Monday, March 30, 2015

What Adds Value to Mental Health Care? Looking for Your input....


I need  your help.  This year at the American Psychiatric Association's annual meeting in Toronto, I will be talking on what adds 'value' to mental health care from the patient perspective.  It's a symposium, and the other speakers will be approaching the issue from the perspective of the insurance company, the hospital, employers, and looking at things like quantifiable measurements of success measured with standardized tools and how to recognize waste in the systems.  I won't be talking about standardized tools.

So I need input.  If you're a  health professional and you've never seen a psychiatrist as a patient, please don't answer.  I want to hear what people see as 'value in mental health care' straight from a patient's perspective.  

Some possible questions include those below, but please feel free to tell me what you value about your mental health care.

  •  I'd like to hear what experiences and outcomes make you feel like you've gotten your money's worth?    
  • Why do you go to treatment?
  • What are you looking to get from it?
  • Do you have specific goals that you'd like to see measured by objective criteria?
  • Have you ever seen a psychiatrist for treatment, gotten better from your disorder, and yet not valued the care? Why?
  • Do you like that insurers and providers are looking at what makes for good value, meaning the best outcomes for the lowest cost?
  • In short: what makes for a good experience with a psychiatrist?  You can also tell me what makes for a bad experience.
  • While I've got you here, do you value having your psychiatric chart in an electronic medical record?

If you don't want to comment here, please feel free to email me at shrinkrapblog at gmail dot com.  

12 comments:

Anonymous said...

Seems to me a patient might be better able to give this talk from the patient perspective. Why didn't the APA just find a knowledgeable, experienced patient?

Dinah said...

Anon: so APA doesn't organize the individual symposia. Members submit proposals for workshops/symposia/courses and they get accepted or not. The speakers are not generally patients, and those who participate have to provide their own transportation, housing, and pay the conference fee. It's a bit of a deterrent for your average patient to cope with all this. I don't believe the organizer of this symposia even considered that of hunting down a patient to go to Toronto. Also, I'll add that one thing I've learned from years of Shrink Rap (9 next month) is that one person's experience is one person's experience and the vary greatly.

Having said all that, I'm also the discussant for a talk that was organized by our co-blogger Roy on suicide survivors, and a suicide survivor organization is going to be sending patients up to discuss their experiences, so there will be patient input.

And if folks would like to tell me what gives their psychiatric experiences value, I will be passing that along....

Anonymous said...


•Why do you go to treatment?
Originally, it was to get my therapist off my back. Now, I go because it has greatly improved my life.

•What are you looking to get from it? Respectful, voluntary, competent psychiatric treatment.

•Do you have specific goals that you'd like to see measured by objective criteria?
I think the objective criteria that matters to me is that I am employed, self sufficient, I require less and less frequent psychiatric appointments as I do better and better, little to no symptoms, etc.

•Have you ever seen a psychiatrist for treatment, gotten better from your disorder, and yet not valued the care? Why?
No. I don't value things that don't help. That's why I've never valued coercive and/or involuntary treatment. It doesn't work for me. When treatment has been helpful, I value it.

•Do you like that insurers and providers are looking at what makes for good value, meaning the best outcomes for the lowest cost? I don't think insurance companies really care about good value when it comes to psychiatric treatment. They just care that they pay as little as they can get away with. My psychiatrist doesn't take insurance.

•In short: what makes for a good experience with a psychiatrist?
For me, a good experience with a psychiatrist requires the following:
Mutual respect (I respect my psychiatrist because he has always treated me with respect), judicious use of medications, the treatment must actually work, it must be voluntary, compassionate, a psychiatrist who is strong calm and steady, the psychiatrist honors what is important to me. Conversely, I have never respected any psychiatrist who has used threats or force with me, and if I don't respect them there isn't much point because I wouldn't listen to then, would not return, I threw their prescriptions in the trash, and I would tell them whatever lie I needed to to get away from them.

•While I've got you here, do you value having your psychiatric chart in an electronic medical record?
No, I would not see a psychiatrist who used an electronic medical record, unless it was on the desktop/laptop and not connected to the internet. They are not secure. The government keeps a running list of all of the security breaches with over 250 patients affected (I think that's the number). The majority of the breaches have to do with electronic medical records, and this should make anyone think twice about sharing sensitive information with a psychiatrist who uses an electronic medical record. I am open with my psychiatrist, because he uses a paper medical record. I work in a hospital, and we have had hundreds of patients' electronic medical records compromised as have most if not all of the rest of the hospitals in my city. Not worth it.

P-K

Jen said...

Why do you go to treatment?
To treat severe, recurrent depression.

•What are you looking to get from it? Respectful, voluntary, competent psychiatric treatment.

•Do you have specific goals that you'd like to see measured by objective criteria?
My goals are to decrease the levels of depression, to work well at my meaningful job, to be successful at work, to maintain social relationships, to be able to take care of myself and my needs. I would like to be on as minimal medication as possible.

•Have you ever seen a psychiatrist for treatment, gotten better from your disorder, and yet not valued the care? Why?
No. I have seen psychiatrists and not gotten better and therefore not valued the care. I have seen psychiatrists and gotten better, and I very much value that care.

•Do you like that insurers and providers are looking at what makes for good value, meaning the best outcomes for the lowest cost? I don't think insurances are looking to make special money from mental health any more then they are from any aspect of health. They all just want to save money. My psychiatrist does not take insurance; my insurance reimburses a high level of the sliding scale fee that she charges me.

•In short: what makes for a good experience with a psychiatrist?
Being treated like a person. Mutual respect - I respect your excellence in your field, you respect the heights I've attained in mine. We are both people. I expect a therapist to be well-versed in psychiatric medication, and to have someone that she can consult with for another opinion on meds. I expect a good psychiatrist to be in supervison; I expect a good psychiatrist to appropriately monitor effects of medication, with blood tests, EKGs, etc, as needed. I expect no confidentiality violations; I expect to be told in advance the fee and that it not change without notifying me. These are the minimum of what I expect.In order for a good experience, I would hope for a sense of humor that gets mine. Intelligence that matches min. Genuine empathy. person willing to try my ideas at least once. Someone avialabe in the midst of a crisis. Someone who will collaborate with other professionals as needed (GP, endocronologist, etc). Someone who doesn't hesitate to request I get a consult for meds with the best guy in the city to make sure we are on the right track, and someone who gets supervision for herself when we get stuck. Someone who respects me as a person and an individual; who respects my career, who sees what I do as meaningful, who supports the major decisions I've made in my life. Someone who is not afraid to show bits of herself, to be a person with me.
Someone who laughs with me. Someone who trusts me to stay alive or to contact her, and someone I trust to help if I do contact her. Someone with whom it is easy to speak.


•While I've got you here, do you value having your psychiatric chart in an electronic medical record?
No, I would not see a psychiatrist who used an electronic medical record.

Anonymous said...

I have seen 4 psychiatrists in the past 10ish years. The first was awful -- he handed me questionnaires and made me feel like I wasn't even a person. The second was incredible. She listened to me and could sense what I was feeling by paying close attention to me. I had to leave her once I finished grad school and couldn't go back to the campus counseling center. The third was socially awkward and didn't make me feel comfortable. The fourth (and current) one is careful and makes me feel valued. She checks in with my therapist. She keeps notes on her laptop but I don't know if they are stored online. Insurance doesn't care at all about me or the best value. I go to someone good because there are hardly any in-network providers. My psychiatrist charges $200 for a half hour session. I am reimbursed $63 -- what insurance seems to think is fair and customary. I feel very lucky that I am able to see someone who is so responsive and careful.

Andrea said...

I am a patient. I have been in treatment for bipolar I since 1989, so it has been about 25 years. I have appreciated when psychiatrists take my side effects seriously and work to adjust my doses of medications in order to minimize them. I am glad that I have a general practitioner who treats me with respect even though I have a psychiatric diagnosis. I would appreciate it if my psychiatrist would communicate with my therapist and general practitioner, but the transfer of information is left up to me. I would appreciate it if my psychiatrist would order labs appropriately, but this is left up to my general practitioner. I have spent a lot of time educating myself about general health, mental health, and side effects of medication. I also have a good relationship with my pharmacist who is very knowledgeable and helpful. I have the feeling that if I didn't know so much about health and healthcare, I definitely wouldn't be as healthy as I am.

clairesmum said...

Good treatment - psychotherapy, counseling, psychopharmacology - needs to fit the protocol/treatment algorithm etc TO the patient in the room - not vice versa! Curiosity mixed with compassion, careful use of self in order to humanize the therapist, and an ability to adapt to changes in the patient over time. Being willing to do a real sliding scale is key. I had good insurance at a time when most therapists and psychiatrists did take insurance billing and did not balance bill. Over time I saw that almost all psych MDs did NOT do insurance billing and that many many skilled therapists stopped as well. You all had education that had public funding at the basis, no matter where or when you went to college. So, give back, please.

JK said...

So, just to be clear: did you want only positive experiences in your responses to this blog or are you accepting opinions on adding value to mental health care that stem from negative experiences as well.....

Anonymous said...

• Why do you go to treatment?
To get well and stay well! I’ve been diagnosed with schizoaffective disorder, but I go to treatment because I suffer from symptoms that I find troubling- namely depression and symptoms of psychosis.

• What are you looking to get from it?
To be well, and to live the best life possible.

• Do you have specific goals that you'd like to see measured objective criteria?
I guess I’d like to minimize my symptoms and maximize my ability to achieve my life goals.
But I’m not sure if I want them measured by objective criteria; if I am interpreting what you are saying correctly. I would imagine that my goals would be different from another persons’ goals? And I would imagine that my acceptable levels of symptoms would be different to another’s’?
My main goals would be to be able to work, to study, to be able to work towards my work/educational aspirations. To have enough energy to be able to exercise and enjoy what my body can do, to be able to have fulfilling and enjoyable relationships with other people, to not spend periods of time emotionally distraught, to be happy and healthy.

• Have you ever seen a psychiatrist for treatment, gotten better from your disorder, and yet not valued the care? Why?
Yes, I was given medication that helped, but I found the treatment itself very traumatic.

• Do you like that insurers and providers are looking at what makes for good value, meaning the best outcomes for the lowest cost?
I think my definition of good value may not agree with insurers ideas of good value. But if they aimed to fulfill what patients perceive as good value, I think this would have merits.

• In short: what makes for a good experience with a psychiatrist? You can also tell me what makes for a bad experience.
Getting the right treatment that helps your condition and to be supported and listened to.
My psychiatrist, even if we don’t agree, always listens to me and my thoughts and opinions. He genuinely seems to care. It probably doesn’t matter to my treatment outcomes, but he appears to be interested in how my life is going.
I was thinking a few days ago whilst getting coffee about how sad it was that my barista was moving and that I’d no longer have our morning chats whilst I got coffee and I guess it’s the same with my doctors, its nice to have some human connection, particularly as he is dealing with some of the most distressing and embarrassing aspects of my life.
I know my psychiatrist seems to think my idea of a good weekend in the bush- hiking and climbing to be weird, but he likes that I really like it and he gets how important to me it is, and that really matters.

Bad experiences:
- Getting treatment that is not appropriate or effective and then being blamed for the treatment not working.
- Being talked at, not talked to.
- Being treated as someone who is ill and therefore someone whose opinions feelings and thoughts don’t matter.
- Being told that I was a fundamentally flawed person who had no hope of getting better.
- Being told I’ll never achieve anything with my life.


• While I've got you here, do you value having your psychiatric chart in an electronic medical record?
Hell No! If I have to see a doctor other than my psych or GP I often lie about my medical history.
I currently have to go into hospital regularly for treatments for an unrelated condition and I rarely get the same doc more than twice. They don’t need to know about my medical history, and it’s in the file if they ever bothered to read it. The nurses on the other hand I have found to be universally non-judgmental and supportive.
BecB

Anonymous said...

I was a patient for severe depression. In my experience, from seeing 3 psychiatrists in 3 years, there is not enough balance between considering biological causes requiring medication and environmental causes. Case in point, I complained of bullying at work, and how it triggered nightmares, anxiety, and memories of childhood abuse. I was misdiagnosed as bipolar (at age 32 having not had symptoms of it before) and medicated with more and more stuff that made things worse. I have to believe that if psychiatrists learned more about the impacts of severe child abuse on adults, someone would have realized the issue was ptsd, not bipolar. A more wholistic approach to what causes psychiatric pain would be helpful.

And I prefer to keep it all out of my medical records since it could affect my job.

Dinah said...

Jen -- I'm thinking about my talk and may read part of your comment (no name attached, obviously). You have a lot of expectations -- have you found a psychiatrist who meets all these?

Dinah said...

Thank you all -- my talk went well and I read some of your responses. It was a group of people talking about 'value=based' care (I still don't quite get it, but it has to do with Medicare reimbursements based on improvement in measures) and I was a bit of the odd man out talking about how patients want to be treated with respect and kindness, but I think that was the point, and I got a lot of good feedback. Thank you for your input and help.