Saturday, October 09, 2010

How To Find A Psychiatrist


Seems like a simple enough questions: How do you find a shrink?

It's not that easy to answer. There are all sorts of shrinks who do all sorts of things (therapy, not therapy, specific forms of therapy like psychoanalysis or CBT), and then there's the overriding insurance question. Not to mention location, location, location.

We've talked before about insurance, and if you haven't read Why Shrinks Don't Take Your Insurance, please do. It's a good place to start. In areas where shrinks are in short supply, often, they do take insurances and they only see patients for medication management. In areas where there are more docs and people have treatment options, they may split between those who do and don't take insurance. You should be aware that if a shrink doesn't take your insurance, you will likely still get reimbursed, but there may be a higher deductible, you'll need to mail in the form yourself, and there will be a long wait (and assorted hassles) for the money to come back. Some people are reimbursed very well, others or not. If your insurance is an HMO or has no out-of-network benefits, then a non-insurance doc will costs you the entire fee.

So start here:
--Does it matter if the shrink is in your insurance network?
If it does, and you live in an area where many shrinks don't participate with insurance, then call the insurance company and get names and numbers and do hope they aren't all dead or not-accepting patients.

--What kind of shrink? If the patient is under age 16-18, your best best is a child & adolescent psychiatrist. Be aware that many psychiatrists at academic centers run research projects and teach, and don't see many outpatients. That's not to say never---and most have a few patients, but they are often a bit harder to reach, especially when they are presenting at conferences or have grants dues, and may have difficult parking. So child, general adult, or is there some specialty need which may be very restrictive---for example treatment of sexual or eating disorders or psychoanalysis? For ClinkShrink, I will throw in that if you are looking for evaluation for a matter pertaining to the legal system, you may want to look specifically for a forensic psychiatrist.

--Finally: does it matter to you if the shrink does psychotherapy or are you fine seeing one person for therapy (if necessary) and another for meds? If it matters, you need to clarify this upfront.

Now you've got the big three questions. There are other obvious ones: parking is always a biggy, the setting may be a concern (is your ex-lover working in the same practice?), how difficult is it to get an appointment? How long do appointments last? If the first evaluation is routinely scheduled for under 50 minutes and you have a choice as to where you go: then go somewhere else. In an institution---jails, a substance abuse clinic, the medical unit of a hospital, an emergency room--- evaluations may be very brief, but in these settings your records may be available for review and the evaluation may have a very specific and limited purpose. But for a thoughtful, comprehensive evaluation before beginning on-going treatment, the usual is a minimum of 50 minutes and often 90-120 minutes. Some psychiatrists do their evaluation over several sessions.

Okay, so to start:
If you have no insurance and no money, your options are limited. The traditional place for treatment in this case is a local Community Mental Health Center or CMHC and the standard has been to have one per geographic catchment area. These clinics usually offer split care, there may be a wait, and you don't get to choose your shrink. They take Medicare and Medicaid, and they sometimes don't take private insurance. How do you find your CMHC (or OMHC)...I'm not really sure. Try Google, and then call any clinic in your area and have a heart-to-heart with the receptionist. He may be able to give you the number of the clinic that serves you.

There are other agencies that over care for the indigent. In Baltimore, HealthCare for the Homeless offers psychiatric treatment, and The Pro Bono Counseling Project will give referrals for free or discounted care from professionals in the community who have agreed to volunteer their time. Again, there's no choice in which shrink you get.

If you have insurance and want to stay in network: Call your insurance company for a list of names.

Aside from money concerns, here are the best ways to find a good shrink:

  • If you know someone who likes their doc, see that doc!
  • If you know someone who like their doc, but you can't see their doc, ask your friend to get some names from their doc, or call yourself.
  • Call your state psychiatric society and ask for a referral. If the office is located near where you live, the staff may well know some of the psychiatrists and you can ask for a nice one.
  • Ask your primary care doctor, they are used to making referrals.
  • Ask a Shrink. Ask any shrink---shrinks tend to know each other....so if you can get one on the phone, they may give you names even if they can't see you. In our state, we have a shrink listserv, and people frequently post, "Does anyone know a psychiatrist in Timbuktu?" for a patient who is moving, a child of a patient, friend of a friend of a friend. As a rule, shrinks don't know what insurance networks other docs participate in.

  • Ask a doc, any doc. A random doc may not be able to help you, but they may. My favorite was the friend who asked me for a referral for a breast surgeon in another part of the state. Not something I'd know, but my neighbor the breast radiologist was able to give some names and so I was email-helpful. Between listservs, Facebook, email, etc...people can sometimes find names.

  • If you're a student, try the school's counseling/health center. They may also be able to suggest off-campus referrals.
What to ask on the phone (besides the obvious money issues):
It's fine to tell someone the one-sentence version of what you want help for and to ask if they are taking new patients. It's probably a burden to try to tell them your whole history.
It's fine to ask how long the evaluation is, how long a typical appointment is, and if the shrink sees people for therapy or just meds.

13 comments:

moviedoc said...

That's most of it, Dinah. I would like to add: If you need a forensic psychiatrist, many of us contract only with attorneys. For psychotherapy, some psychiatrists probably still do groups, and some definitely still work with families, which I believe is the best approach. Finally, if you have an addiction problem, say so up front, and talk to others in recovery or to addiction counselors to find a psychiatrist whom you can trust not to prescribe benzos or other addictive drugs that might lead you into a relapse, or worse.

Sunny CA said...

I am about to go off my independent insurance and onto an emplorer's insurance. The employer is a small group of schools with a meddling CEO who fires people without provocation. If I see a psychiatrist through the new group health plan, will the employer know the name and specialty of the doctor I am seeing? In other words, is it automatic that they know I am seeing a psychiatrist if I do not pay for it myself?

Anonymous said...

Thanks Dinah!

My GP said he could give me a list of who was available, but didn't know anything about any of them, so it would be a case of trying to find a good 'fit'. And considering here in Aus meeting up with a shrink means $100-200 a pop (AFTER insurance/government rebates) with ~3 months wait for an appointment makes 'shopping around' seem like an expensive and long 'shop'.

I think my uni counselling service would be able to give me some good advice as to who is out there and what they do, so I think I'll try that.
(Now why didn't I think of that option?)

And I'll ask a few friends who are docs and see if they have any suggestions.

Thank you so much!
:-)
bec

Anonymous said...

Hey bec, I'm a uni student in Aussie and I've used some services before. You don't say what state you are in and whether you are in the country or city. The uni service, at least for my uni has a clinical heath department where you can see a GP, psychiatrist and some other specialist doctors if you are a student, It's free if you are with medicare as they bulk bill.

Otherwise you can always use your local mental health team facility, it has a few mental health workers that also include social workers, psychologists and therapists in other branches. You don't need a referral, it's all free, normally there are a few psychiatrists in the facility. I don't even use my medicare card there ... but I'm going to assume they are covered by the government ...

Anonymous said...

If you want to find a psychiatrist go check into a vacation hot spot anytime in August.

Sarebear said...

Crap. It ate my comment with complications to finding a shrink that you don't talk about. Too frustrated to rewrite it now, UGH.

Hubby out of work since mid-july, my life has gone to hell in a handbasket.

I'll bring up the complications that made things an unpleasant maze, like opening a can with one of those sproing fabric covered snakes in it, each time I called a new potential shrink, sometime soon.

Anonymous said...

Hi Anon,

My uni health service is pretty small and not very good: long waits, cranky docs and weeks to get an appointment and doesn't appear to have specialists.

I was referred to the mental health care team after I left hospital. But I had a 'disagreement' with the last psych I saw there, and due to this I lied and denied the presence of any worrying symptoms and disengaged myself from the MH system and decided that because all anyone did was tell me that it was depression and to throw more drugs at me (wiki told me I was on 4-5 times the normal dose!), that it was up to me to understand exactly what was happening and to get better.

Anyway, I work full time as well as study so I don't think I qualify for the 'free' community based services anyway.

I like to think that I have just had a bad experience with mental health care services, or possibly as this was my first time engaging with them, that I had unrealistic expectations, and lets remember that I *was* crazy and not thinking right.

This is partly just a rant#, but I found it unacceptable that I was not informed that I was delusional and hallucinating. I have no idea what is clinically appropriate, but I was so distressed and confused, and I *knew* I wasn't following conversations from peoples reactions, but I had no idea why.

I was never offered any form of therapy or CBT. And I do understand that for the majority of the time I was far too unwell for this to have been beneficial and that many of the clinical models suggest that this is not useful in 'biological' forms of depression. At the time knowing I was not being offered it, even when I asked about it just reinforced my view that I was an inherently bad/invalid/automaton.
Btw I have followed up on this and found CBT and the ability to talk about my experience very useful.

And the last psych I saw started the appointment with this pearl: "So tell me about your plans to kill yourself", he didn't even introduce himself, or ask who or how I was. This started me crying, and when I said I didn't want to talk about it, I was informed that he couldn't help me if I didn't want to talk about it.

And all of this was imposed upon the view that if I told anyone how I was feeling I would be forced back into hospital.

But 10 months, wonderfully supportive friends, family and flatmates, and even an understanding workmate or two, LOTS of exercise, remembering to eat 3 times a day and no more than 6 hours sleep each night and I think I'm almost back to normal.
Now all I need is to know how to prevent it happening again!

#partly= totally.
WHEW!
I feel so much better having let that off my chest! :-)
Sorry and thank you to everyone having to endure this response.
Sorry shrink-rappers. But I imagine you are accustomed to colossal whinges like this one.

Anonymous said...

Hi Anon,

My uni health service is pretty small and not very good: long waits, cranky docs and weeks to get an appointment and doesn't appear to have specialists.

I was referred to the mental health care team after I left hospital. But I had a 'disagreement' with the last psych I saw there, and due to this I lied and denied the presence of any worrying symptoms and disengaged myself from the MH system and decided that because all anyone did was tell me that it was depression and to throw more drugs at me (wiki told me I was on 4-5 times the normal dose!), that it was up to me to understand exactly what was happening and to get better.

Anyway, I work full time as well as study so I don't think I qualify for the 'free' community based services anyway.

I like to think that I have just had a bad experience with mental health care services, or possibly as this was my first time engaging with them, that I had unrealistic expectations, and lets remember that I *was* crazy and not thinking right.

This is partly just a rant#, but I found it unacceptable that I was not informed that I was delusional and hallucinating. I have no idea what is clinically appropriate, but I was so distressed and confused, and I *knew* I wasn't following conversations from peoples reactions, but I had no idea why.

I was never offered any form of therapy or CBT. And I do understand that for the majority of the time I was far too unwell for this to have been beneficial and that many of the clinical models suggest that this is not useful in 'biological' forms of depression. At the time knowing I was not being offered it, even when I asked about it just reinforced my view that I was an inherently bad/invalid/automaton.
Btw I have followed up on this and found CBT and the ability to talk about my experience very useful.

And the last psych I saw started the appointment with this pearl: "So tell me about your plans to kill yourself", he didn't even introduce himself, or ask who or how I was. This started me crying, and when I said I didn't want to talk about it, I was informed that he couldn't help me if I didn't want to talk about it.

And all of this was imposed upon the view that if I told anyone how I was feeling I would be forced back into hospital.

But 10 months, wonderfully supportive friends, family and flatmates, and even an understanding workmate or two, LOTS of exercise, remembering to eat 3 times a day and no more than 6 hours sleep each night and I think I'm almost back to normal.
Now all I need is to know how to prevent it happening again!

#partly= totally.
WHEW!
I feel so much better having let that off my chest! :-)
Sorry and thank you to everyone having to endure this response.
Sorry shrink-rappers. But I imagine you are accustomed to colossal whinges like this one.

Anonymous said...

Hi Anon,

My uni health service is pretty small and not very good: long waits, cranky docs and weeks to get an appointment and doesn't appear to have specialists.

I was referred to the mental health care team after I left hospital. But I had a 'disagreement' with the last psych I saw there, and due to this I lied and denied the presence of any worrying symptoms and disengaged myself from the MH system and decided that because all anyone did was tell me that it was depression and to throw more drugs at me (wiki told me I was on 4-5 times the normal dose!), that it was up to me to understand exactly what was happening and to get better.

Anyway, I work full time as well as study so I don't think I qualify for the 'free' community based services anyway.

I like to think that I have just had a bad experience with mental health care services, or possibly as this was my first time engaging with them, that I had unrealistic expectations, and lets remember that I *was* crazy and not thinking right.

This is partly just a rant#, but I found it unacceptable that I was not informed that I was delusional and hallucinating. I have no idea what is clinically appropriate, but I was so distressed and confused, and I *knew* I wasn't following conversations from peoples reactions, but I had no idea why.

I was never offered any form of therapy or CBT. And I do understand that for the majority of the time I was far too unwell for this to have been beneficial and that many of the clinical models suggest that this is not useful in 'biological' forms of depression. At the time knowing I was not being offered it, even when I asked about it just reinforced my view that I was an inherently bad/invalid/automaton.
Btw I have followed up on this and found CBT and the ability to talk about my experience very useful.

Anonymous said...

Hi Bec, sorry for the belated reply - I still live with my parents, they make a lot of money and I still am entitled to free services, I've done my reading and turns out anyone can walk into any health service and get free services, doesnt matter what the circumstance - you sound like you have the GP on your side ... so yes, maybe he can tell you about other mental health teams and he can also refer you to a psychologist - this can be all under medicare. He can also prescribe. If he doesn't know what he is doing, then find someone else under the beyond blue 'find' a GP pages and look for a GP with a special interest in depression and mental illnesses. There's a way :) ... I thought mental health services were restricted only to ones who were referred but I was wrong, anyone is entitled to them.

Sarebear said...

I kind of have a post floating round my brain that will address what I wanat it to on this subject, but I'm not up to writing it right now. I'm not even editing my comments very well right now, although that's not so unusual for me, but I'm especially displeased with my self-editing lately. Just not up to much, right now.

Anonymous said...

Hi anon;
Yeah, my GP is pretty good. Not very interested in mental health, but he is a good GP nonetheless (and I live in a town where getting a GP is hard enough!).
I asked about psychologists when I was in hospital and all you need is a referral from your GP - a"mental health care plan" which I have already utilised.
I just have questions about long term plans, and I need a medication change that my GP (and I) would prefer a psych to take care of.
I have no problem paying money, particularly as I would like to be able to choose who I see and when I see them and to see the same doc and be able to form a relationship with them.

"I've done my reading and turns out anyone can walk into any health service and get free services, doesnt matter what the circumstance"
Yes.... and no. In Australia in any public health service an owner of a medicare card and usually get their care for free. But like all services this is subject to supply and availability. Long waits, and no preference of doc or time, and not necessarily follow up with the same doc.

I want a doc who I can have an intelligent discussion with, and who will let me have a say and be active in my own care. Who won't just throw drugs at me and will give me a kick up the bottom if I need it.
I'd also like world peace, a new job and my tax rebate back sometime this century.
I know I cant have everything, but it is nice to dream!

Anonymous said...

Sorry to hear about your frustrations Bec, where I live, there are several local mental health teams with several different counsellors and psychiatrists to choose from in each team... the psychiatrist I saw really did a good job even though I didn't really get to choose him I was happy with what he said ...and the help I got was immediate (I called them and left a message, two hours later they called me back!). There are so many GPs to choose from (there are 4 medical centers within walking distance of where I live) On top of that my uni services are great and if I am ever in an emergency, there are two local psychiatric wards that are less than 15mins-30mins drive.

I guess it's easy for me to think that the mental health facilities are this great all over the country... The whole government thing about no money towards mental heath mystified me but now they make sense.

I can't believe that you didn't have good psychiatrists dealing and handling you to start with, but I'm sure it's partly got to do with the fact that you had a more severe diagnosis (I just had a classic case of unipolar depression - no hallucinations or delusions.)

You are right to go with your counseling services at uni, most of the time there will be trained psychologists who are able to know a few things about the matter.

Best Wishes :)