Letting someone else talk for once–is there a diagnosis for that?

21 05 2012

I don’t only make people think, laugh, cry, or angrily comment/tweet at me. Sometimes I inspire a frustrated blog post. Our friend RealityTx is back with a dose of mental health reality. Listen closely to your substitute blogger, she’ll be reporting on your behavior to me when I return. 

Stop Diagnosing Already!

Hello, this is RealityTx here with a new dose of reality about mental health and wellness. Let me preface this by saying that I am a licensed provider in NY. In other words, I’ve been trained for this. I went to grad school for three years, did a 700 hour internship in school and did 3000 hours (yes, 3K) of clinical work post-grad plus took an exam to get my license. Ok, now that’s out of the way, I can talk about what’s been bugging me lately. SocialJerk recently wrote a post about not diagnosing fictional characters and inspired me to write about something that’s been festering within.

One of the things that annoys me about technology is the rapid access to information (and misinformation). Thanks to the internet and many other forms of technology (which I do love very much) random people think they are qualified to diagnose others. Guess what, if you haven’t gone to school for it, chances are you’ve no clue of what you’re saying.

So here is a list of things that go into diagnosing a mental health disorder (and NO, reading the DSM does not qualify you to diagnose either.) And if you don’t know what the DSM is, stop diagnosing ASAP!

  1. A recent physical with all the works. Why? We in the diagnosing field of mental health (therapists, counselors, social workers, psychiatrists, psychologists, etc.) have to figure out where symptoms are coming from. Maybe someone is woozy because they drank cold medicine and later drank. Or a child who has low blood sugar ate too much candy and is now bouncing off the walls (commonly diagnosed as ADD or ADHD).
  2. Now that I’ve mentioned symptoms, here’s another tip: don’t diagnose based on one thing. Bouncing off the walls (aka a symptom) isn’t only a sign of ADHD. Being forgetful isn’t a sign of Alzheimer’s or Dementia. Several criteria are used to determine whether or not someone has a particular disorder. After a physical (see #1), practitioners look at the symptoms (ie what is happening), the time frame (how long have the symptoms been present), the lifestyle (what’s happening in the person’s life), the age (stage of development) and level of functioning (how is the person doing in all environments). See why it’s so hard?
  3. Age is important! In mental health, age isn’t just a number. There is a reason why there are several theories of development. Freud wasn’t the only one with developmental stages (Piaget and many others). Check out books on developmental theories and you’ll see what I mean. A child, teen, adult and older adult can have different reactions to the same thing. Everyone has specific body chemistry at various stages as well as different lifestyles.
  4. Emotions are not mental health disorders people. Being happy does NOT mean a person is manic. Being sad is NOT the same as being depressed. If you’ve seen commercials about depression medication on television, some of the more recognizable symptoms are mentioned – no longer doing what interests you, frequently isolating from others, etc. But, being sad because you didn’t get a job isn’t the same as being depressed. Depression (yet another disorder that regular Joe Schmoes misdiagnose) is an on-going diagnosis that isn’t treated easily. Therapy, medication and constant work all go into treating an individual with a diagnosis. Normal is relative to each individual and all people have different kinds of normal.
  5. Medication isn’t magic. A mental health disorder is a serious thing. It disrupts your life and interrupts your level of functioning. A disorder can keep you from doing well in school, at work and/or at home. In short, it can stop a person from being the best that he or she can be. Yes, medication helps with chemical imbalances in the body, but it doesn’t automatically solve other lifestyle issues that come from having a diagnosis.
  6. Diagnoses come in several flavors – mild, moderate, severe and profound. They come in degrees. How bad do the symptoms affect the person’s day-to-day life? How often do the symptoms appear? How long is a person symptomatic during an episode? A diagnosis does not allow the person to control the symptoms alone – on-going therapy and medication and lifestyle changes help an individual manage his or her symptoms.
  7. Medication isn’t the only option. I believe in medication as a last resort. If therapy and lifestyle changes aren’t enough to reduce the frequency of the symptoms then medication can be explored starting off with the lowest dosage.

Please note that even with all of this going on, there is much more to diagnosing. So please, if you’re not a professional in the field, don’t diagnose. However, if you do see something out of the ordinary in a person’s behavior, seek professional help. Go through your doctor, school social worker or guidance department or through your insurance or employee assistance program. There are many practitioners out there. Make sure to use your best judgment to ensure that you’re loved one gets the proper diagnosis. Ok spiel over. You can now return to your regularly scheduled programming.

Why Mental Health is Bad for My…Mental Health

12 04 2012

When ACS refers a case to us, there are certain things they want done. (Most often, these are things we don’t do. But that’s for another blog…) A lot of times, it’s counseling for domestic violence, sexual abuse, or substance use. These don’t apply to everyone. But one thing is constant. Everyone in the family–parents, kids, household pets–should have a psychiatric evaluation.

I’m rarely against an evaluation. It can’t hurt, right? Well, I guess anything can hurt, but the professional would have to be a real idiot. Surely there aren’t any of those. I think our kids are overdiagnosed and too often prescribed serious psychiatric meds but evaluations…why not?

There are a few problems, of course. Some parents don’t agree with them, some kids think it means I think they’re crazy. The number one obstacle, though?

Where the fuck are they supposed to get this done?

With the health care debate raging in this backwards ass country, I keep hearing about these “free clinics” that one supposedly trips over on any stroll through the ghetto low-income side of town. They’re doing free well-child visits and tossing out birth control like Gobstoppers at Willy Wonka’s factory.

Unfortunately, they don’t exist. Most of those “free clinics” actually charge Medicaid. You can get urgent care, not ongoing treatment.

This is also true for mental health clinics. In my first months on this job, I thought they were a myth, like Sasquatch, or the G train. But they’re out there. They’re just hard to find. It’s especially hard to find one that takes your insurance. Sure, everyone has Medicaid, but most people also have supplemental insurance. This place takes straight Medicaid, not Health First. This place only takes blah blahdiddy blah…

Most unfortunately, we don’t have mental health staff here at anonymous agency. We’re social workers and case workers, but no doctors. I can do family counseling, play therapy, which is all good stuff, but I can’t prescribe Ritalin. No matter how much I may try. This means that we have to refer out.

Until recently, we had a connection with a nearby mental health clinic. They came by when they felt like it to collect our referrals, and our clients were able to get appointments within a couple of months. To be honest, I thought they did supbpar work. But we had to take what we could get.

That relationship was terminated for some reason that hasn’t been explained to any of us because we’re not important. Now, we’re back to the old referral process.

Agency names have been changed for my amusement.

I call Shining Time Mental Health Station to refer a nine year old girl and a thirteen year old boy. Their mother is also to be evaluated, but I don’t mention that at first, as I don’t want to seem greedy. No one answers, so I leave a message. I do this fourteen days in a row, while also leaving messages at Miss Kitty Fantastico Memorial Mental Health Center and St. Mungo’s Center for Nonmagical Mental Maladies. No one will answer me, and I start to take it personally. I leave decoy messages, telling the intake worker that she’s won a sweepstakes and needs to call me immediately, or saying that I’m holding her puppy hostage. Nothing. That woman does not care about her imaginary millions, or her puppy.

At some point, I give up on St. Mungo’s, because they don’t take this family’s supplemental insurance. Miss Kitty Fantastico is no longer seeing children. That leaves me with one in their area. Oh god.

Finally a coworker sees me sobbing into the phone, and mentions that she has a contact at Shining Time, who might help. I get my hopes up (always a mistake) and call. Of course, this person is a domestic violence specialist only. Could you encourage their dad to stop by and rough up the mom? OK, in that case I can’t help you. Let me transfer you to our intake worker.


Next, I try the child study center at St. Anastasia Beaverhausen Hospital. I call their general intake number, and am given the option to press one for the diabetes program, two for women’s health, three for dental, all the way to nine for foot problems, but no child study center.I start cursing into the phone, hoping that this will cause them to connect me with a real person (it works with FedEx) but all this gets me is some looks from my coworkers.  I hit zero for all other calls, and am told that my call is very important to them, but there are six other callers ahead of me. After an hour, I begin to doubt the importance of my call. Someone answers. I ask for the child study center. She transfers me to the foot center. I ask for the child study center. Foot lady transfers me back to the lady who transferred me to her. I finally get the child study center after three more rounds, only to be told that they aren’t accepting new clients for five months. Can’t I put my kids’ names down now, that way in five months they can have an appointment? No, it doesn’t work that way, because we say so. Oh.

While I’m chasing my tail, there are children who need help and aren’t getting it. Counseling, play and art therapy, are crucially important to their well being, and I do that. But when there are things like PTSD, ADHD, bipolar disorder, or a family history of schizophrenia going on, they need to see a doctor.

People in need can always walk into the ER. We always hear this from people who don’t want to pay for our frivolous health care, and it’s true. They can walk in, sit down, and wait for hours. Wait, and wait, and wait. Often they choose to leave. Generally, if they aren’t actively suicidal, they don’t get to stay. I once got frustrated enough that I asked a mobile crisis worker if I should wait to call back when my (pregnant, schizophrenic, drug abusing, cutting, but not presently suicidal) client was setting herself on fire.

In retrospect, that was too far. This is not how we get what we want.

If a client is admitted, they’re often transferred to a different hospital, particularly if they’re a child. Depending on insurance, this can take forever. Not literally, but just about. There’s a sort of time suspending limbo you enter when you walk into an ER.

One of my teen girls who had attempted suicide more than once wound up being sent to a notoriously unpleasant (to say the least ) psych hospital in Brooklyn. They had an available bed and would accept her despite not having insurance. Her mother was afraid to send her there, and didn’t want her to be two and a half hours away, but she did it because she had no other choice.

I don’t think I need to point out the irony that the mental health system in the Bronx has driven me a bit insane. I’m glad I get to absorb this frustration for the parents I work with, honestly, because I can’t imagine that they could do this on their own while also worrying about everything else going on in their lives. But it’s infuriating to see how difficult it is to get someone help. Are they a danger to themselves or others? Yes, but not enough of a danger. Come back when something tragic happens, so we can all blame the parents for not having done enough.

We are tragically failing our people in need when the only way to get (temporary, kinda-ok) treatment is to be brought in slitting your wrists.

I wish I could end this by offering a solution. All I can say is that we need more, and we need better. Prevention is almost always the answer, says the preventive worker. Maybe if some of those earlier evaluations and mental health treatment could happen, we’d be taking fewer trips to the ER.

But what do I know.