report of your experience.

Its given me some inspiration to go and seek councelling but I am still conflicted whether I can deal with my own issues or whether the situation at hand is getting a little heavy to handle and external assistance is needed.

I would just LOVE for a health care professional to help me by telling me WHY my mind shuts down from MATH.
Apparetly it's a mystery ...now if I can JUST get the VA to pony up an FMRI.

Yep, you're right on points one and three. The issue with the mental health system for me is funding and the problems lie in the government not prioritising mental health in the budget. At least that is the case in the UK. It's almost like the government knows people who work in care will never be able to strike and therefore leave the sector to its own devices. The UK is has experienced many recent scandals with it's care-homes as a result of this. Under-staffed doctor's surgeries, under paid workers, and care companies that seldom make a profit is the reality unfortunately. It's the service users and lower level staff that suffer.

This is a fascinating account of your direct experience with this profession. I enjoyed the read, but felt your frustration as well. I can understand how you feel like your hands are tired, both as a patient, and as a therapist. Thanks for sharing this with us.

*****

Although not particularly on-topic, I'd like to share my frustration with the 'health-care system' if you'll permit. As my name implies, I was diagnosed with narcolepsy. It was diagnosed and treated (if you can call it that) by the supposed leading neurologist in my area.

So we experimented with meds for about 2 years. He threw the entire catalog at me in various doses and I felt negligible relief. In fact, many of the meds gave me intolerable side-effects. I consistently expressed my dissatisfaction with the medications; these were not a solution. Finally we reached a point where I had tried everything to no avail.

I felt the neurologist wasn't very understanding of my concerns and complaints. He never seemed to truly understand the symptoms I complained of (whether due to the narcolepsy or the side-effects of meds.) When I'd complain about how awful the side-effects were making me feel (coupled with the fact they weren't helping me,) he'd pretty much just say deal with it. He seemed totally clueless and unsympathetic. Even worse, he seemed very overbearing--he often 'guilted' me into taking higher doses of a med that I complained to be having side-effects from. He'd guilt me into it by saying things like I'd cause a car wreck while driving etc. etc. "You have to try this or you'll never be able to function." This was his attitude. No, I'm not exaggerating.

I discontinued treatment at his office. I got a second opinion on my diagnosis from another clinic and they offered to try some medications that I have already tried. I felt helpless so I just gave up on treatment altogether.

A few years later I returned to the office of my original neurologist to see if any new treatments were available. Nope, just the same old roads I've been down before. Oh well, I tried faithfully. Then I mentioned, "Oh by the way, there's this one med I heard of recently called _____. Would I benefit from that?"

"No," he said, "I wouldn't prescribe that to someone with your symptoms. It's used to treat a symptom you don't exhibit."

I said, "Thanks for your time, but I'm not going to seek treatment with you at the moment."

He wasn't having it! He wanted to schedule me for another sleep study, another multiple sleep-latency test, as well as another test he designed himself. "No thanks," I said.

He told his receptionist to check with my insurance, to schedule all the tests for me. "No," I insisted.

He then turned on his guilt tactics. "NB here will be a danger on the road for everyone. Would you want to drive knowing he's out there?" he disingenuously asked the receptionist. He told her again to make the appointments. (By the way, I've never been in an accident, never fallen asleep at the wheel. Totally spotless record aside from a single traffic ticket when I was 16.)

I say, "Here's my co-pay. Don't schedule the tests. You won't be seeing me again. Bye!" And I start walking out of the office with the doctor saying, "At least take some free samples of _____, then we'll talk again."

The free samples he wanted to give me were of the medication he just said he would never prescribe to me! Sheesh, just how many kickbacks does this guy get from pharmaceuticals?

I felt like I was dealing with a used car salesman, not a respected neurologist. I had to deal with this for about 2 years while being treated in his office.

originally posted by: InhaleExhale
Thank you for such comprahensive report of your experience.

Its given me some inspiration to go and seek councelling but I am still conflicted whether I can deal with my own issues or whether the situation at hand is getting a little heavy to handle and external assistance is needed.

and I am a strong advocate for appropriate mental health care but when I say MH care I mean full on MH care, not just toss you a pill. I don't wish to scare anyone away. This was more of a 'be wary' post and a tipping point of my undying frustration as both a client and a clinician. I'm so tired.

There ARE awesome therapist, awesome psychiatrists and awesome social workers out there. I truly mean that but the fact is that the system is designed to control us therapist.

Example...

I had a client come into therapy once who had depression and PTSD from a year long battle with her father molesting her as a child. Ok...i can handle this. I told myself that I am going to do what I was trained to do; take my sweet SWEET time and let her approach this dangerous topic when and only when she is ready

then came BCBS who sent me a response to insurance inquiry and told me I had 15 sessions allowed on her plan...

15 hour-long sessions to try and help this lovely women who was molested by her dad for a year. You don't have to have even the slightest of psychological knowledge to know that what she is experiencing can't be capped by money. These things take ages sadly and it isn't her fault. consider the damage she withstood. You really think that's gonna be 'cured' in 15 hours?

When I start my own clinic I would love to work without insurance but then how do all the people on insurance get help? Yeah I can do sliding scale but then operating and governmental costs will threaten to close me unless I work 14 hours a day, seven days a week. What then? I get burnt out in two months and become an extreme danger to my clients?

a reply to: NarcolepticBuddha

no to be honest, although this thread was directed at mental health care, I am totally open to hearing about medical healthcare as well and discussing how to solve both because let's be honest, they are intertwined whether we like it or not.

I am sorry to hear of that experience. I wish that I could say, well NB had a bad experience but that experience is one in a million. The sad part is we are closing in on another statistic these days where your experience is getting near to majority status

Who was it that authorized general practitioners to dispense PSYCHOTROPICS without Psychiatric training ?

Most "therapists" or psychiatrists I've been to simply sit there and stare at me while I talk. I never seem to get anything out of the sessions, as I already know where all the issues stem from. I'm not looking for a shoulder to cry on, I'm not looking for someone to vent to -- I'm looking for solutions and ways to make things better.

I have friends I talk to, why am I paying this person to sit there and listen to the exact same things my friends hear? I could see paying these mental health people if I was a complete shut in and didn't have a social life.

But no, they always want to string you along and milk the almighty insurance company for all it's worth.

a reply to: KyoZero

For the record, (because there has been confusion about this in the past) I am not a licensed professional. I am a lowly 4th year undergrad. But...

I am so glad that you wrote this. Someone else sees it. Mental Health is dying an anemic death. The system has evolved to make it nearly impossible to actually help someone. Most insurance companies will pay for two visits for therapy and that is it. After those two visits you had better figure out what pill you're putting them on because insurance will certainly pay for that. As you said there is more money in the pharmacological approach. Besides, it looks almost like a magic bullet to just drug people into submission.

I love your emphasis on community based solutions. I think that may be the answer, but... good luck, where is the money in that? It's so sad. I think that part of the reason why we are having so many mass shootings in this white middle-class demographic is because even these people are running into that brick wall for getting quality help for these kids. The resources just aren't there.

Even the people that have the knowledge base (and more importantly) the desire to try to do things the right way are pressured by the system itself into doing things the wrong way. There needs to be a revolution in mental health care.

At this point, I am going to get my degree and move on to nursing (I have most of the pre-req's anyway) and hopefully move into case management and call it good. I'm not even going to get my toe in the water to be a therapist. Disillusioned doesn't even begin to describe it and I haven't even gotten started. I admire your compassion and your courage for what it is worth.

a reply to: cavtrooper7

In Australia 80 percent of anti-psychotics are prescribed by general practicioners I am a schizophrenic and even I cant get to see a state psychiatrist unless Im having a psychotic episode or just coming out of hospital and private psyschiatrists are too expensive and no better than state ones.I put high praise on the employees of the system but the system itself has been run into the ground .

I too found the Mental health System to be a sham......
It is an industry that simply makes a living(and a damn good one) for those who will jump through the systems hoops and get" qualified" officially by that system.......They then are supposed to be capable, but sadly are very often only capable of collecting their paychecks......

Not much to add but its the same mess in the UK

Mental health just gets glossed over.

originally posted by: MystikMushroom
Most "therapists" or psychiatrists I've been to simply sit there and stare at me while I talk. I never seem to get anything out of the sessions, as I already know where all the issues stem from. I'm not looking for a shoulder to cry on, I'm not looking for someone to vent to -- I'm looking for solutions and ways to make things better.

I have friends I talk to, why am I paying this person to sit there and listen to the exact same things my friends hear? I could see paying these mental health people if I was a complete shut in and didn't have a social life.

But no, they always want to string you along and milk the almighty insurance company for all it's worth.

I have been off and on drugs for panic disorder since I was 31, I am 64.

If I had been diagnosed correctly in the beginning, I don't think I would still be fighting this.

The last psychologist I went to was twenty some years ago, he told me all HIS problems, I hope I helped, lol

I was appointed to a district health council, while at home I had a tenant in an in-law suite with multiple diagnoses. He was very dependent person and his thought processes were quite unpredictable, so I put aside certain times for coffee and exchanges with him in a 24-hour period. One morning he told me that he had stood all night at my bedroom door with a knife in his hand. He knew it was wrong, as he had no business being in my part of the house in the first place, but also Lord only knows what stopped him from acting out whatever fantasy he had. He agreed to pack a suitcase and let me drop him off at the doctor's office where I had called to explain the situation, after which I went to work. Needless to say I was completely outraged and fearful when upon returning home that evening, there he was! The doctor told him that there were no beds.

I did not sleep a wink that night, hid all my knives and kept the dog by my side, until the next morning when I personally drove him to the ER of the nearest mental care hospital, some forty kilometers away. ("Either you hospitalize him or you give me a room for my own protection.") I threatened to have it on the suppertime news and to make sure my government rep commented. That threat worked, as after several hours of hesitation they decided to keep him for assessment of his meds. He stayed in a couple of weeks.

Back to the health council work: The mandate was to centralize and consolidate mental care in my region knowing all the while that the budget would be severely cut back. That meant that vital beds would be eliminated and some hospitals would close. The unfortunate ones who could not cope on their own would be dumped into various communities and these communities would have to cope. In my area I arranged to open a couple of drop-in centers for the socially isolated, but we had four regular visitors in one and eight to twelve in another, so that was a plus. We formed family caregiver support groups for families and friends, and the challenges were many but the best outcome of this action was not only the support and networking opportunities among the various groups, but the education families received on legal and policing issues, medications, system weaknesses, etc.

I was happy to be involved, but man did it ever take a lot out of me! It totally killed any social life I wanted to have, and any hope for a break during all of five years, after which he moved away. I can feel your pain and frustration all the way through the internet wires and waves, yet I do hope you can find some measure of finding new resources and replenishment. It does sound like you need a break, imo. Do not neglect your own personal needs.

I agree with most everything you posted, and others here. I think we can all come to a consensus that the system we have is not working, just 7 minutes and here's the solution a pill. I think people would benefit more from therapy than pills. I have bi-polar disorder, take invega, but constantly want to go off my medication, I just feel like there's no such thing as a chemical imbalance of the brain. I'm not damaged, its society that damages me and when I bug out that is my response. I just have simple relationship issues, but as long as I throw a pill at the issues, I'm ignoring the root cause of the situations that cause me to get emotional. thanks for your time.

a reply to: khnum

That's how i got my meds. From my GP.

Now i trust this doctor, and been with me since I started having issues. The problem I have is actually going through to a psychiatrist, as I still have anxiety issues with phones. But the last time i was in, we spent a nice hour together talking about comic book superheroes

originally posted by: cavtrooper7
Who was it that authorized general practitioners to dispense PSYCHOTROPICS without Psychiatric training ?

I agree on that. typically...the way it is SUPPOSED to be is General's are usually only allowed to prescribe anti-depressants (Prozac, Zoloft blah blah) and short-term anti-anxiety pills (Ativan and Xanax)

But yes there has been this shocking increase in anti-psychotics being given by GP's...I don't know where it came from but at the very least the psychiatrist specializes in those meds

Mystik - I see your point. Trust me when I say there are good ones out there. It is a delicate dance we perform between guiding but not telling you what to do but I have seen both personally and professionally what you describe here.

rehorse - keep fighting the fight. RN, MD, therapist whatever it is, join the battle and treat people like humans with names and feelings, not just DSM-diagnoses. It is sad that in the mental health field it's never, "John is here to be assessed"...it's "The schizophrenic in bed 17 is here because he is off his meds again"...true story

stirling - you are quite right. I will say right now that I don't make much at all. The psychiatrists make a BUNDLE because they use the right drugs. Honestly, I have sat through drug rep meetings because I need to be informed what my patients are taking and man they either gloss over the side effects or don't even mention them. We're given a business card, samples and a pretty pen with the Glaxo logo on it. Frankly a lot of the decisions made by doctors is based on who woo's them the most? Who woo'd them? Invega? Zyprexa?

StormDancer777 - I really wish that didn't happen...but man it does. I slipped once in a session and got to personal...ruined the trust immediately and I felt like **** for weeks. I hope you are well

a reply to: KyoZero

I'm a believer/hold in high esteem; talk therapy.

Incorrigible.

One that cannot be corrected or reformed.

Life upon the earth has become a free-for-all.
Free for all to pluck the others who have the same stake in the ground...