Mental health - How do we know when we need help

[Ettabell]

After spending almost 10 years in therapy and on different meds with not much relief, is it time for something more intense??

[WhoAmI]

What are you thinking? ECT?

[Ettabell]

No....nothing that intense..maybe some inpatient therapy. I dont know anyone that has done this so I have no idea what it entails, but I am so tired of being tired, if you know what I mean. I hope that there are people here who have been there and done that and are willing to tell their stories.

[WhoAmI]

Check out your health insurance and see what it'll cover. If it's not so great, you could be in worse shape when you get out if you have huge bills looming over your head.

[Ettabell]

Well that is part of the reason I ask. I have recently been laid off (again) and no longer have health insurance. I am collecting unemployment and am looking into state insurance. I have spent the past 15 years doing medical billing and cant find any insurance to cover myself at this point without paying an arm and a leg......how ironic.

[DeadDwarf]

My husband's grandpa was bipolar. He suffered with it for 5 years until he just couldn't take it anymore. He went into the bathroom and sat there for hours and told his wife that he was so tired and couldn't take it anymore. He had trouble sleeping, eating, being happy and turning his mind/worries/anxiety off.

He went that night and checked himself into the "psych ward" at the hospital. He stayed there for 2 weeks and luckily his insurance covered it. He was diagnosed, given proper medication and therapy. It made his life tolerable.

My older brother also checked himself into the hospital last February. He didn't have a job or any income, they helped him fill out all the paper work so he could get inpatient care. He was really at rock bottom mentally.

Sometimes you just can't do it all on your own and need extensive help. There are resources out there for people like you. Try calling the hospital and explaining the situation with them and see where they can direct you for help. My friend is a nurse and she told me before that they actually spent a lot of time helping people find programs/insurance/resources so they could be hospitalized for mental health reasons. Call them ASAP.

Be strong and I'm proud that you are reaching out and looking for the help you need.

[Honey]

I'm glad your grandpa got help, it sounds like he reached his rock bottom

Jin, maybe a stay at hospital would help, do you have support- friends and family?

[Ettabell]

Thanks for your input guys, I really do appreciate it. My husband is the only one who really knows what is going on with me. I dont want to burden my friends or family with my 'problems', I know, really stupid but I just cant get myself to open up to them, I dont want them to judge me.
DD, good idea about calling the hospital to see if I have any options when it comes to paying for the help. I have also forced myself to make some calls to local insurance brokers, maybe I will have some luck.

Thanks again guys!

[qwerty]

No words of advice Jin, just wishing you the best of luck!

[crumpet]

I'm really sorry to hear you are going through a painful and difficult situation, only compounded by not having health insurance. This topic is sort of a specialty of mine so I'll give you my best input and hope it helps. Keep in mind some things may vary by state but for the most part what I can tell you will apply to most places.

First of all, even with insurance, inpatient treatment is only covered for acute cases and is intended to be short term, usually no more than a few days. The days of residential care at Shady Acres Recovery Center are pretty much over. To meet the criteria for acute inpatient care there needs to be evidence of imminent danger to self or others due to mental illness. What this means is if a person is not admitted right now there is a strong possibility of suicide attempt or other dangerous behavior (such as violence related to a psychotic episode). The inability to care for self or allow care by others is another part of the criteria. This would refer to someone who is unable to bathe, who is soiling themselves, not eating for an extended period of time. A schizophrenic wandering the interstate in August wearing a fur coat and snow boots would be a good example of this. Admission criteria for inpatient does not refer to a person not functioning at their optimal level or even just feeling really down. They have to demonstrate that there is no lower level of care that could meet the patient's needs safely and adequately. Lower level/less restrictive levels of care refers to not only outpatient (which may occur once or even twice per week depending on symptomatology and can include individual/family/group therapies) but also to partial hospitalization which generally consists of 3-5 hours per day approximately three days per week at the facility. It is not atypical for there to be a step down process where if a person is admitted they are discharged to a lower level of care as soon as they are stable (not well or cured, just stable). They may go to partial for a week or a few weeks then move to regular outpatient care. Your relationship with your provider is one of the most crucial elements in successful treatment. The psychiatrist relationship is not as important as the therapist relationship/connection because you don't see them as often (starting weekly then quickly moving to monthly or quarterly once a good med regimen is established). Of course it is important that they know medicines really well but the bedside manner/relationship is most important with the therapsit. In other words, you may have a great doctor who is very skilled with meds but don't dispair if he isn't warm and fuzzy with you as long as you feel he is competent. That doesn't mean he should be rude or dismissive, of course. Many doctors do not do therapy anymore and their focus is on med management. Some do not even have extensive training in talk therapy.

As far as substance abuse goes inpatient admissions are usually only approved for detox of substances where there is a risk of death or injury from withdrawal. Alcohol and meds like Xanax fall into this category. Withdrwal from opiates, cocaine, and most other drugs do not . Inpatient detox is still a short stay admission usually lasting about 3 days (although it varies).

As far as funding goes: if you lack insurance and other $$ resources, you will need to contact your local Community Services Board. That is your local/county mental health clinic. Sometimes there are funds allowed for indigent people but with the economy many agencies have had layoffs and much funding has been slashed (that's a whole other talk show). It is good that you ask the facilities themselves what your options might be. Inpatient care is ungodly expensive. It is also my understanding that there is not a great statistical difference in the success of treatment in outpatient vs. inpatient care.

Good luck and please keep us posted on how things are going for you.

[Ettabell]

Well, I guess my fist step is to find some sort of affordable insurance and get back to weekly therapy. I am not to the point of being a danger to myself or others, just really depressed. I know the unemployment situation is adding to it.
Maybe with the change of meds and weekly sessions I will move past this low point soon. I have been spending hours a day on this site (love it!) and have been enjoying the diverse personalities... you are all great and entertaining.

Thanks for the info Crumpet and good thoughts from everyone!

[crumpet]

Originally Posted by Jin13

Well, I guess my fist step is to find some sort of affordable insurance and get back to weekly therapy. I am not to the point of being a danger to myself or others, just really depressed. I know the unemployment situation is adding to it.
Maybe with the change of meds and weekly sessions I will move past this low point soon. I have been spending hours a day on this site (love it!) and have been enjoying the diverse personalities... you are all great and entertaining.

Thanks for the info Crumpet and good thoughts from everyone!

You are welcome. I am actually very pro-medicine even though I know opinions on the subject vary, even amongst professionals. Yes, therapy is crucial for situational related depression but if meds help alleviate some suffering I don't see the problem in that. In fact, some people who are suffering severe depression related poor concentration, poor sleep and appetite, and low energy may even have a difficult time benefitting from therapy until some of these symptoms are improved. Poor memory also accompanies depression for many people. It is another reason depression in the elderly is often misdiagnosed as dementia. While you are waiting to be insured it would be a good idea to contact your Community Services Board and see if you can get an appointment. They are in the blue pages of your phone book.Their sliding scale fees are generally pretty affordable and many of them are only seeing people without insurance.

[katerpillar]

I stayed in a private psychiatric facility for a week when I was almost 16. It didn't hurt, but it didn't really do much that my therapy and meds were already doing for me, either. I was like you - really depressed, but not suicidal or a danger to myself or anyone. To be honest, being cooped up inside and surrounded by people who (although they were very nice) weren't exactly the most uplifting of company kind of disturbed me. It's hard to describe. I felt very claustrophobic and frightened - scared I was doomed to end up like one of the chronically dysfunctional patients who'd seemingly spent almost half their life in a psych hospital, or one of the ones who're in and out every five minutes with some sort of addiction. Or one young woman who was there, who was bubbly and cheerful to talk to, but so severely agoraphobic I heard her scream and break down when her doctor tried to make her go outside.

I think inpatient care can be very good for people with problems from their illness that need close supervision, intensive treatment and an escape from the world (eg, the suicidally depressed, addicts, people with crippling phobias, that sort of thing). But for people like you and I, I think they have the ability to make you feel even gloomier while you're there.

On the upside, though, the claustrophobia and fear of ending up like some of the patients I saw provided all sorts of motivation that I didn't fully realise until well afterwards. I was still depressed, but I was depressed and motivated... which beats the hell out of depressed and unmotivated. I slowly started changing behaviours and ways of thinking that had been making me depressed - often without even realising I was doing so until afterwards.

It took me about another year and a bit of gradual improvement before I recovered to what you could call "normal", but I did eventually get better. I think weekly sessions with your shrink would be a very good idea - they certainly helped me. How often do you see him/her at the moment? Learn to "open yourself up" as much as you possibly can, discuss everything and anything with him/her, especially things you do or think which are a part of the present problem. People often talk to their psychiatrist too much like he's a friend or a biographer and not what he is - a shrink. He's there to analyse your situation as much as possible and to address thoughts and behaviours which are abnormal, so guide him. They're well trained... but they're not psychic. Tell him all your unemployment and money worries, the fears you have about burdening your friends... everything.

I can understand why the unemployment situation would make you feel much worse. I spent a lot of time off school with my depression and sitting around brooding did not help things one bit. It was a vicious cycle there for a bit... doing nothing made it worse, but I couldn't go to school because I could barely even bring myself to get out of bed some mornings. If you don't find employment soon, maybe try volunteering somewhere in the meantime, something like that. Force yourself into some distraction, if you are able to. It's a fuckload easier said than done, I know, but it is worth it.

Everyone is different. If you really think inpatient care might help, and you can find a way to fund it, go for it. What have you got to lose? Even if it proves ineffective, like for me... the ineffectiveness, ironically, might also help in some way. I think I had fixated so much on getting hospital treatment that I had closed myself up to my regular treatment a bit. When it turned out not to be the solution I had hoped for, my subconscious kind of realised "right, well - it's either therapy, possibly meds, and your own stubbornness... or it's nothing. And you don't want nothing."

*hugs* It sucks, but it can get better. Don't lose hope, do whatever you think you need, and don't feel ashamed. Let us know how things are going.

By the way... I'm in a different country. We have universal healthcare here and a completely different system, so if I seem to be assuming access to treatment and therapists that is impossible or impractical for you, I apologise. I'm not being insensitive - it's just I've never paid a cent for my shrink and barely anything for my meds so it's really hard for me to accurately put myself in your shoes. Even when the going gets tough, thankfully the Aussie government covers most of it for me anyway.

[McJag]

I have had a good friend with serious depression. I noticed a few things: if your body chemistry is off,all the therapy in the world can't help. You can't talk yourself out of diabetes,either. Get the right balance of what you need. 10 years is long enough,without a good result. Give yourself some credit-job loss can lead to depression,with good reason.You have a valid reason to be depressed. Focus on getting yourself in order & getting back in the job market fast. A new job,with people who are nice, can make a major difference.So can a decent paycheck and benefits. I personally saw medicine take a grown man from unable to move out of his bed sobbing to a back to normal neat person again. I am not sure I could have understood this had I not actually seen it happen. We all went from worried sick to amazed. This took (for him) a few weeks. Not months or years. I think finding a good job that you really enjoy is the first key-force yourslf to get out there. One other thing-getting your mind off yourself a bit & helping others (there are always those worse off) is a depression killer-you get back more than you give. There are drug babies in hospitals that need volunteers to just rock them. There are dog shelters who need people to just walk them. By making yourself help others while you have this time off also gets you in contact with people you would never meet otherwise. All those people know other people,etc-you could easily find a new job or even a life's calling you didn't know you had. Use this time. Keep looking for help for yourself,yes. But use some of that time to help others in some way. You will not regret this.