bill slaughter md
Integrative, holistic support for
development and health of the adult psyche
Some thoughts for shopping for healthcare...
The US generally has more availability and better healthcare than most of the world, and also there are clearly countries which are generally better in this regard (usually smaller and more homogenous ethnically). Our overall way forward will be with best social systems for healthcare; please consider putting energy into helping build that.)
Here and now, finding support (access) can be difficult. *Don't be too discouraged if it takes some time to find providers. Stay with the process.*
If you don't find exactly what you want, consider starting with whatever you can arrange, then making changes. This can mean starting meds via a PCP, with talk counsellor, then seeing if it might make sense to switch prescribing to a specialty mental health prescriber(of any license), or combo talk and prescribing, etc. All this while optimizing your social relations, exercise, diet, general health and such as best as each circumstance allows, of course. Here are some aspects which might be be good to consider:
Combo prescribing plus talk therapy, or separate: Both have arguments for and against. I usually feel combining these might be best, to allow easier holistic discussion. But depending on the situation, I sometimes prescribe for some folks who have other talk therapists (or aren't currently in talk therapy), or do the talk therapy part with folks who have someone else prescribing (or aren't currently taking mental health meds.)
"Hmm...maybe I shouldn't use insurance to meet, and just pay directly myself...": *Do* use your health insurance if at aaalll possible. Some folks intend to pay (sliding scale) on their own, but over time most folks gradually feel burden from paying , and decrease services below what they intended and may best benefit from (consciously/intentionally, or just kinda do without realizing it...) That being said, I work with some folks who pay directly, for this or that reason.
How do I find a prescriber and or talk therapist(s--including
separate individual, relationahip, specialty, etc cousellor):
- PCP's: Most mental health medications in the US are prescribed by primary care physicians/PCP's, and that often goes well. PCP's are among my heroes in health/human services, with broad scopes of knowledge and responsibility; each one is of course different. Each may have particular approaches to psychiatric medications becuse of the system they're in, or their own personal stance, etc. Feel free to ask them about these issues:
- Often PCP's may "bridge" meds for a month or two, while someone is looking for an ongoing psych prescriber. This is one argument for have a PCP, including setting primary care as the first healthcare support when moving to a new area, changing insurance which necessitates provider changes etc.
- If a PCP or theri system can't help, at least consider asking the PCP office about possible providers. Often they have built lists of providers in the community, outside of their system, or within the system where they work, PCP may have a "coach" for their psych prescribing, or psych prescriber available who takes over that responsiblity, etc.
- The more complex the situation may be, the more likely it is that a PCP will ask a person to see a psychiatric prescriber (M.D., D.O., prescribing nurse, etc, for controlled substance meds, with their habituation concerns; meds needing blood monitoring; people who've had challenges with meds, and might benefit from more in-depth specialty assessment, etc.)
- Insurance: If you're close to changing insurances, be sure a new provider can switch with you, or perhaps wait until you have the new insurance in hand.
- Consider asking your insurance company for help finding health providers. Sometimes I get calls from insurance company workers who say that a person with their insurance hasn't had success on their own finding a provider, so the insurance company is taking on some of the search function. I don't know if all insurance do this.
- If you have problems with insurances (different answers from different people, etc), log your experience, ask for supervisors, ask my billing company for help if we're working together, and go to your state Insurance Commissioner as need be. Insurances do business in a state with permission of the state government; often insurances which are not doing what they should will respond to state regulators. That being said, sometimes state insurance office can be challenging to interact with.
- Other settings, for possible off-hours supports: I simply work alone, and don't respond "24/7/365", and thus need to rely on people I work with to themselves use public emergency services if that should ever be a question and I'm not immediately responsive. (I'm old fashioned and actually turn my phone off from time to time).). Some people benefit from meeting with mental health providers in settings where there is off-hours meeting with mental health providers in settings where there is off-hours coverage. For example, sometimes a hospital episode can be appropriately avoided by talking off hours with a worker who is at least somewhat organizationally connected to one's provider, to perhaps set a next da-day appointment, or other crisis respite support.
- Provider search detail logging: It can help to keep a clear record of what calls to potential providers, insurance etc you make. Record phone number, date, what happens--who you talk with, left a message, etc, and what next steps may be (await call back, expect that office to call, etc). This can help show an insurance company that you've been diligently looking, and just for your own tracking.
- Specialty treatment areas: Do consider whether you want to look for a provider with any specialty niche interests, experience, training, etc. I put some examples of some specialty community provider-search websites on the "Resource Links" page.
- Speciality assessments; Some specialty mental health assessments (family or other legal, disability, insurance, etc) are done by practioners who specialize, have particular training etc at least somewhat in that activity. Many times PCP's play this role (with short-term disability notes, for example). Some such assessments require specialty training, which I don't have.
One aspect to consider is background of folks listed on provider-search websites. For exaqmple, many providers have some schooling in yoga-mediation etc range of proactices which have flooded into Western/Global North healthcare in recent decades. There are a few practioners who have perhaps highest level training (a doctor-level degree or similar), and folks who've had a short seminar instead.
My level of schooling is Master's re: Buddhist psychology, mid-level Jungian analytic training, current cognitive, dialectical, psychodynamic etc approaches, "experienced, with some specific training" working with Muslim (not Muslim myself), and poly/open/consensual non-monogamy folks.