RE: why would mental health services make people calling for help wait up untill 2 days to evaluate? (Full Version)

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SavageFaerie -> RE: why would mental health services make people calling for help wait up untill 2 days to evaluate? (1/15/2009 9:39:25 AM)

quote:

ORIGINAL: CalifChick

quote:

ORIGINAL: SavageFaerie
Been with him since May and since I see him outside the realm of the center he has yet to bill 1 cent to medicare or me.  In other works pretty much pro bono.


Well, let's hope he just has an incompetent billing staff and is really NOT doing pro bono work as a Medicare provider to a Medicare patient.  It's considered a kickback because you aren't paying your copay, therefore, he is enticing you to obtain more services.  (yes, I know, it's a circular argument, since Medicare isn't paying anything either, why do they care, but it's the government).  And please, if you care about this doctor, don't send any of your friends there, because that compounds the issue since he is giving you free care, you are sending referrals his way.


Cali



His being the Medical Director of the rehab and nursing center is seperate from the care he gives me. Two two are not connected.   I have never referred anyone to him. There is no question of him being shady in any way. I have told him several times I havent seen medicare nor myself billed, and he always tells me dont worry about it. I mean he can have private patients outside his Director job. He has no overhead for an outside patient. I have no doubt how up he is in regarding medication care,as he also sits on the New York City Medical Board. He is very active in the community.
And if he is billing neither myself or medicare how is he breaking the rules. I have carefully watched my medicare payments and there is no billing thus far to him. He doesnt intice me to extra service. He is more or less the qualified dr to manage my medication.

Im sure he would never risk his status in the community nor put himself in that position.



CalifChick -> RE: why would mental health services make people calling for help wait up untill 2 days to evaluate? (1/15/2009 9:46:22 AM)

I'm not going to argue the Medicare laws and "pro bono" work with you.  I didn't say he was shady.  Lots of doctors do things they aren't supposed to, because they think they are somehow "helping" someone.

I was merely cautioning you.  If you don't want to take the advice from me, that's fine, no skin off my nose.  Doctors pay me for this sort of advice, and yes, I occasionally give it away "pro bono".  [;)]


Cali



DiurnalVampire -> RE: why would mental health services make people calling for help wait up untill 2 days to evaluate? (1/15/2009 9:47:33 AM)

Could you even imagine the staff they would have to keep in order to evaluate every single person who called in as soon as they called in? The call staff would all have to be certified and able to do that ratehr than just phone people who asnwer and pass alone messages. The cost to have that large a certified staff just on the phone would be prohibitive, which would make it impossible to keep the service low cost or free.

Which would you prefer? Waiting 2 days to be evaluated by a properly certified practicioner or having to answer a list of questions in a booklet asked by someone who has no training and is crosschecking answers with another list of graded responses. If they think your a risk, you come in, if they think you arent or if they just dont care or have had a bad day, they put you off.

DV



sirsholly -> RE: why would mental health services make people calling for help wait up untill 2 days to evaluate? (1/15/2009 11:44:32 AM)

quote:

so I guess my statement was right? They figure if you're calling in and not going directly to 911 or having people drag you in, you're not critical.

they are trained to ask key questions over the phone to assess the condition of the caller. If his answers told them he was in crisis, the advice given would have been different. He would have been told to go directly to the nearest ER, or the police would have been sent to get him.

If you call your doctor with a complaint, chances are you will have a 24-48 hour wait to see the doctor, after the staff has asked several questions to assess the situation. The mental health field is no different
quote:


We aren't in the critical part, He's just been so stressed and had such a hard time he realizes he needs help, and wants to seek help before it gets to the critical stages.

He has waited this long. A day or two more is not going to make that much of a difference.
But one other thing you need to consider...there is no insta-cure with mental/emotional issues. It is possible that he may be put on a medication for his issues. The average medication takes two weeks to be effective.



YourhandMyAss -> RE: why would mental health services make people calling for help wait up untill 2 days to evaluate? (1/15/2009 2:38:10 PM)

They wanted to know his date of birth his social security number his telephone number and the address where he lived, he said.
quote:

ORIGINAL: wandersalone

Did the mental health service ask him any questions on the phone?  Often services here do a quick triage/assessment by asking a few questions before determining if a person should be referred to the emergency department rather than waiting to be fully assessed.



YourhandMyAss -> RE: why would mental health services make people calling for help wait up untill 2 days to evaluate? (1/15/2009 2:44:51 PM)

He said all they asked him was his ssn his date of birth his telephone number and where he lives.


quote:

ORIGINAL: sirsholly

quote:

so I guess my statement was right? They figure if you're calling in and not going directly to 911 or having people drag you in, you're not critical.

they are trained to ask key questions over the phone to assess the condition of the caller. If his answers told them he was in crisis, the advice given would have been different. He would have been told to go directly to the nearest ER, or the police would have been sent to get him.

If you call your doctor with a complaint, chances are you will have a 24-48 hour wait to see the doctor, after the staff has asked several questions to assess the situation. The mental health field is no different
quote:


We aren't in the critical part, He's just been so stressed and had such a hard time he realizes he needs help, and wants to seek help before it gets to the critical stages.

He has waited this long. A day or two more is not going to make that much of a difference.
But one other thing you need to consider...there is no insta-cure with mental/emotional issues. It is possible that he may be put on a medication for his issues. The average medication takes two weeks to be effective.




DiurnalVampire -> RE: why would mental health services make people calling for help wait up untill 2 days to evaluate? (1/15/2009 2:49:57 PM)

The better question might be what did he offer up when he called? If he calls and says he is stressed and needs to talk to someone, he will be given a far lower priority than someone who is thinking of hurting themselves. When he called up, im sure he didnt just say hi, I need help.



YourhandMyAss -> RE: why would mental health services make people calling for help wait up untill 2 days to evaluate? (1/15/2009 2:50:02 PM)

Nope, there's no insta cure, but the act of seeking help does sometimes make one feel less alone.
quote:

ORIGINAL: sirsholly

quote:

so I guess my statement was right? They figure if you're calling in and not going directly to 911 or having people drag you in, you're not critical.

they are trained to ask key questions over the phone to assess the condition of the caller. If his answers told them he was in crisis, the advice given would have been different. He would have been told to go directly to the nearest ER, or the police would have been sent to get him.

If you call your doctor with a complaint, chances are you will have a 24-48 hour wait to see the doctor, after the staff has asked several questions to assess the situation. The mental health field is no different
quote:


We aren't in the critical part, He's just been so stressed and had such a hard time he realizes he needs help, and wants to seek help before it gets to the critical stages.

He has waited this long. A day or two more is not going to make that much of a difference.
But one other thing you need to consider...there is no insta-cure with mental/emotional issues. It is possible that he may be put on a medication for his issues. The average medication takes two weeks to be effective.




IvyMorgan -> RE: why would mental health services make people calling for help wait up untill 2 days to evaluate? (1/15/2009 2:57:03 PM)

I was waiting 7 years for help.  5 years after I was first referred to a service (which was only a routine referal due to physical problems).

I've been in crisis for months at a time, before, and gotten absolutly nowhere with the NHS.

There was the two weeks in Oxford before someone would see me and admit me, then I wasn't, then the two weeks in Leicester before I was eventually admitted someplace, for 3 weeks in which *nothing* was resolved and I wound up in prety much the same position as at the start.  Oh, and I should point out that the nice NHS in Oxford too *all* my meds before sending me away, so, my first stop in Leicester was the ER to beg for lithium so I could maintain something of a balance.

Waiting 48 hours... nothing.

Ivy
- who is ridiculously frustrated with the mental health care provision she experienced courtesy of her tax pounds but is, thankfully, finally, thinking she might be getting somewhere after last Wednesday.



IvyMorgan -> RE: why would mental health services make people calling for help wait up untill 2 days to evaluate? (1/15/2009 3:08:37 PM)

Oh, and, yes... NHS direct, who you call when your GP is out of action and you're not up for a trip to ER... you phone a call centre, a nurse calls you back, then a doctor calls you back, if you make it through the nurse, and then, if you're *really* going to kill yourself, a crisis team may come and see you.  (But, ime, they tend to decide you don't really mean it and go away again).

The whole process takes a good few hours, and there are a *lot* of hoops before you actually get help.  Chances are though, NHS Direct skip the crisis team and send you to sit in a walk in centre, when the crisis team might come to you if they have time during a shift.

There was that one time, when I might have ODed accidentally on my meds, and so I trundled off to ER under instruction from the Direct people, and after patronising nurses, blood tests, and generally ignoring what it was I was saying I'd been diagonised with (ie a dissociative disorder), the nurse decided I needed a psych evaluation, so, I waited for a couple of hours for the psych to come down, only to find when she did, she had a five minute conversation with the nurse, diagnosed me with schizophrenia, said she didn't need to see me and I could probably go home seeing as how I wasn't dangerous.  (I lip read, this is a good thing, cos, I never got within 20 feet of the doc)

I'm not bitter, oh no, not at all...



CalifChick -> RE: why would mental health services make people calling for help wait up untill 2 days to evaluate? (1/15/2009 3:55:06 PM)

Well, being that you're in the UK and the OP is in the US... let's hope her experience is nothing like yours.


Cali



statusho -> RE: why would mental health services make people calling for help wait up untill 2 days to evaluate? (1/15/2009 4:01:26 PM)

A lot of times the people who answer those phones are just phone operators in a call center. In most states, only clinicians or medical assistants can do intakes and assessments for mental health facilities, so many times they will have one get back to you. To make things worse, the government puts so little emphasis on one's mental well-being, that these places are poorly funded. The people who work in the call centers are at the bottom of the food chain in an already ill-funded organization, which means they get crappy hours, crappy pay, which in turn can lead to crappy attitudes.



califsue -> RE: why would mental health services make people calling for help wait up untill 2 days to evaluate? (1/15/2009 4:03:53 PM)

The reason the initial call and asking for his information is done for the following reasons:
 
To review the database to determine if has ever been seen before and if so where and the diagnoses and why he may have been discharged or did he drop out and to notify who they send the referral to so that they can pull the prior file or make sure they get his prior records to whatever program he is being referred to. 
Most initial intakes done in the County of Sacramento are handled by the Access Team, and while I worked at the
Adult Outpatient Clinic, the staff who does the initial phone evaluation is determined by his personal information and how the work is assigned to staff at Access in Sacramento County.
 
Again..it is FREE care and all regulated by Gov't, County Board of Supervisors and such in Sacramento CA.



YourhandMyAss -> RE: why would mental health services make people calling for help wait up untill 2 days to evaluate? (1/15/2009 10:53:49 PM)

We got the call, they said sign up for medical, and then if you can't get medical, well then there's a community health building in Sacramento he can go to and maybe they'll help.


I don't know if he'll qualify honestly, he's perfectly capable of working has been all his adult life,  And when he talked to the person that you call to find out about being put on medical,  they said you either have to be under 21 or classify as disabled.

Now neither of us know if years and years* since childhood literally* of chronic depression parinia and suicide attempts, counts as disability. Specially since he still works, and is quite capable of working.





YourhandMyAss -> RE: why would mental health services make people calling for help wait up untill 2 days to evaluate? (1/15/2009 10:58:30 PM)

I called them actually, on his behalf to get the ball rolling, What I said said was that I am calling on behalf of someone who's has years and years of history with depression and suicidal tendencies and he can't afford medication nor a doctor nor mental help, and he needs to know if there are programs that he could get into, to deal with his mental illness.

She said is he there now, I said yes, and handed the phone over and he did confirm he has all the problems I stated and is currently suffering depression yes.

When the consult called us back he said yes he has  recently had thoughts of suicide yes, he always had, yes he's depressed and parinoid, No he WILL NOT be making an attempt any time soon, and their reply was to get on medical and go from there to get help.


quote:

ORIGINAL: DiurnalVampire

The better question might be what did he offer up when he called? If he calls and says he is stressed and needs to talk to someone, he will be given a far lower priority than someone who is thinking of hurting themselves. When he called up, im sure he didnt just say hi, I need help.



aravain -> RE: why would mental health services make people calling for help wait up untill 2 days to evaluate? (1/15/2009 11:28:55 PM)

~Fast Reply~

My experience with mental health 'professionals' has been very similar to those here. I've been an in-patient twice, but I've attempted (more than half-heartedly and on a whim, that is) myself six times, I think? Maybe more, but at least six. I had been suffering since age 11-12 and didn't seek help until I was 19. Then they tried to scare me into a psychotic break at the 'walk-in' appointment that I went to in order to send me to the hospital, and commit me for 72 hours hold to be able to place me on medication at higher dosages sooner. I've found that the psychiatrist present (there was also a social worker) at the appointment is notorious for this type of behavior with students (and no, there's nothing that can be done about it).

I held up under their scrutiny then immediately broke down when I left and broke off all contact and thought of help. I was under the opinion that if any help I received would be THAT hostile it would be worse than I ever thought. I attempted again about 6 months later but was snitched on and taken to hospital, and forced (for two years) to be under psychiatric care and adhere to any drug regimen given to me as long as I was a matriculated student. I also took part in psychologist visits for a while, but those had a tendency to make me so riled and sick that I was inconsolable and useless for a day before, the day of, and the day after. Granted, once I *had* the help it was... well, mildly helpful for a short bit, but getting it was certainly a bitch. Lately though it hasn't really been helpful at all.

I'm still wavering about if I'm going to go back, or let my prescription that my last doctor left me with lapse and drop it. Getting help, really, has done no long-term good for me... and like you mentioned, I'm now uninsurable (no, really, I've looked. Nowhere will sell insurance that covers pre-existing mental health issues, including medication for them, that has any approved doctors nearby) which means that if my insurance lapses (which is likely since it's through my mother and I'm 21) before I get a job with benefits... uhoh! The decision's made for me.

Besides, it's all just a waste of money, for me

For others (both with my disorder, and other types of disorders) I definitely see the potential for good, though.

EDIT for spelling and to add: By nearby, I mean 'within the continental United States'



califsue -> RE: why would mental health services make people calling for help wait up untill 2 days to evaluate? (1/16/2009 12:36:52 AM)

To the OP...If he is working have you checked with his employer? There are many companies
that have programs in place for employees who may be having some difficulties and it is not always part of the insurance program. To get government assistance you do need to be qualified as disabled and even if he works there are some programs where you can still get help and have medi-cal depending on income level, dependents and such. The person you spoke with you should have been able to provide either the phone number or web address to start the sign up process for medi-cal eligibility.



DesFIP -> RE: why would mental health services make people calling for help wait up untill 2 days to evaluate? (1/16/2009 4:38:48 AM)

If you have thoughts or plans to harm yourself or someone else, then that is a psychiatric emergency and you need to show up at the nearest ER immediately.

Beyond that, if you called the doctor with a nonlife threatening illness, it is not uncommon to be told you can have an appointment for a day or two later to be looked at. Same thing with mental illness, if you've been suffering with depression for six months the odds are you can wait another three days. And if you're suicidal, then go to the ER. Same as if you've been coughing for three weeks you can wait a couple of days to be diagnosed with bronchitis, but if you can't breathe you go to the ER.



YourhandMyAss -> RE: why would mental health services make people calling for help wait up untill 2 days to evaluate? (1/16/2009 8:47:11 AM)

No we never did consider asking his work.  The company does offer insurance, now actually that he's been there 2+ Years, he just can't afford to do that and a  401k retirement plan, since he's only making 400 dollars, and 10 percent of the 400 goes to 401k. I'll tell him to ask:)
quote:

ORIGINAL: califsue

To the OP...If he is working have you checked with his employer? There are many companies
that have programs in place for employees who may be having some difficulties and it is not always part of the insurance program. To get government assistance you do need to be qualified as disabled and even if he works there are some programs where you can still get help and have medi-cal depending on income level, dependents and such. The person you spoke with you should have been able to provide either the phone number or web address to start the sign up process for medi-cal eligibility.



CalifChick -> RE: why would mental health services make people calling for help wait up untill 2 days to evaluate? (1/16/2009 8:57:14 AM)

It's not insurance they're referring to, it's called an EAP (Employee Assistance Program).  The employer pays for it, and they'll often give 3 to 7 psychotherapy sessions at no cost to the patient.  Sometimes, but not always, they will not give an authorization for it unless it is a problem that can be helped within those 3-7 sessions (meaning, he has to have a problem that he wants help with, a family issue, sudden depression, death in family, etc.).  But it doesn't hurt to ask.


Cali



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