Saw the New Therapist Yesterday

In an earlier post I talked about my disillusionment with state-run mental health care.  There are three cattle farms in my county (that's what I call the Medicaid-funded clinics) and I've been to all of them at one time or another.  None of them did much for me.  I think 8 years is long enough.

In hopes of finding some stability my husband and I agreed that I would try to find someone in private practice.  A psychiatrist in my area who accepts Medicare apparently doesn't exist.  In my search for that particular unicorn I found a local ARNP who, although he doesn't accept Medicare, charges approximately what my co-pay would be if I had found a psychiatrist who does.  I saw him yesterday.

Since the initial 1-1/2 visits are for evaluation I wasn't able to determine if he and I would be a good match.  I did, however, get a sense of what kind of person he is and a learned a little bit about how knowledgeable he is.  He's a very kind man, quiet and sympathetic.  Although he was reading questions from a pre-printed list he took copious notes.  He listened to me without interruption, and asked me to clarify certain things.

It sounds like your basic intake, doesn't it?  But this was such a different experience.  He didn't rush me or treat me like his twenty-third intake for the day - he treated me like a person.  He looked me in the eyes.  He listened to what I had to say.  And best of all, he was honest with me.  He said he couldn't cure me (which I already knew - no one can) but that he would do his very best to help me achieve the best life I could.  

I still don't know how my husband and I are going to come up with the money for me to see this man on a regular basis.  Just these first two appointments are going to wipe out our tiny savings.  But if he proves to be helpful, I'll come up with the money somehow.  I won't skimp on medical care, and now I refuse to skimp on mental health care.  

After all, it's my life we're talking about.  

No More State Mental Health Services for Me!

I've had it. Ever since I qualified for Social Security Disability I've been seen by one state-run mental health facility or another. Not one of them has provided the care I need. The proof? I'm 8 years in and still not stable for any length of time between episodes. I was manic last spring, then dropped immediately into depression for several months, and now I've jumped to hypomania. 

Just the thought of going back to one of those facilities fills me with despair. I don't want to be treated like the rest of the pitiful cattle who go there. I want someone who actually has the time to care about me and my illness. Someone who knows a lot about BP, including keeping current on research and new treatments.

I saw an ARNP for 5-10 minutes every three months for med management. I spent 50 minutes twice a week with an overworked, undereducated counselor (when her kids weren't sick and she was there). I took a few free classes on things like mindfulness (which was actually very helpful, I have to admit). That's it. Nobody actually got to know the real me. Just me as a bipolar person.

I had a long talk with my husband. I asked if it were wrong for me to want to see an MD for a medical illness? We agreed that no, it's not. I told him that if I didn't go to the state-run facilities we'd have to pay some out-of-pocket costs. He said that we shouldn't scrimp on my care so that was fine with him. I feel angry and a bit guilty about spending our cash - since I have Medicare and Medicaid (which I pay $94 a month for)- but hubby believes I've made the right decision.

So I tried to find a psychiatrist in private practice who takes Medicare. Apparently it's like finding a unicorn; they just don't exist in my part of Washington state. I started with the King County Medical Society website and called the psychiatrists there. I don't live in King County but Seattle is there - it's 50+ miles one-way but maybe? Nope. I searched the yellow pages, both online and off, in towns within a 50 mile radius of my home. Nope. I spent hours on the phone.

At one point I thought I'd found a psychiatrist who didn't take Medicare but who had reasonable fees. Turns out he's an ARNP. In private practice. By that point I was so frustrated that I let loose on the guy who answered the phone. Told him I didn't want to see an ARNP, I wanted an MD. Told him why. Wasn't polite about it. He said for me to think about it and if I changed my mind I could call back.

Later that night I thought about how I had denigrated ARNPs to the guy on the phone. Then it hit me - OhMyGod - the guy on the phone WAS the ARNP. I'd bet a hundred bucks on it! I had just insulted the man nine ways from Sunday! I bet that guy wouldn't see me even if I wanted to go see him, after the things I said about ARNPs.

I thought about it anyway. I talked to my husband. We reasoned that since the guy has 5 different degrees, used to work at the Pentagon and is in private practice he has enough experience. We decided that since I'd be paying out of pocket, perhaps I'd get the kind of personalized care I needed. And maybe if I apologized he'd agree to see me.

 He did. So next Friday I'm going for an evaluation. After that I'll have to spend another hour with him finishing up the eval and talking about a course of treatment. Just those two appointments are going to cost me $400 altogether. It's going to wipe out our savings account. I don't know how I'm going to get together the money to see him for therapy after that, even for just half an hour. But if he works out and I get better it will be money well spent.

Wish me luck.