How to Arrange and Coordinate Your Mental Health Care as an Outpatient

If you've ever been a patient on a psychiatric unit of a hospital you've experienced coordination of care. Your team consisted of a psychiatrist and a psychiatric nurse and a psychiatric social worker. There were also mental health workers who assisted with observations, take downs when needed and other unit tasks. Everyone knew your diagnosis and worked together to help you recover and be discharged. Most likely you left with a follow-up appointment to see a psychiatrist and possibly a therapist.

Most people who seek mental health care have never been on a psychiatric unit. They are out in their communities trying to get the help they need, struggling with insurance limitations and having no idea who the right person is to help them. Do you ask a friend and disclose such a personal need? Do you go to the phone book? Here is how to go about finding the mental health help you need.

WILL YOUR INSURANCE COVER IT?

Insurance will only cover mental health if it is a medical necessity. So, things like marital therapy, family therapy, interpersonal problems and parenting issues won't be covered. Your company may offer an Employee Assistance Program (EAP) that will cover these. EAP sessions are always free and are usually available to everyone in your household. EAPs contract with licensed therapists so don't be concerned about the professionalism of the person to whom you are referred. But if you don't have an EAP and you are having these problems tell the insurance company you are struggling with stress or anxiety or depression. Those issues will be covered. You will want to find someone who is in the network of your insurance company so don't go to the Yellow pages and don't ask a friend. Call the number on the back of your insurance card and they will give you some names of therapists in your area.

I ONLY WANT TO SEE A PSYCHIATRIST BECAUSE THEY ARE THE BEST THERAPISTS

W R O N G !!!!! Years ago the medical schools stopped requiring doctors who go into psychiatry to take courses in psychotherapy. They may take it as an elective. Most don't. Psychiatrists are the only mental health professionals who can prescribe medication (some states allow psychiatric nurses with advanced degrees to do so also). They will be paid by the insurance company for one assessment session and are expected to prescribe medication after that session. If they do not they must refer to a therapist and cannot see the patient again. So a lot of psychiatric medication was getting prescribed. Now, most insurance companies will first refer you to a therapist who will assess the need for a psychiatric referral. Your family physician can also make that referral. But make sure the referral is to an in-network provider or your fees will either be partially covered or not covered at all.

THE INSURANCE COMPANY GAVE ME SEVERAL NAMES - HOW DO I CHOSE?

You may already know if you want to see a male or a female therapist. This is strictly a personal issue and has no clinical significance. Do you need them to be near public transportation or handicapped accessible? Would you feel more comfortable with someone of a certain age? Give some thought to this before you call the insurance company and tell them your preferences when you call. If you don't have any preferences then take several names and call them. Most of the time, you will be referred to either a Clinical Psychologist or a Clinical Social Worker. If psych testing is required the psychologist will be the referral. If therapy or counseling is required they will probably refer you to the social worker. Some insurance companies also have Licensed Professional Counselors and Licensed Family Therapists in-network also. When you call ask to speak to the therapist - not the secretary. They may have to call you back. Chose someone with whom you establish a rapport. If you don't like them or they feel they cannot help you after the first session you can always change. If the provider is in your insurance company's network they have already checked their credentials and licensure. You don't have to do that.

WHAT IF I NEED MEDICATION?

The therapist will call the insurance company and inform them of the results of the assessment if they feel medication is appropriate. The insurance company will give either you or the therapist the names of in-network psychiatrists but it will be your responsibility to make the appointment. Ideally the psychiatrist and the therapist will have you sign releases so that they can discuss your needs. If the psychiatrist will not work with your therapist I strongly suggest finding one who will. The therapist will be seeing you far more often than the psychiatrist and will be able to monitor your growth and change, your reaction to the medications and can more easily see the mental health issues that medication may successfully address. Some doctors don't like to work with therapists. But coordination of care will bring about the most success.

MAKE AN APPOINTMENT WITHIN 72 HOURS IF POSSIBLE

Don't call until you are ready to go. You want someone who can see you fairly quickly. A long wait time does not mean they are better therapists. It could mean that they only work part time. You want someone who will be able to see you if you have a crisis. If you can't make the scheduled appointment, call and cancel. The time has been set aside for only you and you may be charged if you don't show up. Appointments with therapists need to be pre-authorized with the insurance company most of the time. Bring the authorization number with you. Know your co-pay, if you have a deductible, and the number of sessions that have been authorized. Arrive a few minutes early for your first appointment to fill out the required paper work so you don't miss time from your appointment.