This is the sixth in a six-part series of articles about how to get better results from mental health care.
Many steps to take to get good mental health care are similar to steps to take to get good health care for other conditions:
- Know what you are trying to accomplish.
- Ask questions - about your diagnosis, about any tests, about any treatments, about side effects.
- Remember that you have a right to have a say.
- Remember whose life is at stake.
Knowing your rights is a good place to start. Richard Zwolinski, a licensed mental health counselor, is the director of an addiction and mental health clinic in New York City with 30 years' experience. He writes the Therapy Soup blog on the nationally-acclaimed website psychcentral.com. He points out that the American Psychiatric Association has created a Patient Bill of Rights for mental health care, which can be found at http://www.healthyminds.org/Main-Topic/Patient-Bill-of-Rights.aspx.
He proposes a bill of rights specifically for talk therapy patients, based on the APA document but easier to understand. Some of the rights he suggests are:
- To know their therapist's credentials, experience, and professional background.
- To be told their diagnosis.
- To ask about their therapist's results with patients with diagnoses like theirs. That is, if the therapist has treated 100 people for depression, after one year how did those people do? Are they back to their normal lives? Still in talk therapy and still taking medicine? And so forth.
- To be told clearly what their role is in talk therapy and what the therapist will do.
- To have a voice in a written treatment plan created early on that includes specific goals and timeframes.
- To know the cost of a session and an estimate of the number of sessions needed - before they agree to start.
To see the Therapy Patients' Bill of Rights, visit http://blogs.psychcentral.com/therapy-soup/2010/05/therapy-patients-bill....
Zwolinski also has a book out called Therapy Revolution: Find Help, Get Better and Move On (Without Wasting Time or Money). It can help people avoid talk therapy pitfalls, such as being trapped in talk therapy that drags on for a long time without leading to much improvement in their lives.
The rest of psychcentral.com offers a wide array of useful information about specific mental health issues such as anxiety, depression, addiction, bipolar disorder and so forth. It also offers quick, online screening tests for these conditions as well as for ADHD, Asperger's, eating disorders and many others.
Dr. David M. Reiss, a psychiatrist in San Diego with 25 years' experience and previous stints in key roles in psychiatric hospitals, offered some additional insight. Even if patients are involuntarily committed, unless they have been declared incompetent, they have many rights:
- To have their records kept confidential;
- To know what medicines they are being given, and what those drugs are for;
- To know side effects of the drugs, and what alternate treatments are available;
- To know who's in charge of their care and who else they can raise concerns to if there's a problem with their care; and,
- To have visitors during visiting hours.
In inpatient facilities, Reiss explained, typically a social worker will meet with the patient and family to explain how things work and what the rules are for patients and family and other visitors. The social worker should also be able to arrange meetings between the family and the psychiatrist as needed.
Reiss noted that he always appreciates it when the family of an inpatient makes the effort to touch base with him. Their comments can provide background and insight that can help get the patient better care.
Other recommendations that he offers include:
- Stay calm in talking with the staff.
- If necessary, go to the next level or get the patient ombudsman or advocate involved.
- Learn about NAMI, the National Alliance on Mental Illness (nami.org).
NAMI, Reiss noted, "will always help people understand diagnosis and process and state laws. It doesn't cost anything. They are in every state. They hold meetings in most hospitals."
NAMI's helpline number is (800) 950-NAMI (6264). The site includes a listing of 1,200 state and local affiliates as well as information about specific mental health issues, a legal center, and many other programs and resources.
Ronald S. Honberg, NAMI's director for policy and legal affairs, confirmed, "Individuals who are involuntarily committed do not forfeit rights to be fully apprised and involved in treatment decisions. This includes information about diagnosis, prognosis and treatment plan." He pointed out that these rights are spelled out under the federal Bill of Rights for Mental Health Patients, which can be found at http://www.law.cornell.edu/uscode/text/42/10841.
Honberg noted that if patients have trouble getting the facts about their own cases, simply pointing out to the staff that they know that they have a right to this information may help.
NAMI also reported that both the American Medical Association and the American Psychiatric Association take the position that it's a good idea to involve families in treatment, as long as the patient agrees.
It pays to understand the legal requirements for allowing family and others access to patient records and other information. These rules arise from a federal law called HIPAA. The government provides a document that clearly explains the relevant parts of the law. It is called "A Patient's Guide to the HIPAA Privacy Rule: When Health Care Providers May Communicate About You with Your Family, Friends, or Others Involved In Your Care."
Honberg noted, "Of course, what should happen and what does happen is often very different. Too often, I have seen providers hide behind a 'veil of confidentiality' under HIPAA when in fact no such barrier exists." Again, knowing your rights can help.
Dr. Kenneth Duckworth, NAMI's medical director, commented that it's important for people who are prescribed drugs for mental health issues to understand what else they can do to get better results: "Consider whether you are getting the other pieces of treatment that have been shown to help: (Are you also getting) psychotherapy? Are you drinking alcohol which is working against your treatment? Are you exercising? The care plan should not be all about the meds."
Duckworth pointed out that understanding something about different types of talk therapy can help people get better care. NAMI offers a document geared towards children's mental health issues, but it provides questions to ask that may be useful for adults as well. It is titled "Choosing the Right Treatment: What Families Need to Know About Evidence-Based Practices." It can be found at http://www.nami.org/Content/NavigationMenu/NAMILand/CAACebpguide.pdf.
Getting the right talk therapy is important. It is also important to choose the right talk therapist. Dr. Daniel B. Wasserman, a psychologist in private practice in Prescott, AZ suggested asking family and friends to describe talk therapists with whom they have personal experience, to find out what the therapist is like, how personable they are, and what it is like to work with them.
Wassermann recommends calling the therapist and talking for a few minutes by phone if at all possible before committing to an in-person session. If that isn't possible, and even if the therapist does not offer a free initial consultation, Wasserman noted that it is well worth considering the first paid session as exploratory. If you do not feel comfortable working with the therapist, it is good to recognize that fact as soon as possible, and look for someone else to treat you.
The NAMI affiliate in Yavapai County offers support group meetings for people who have a mental illness and separate meetings for family members and loved ones of those struggling with mental illness. Jim Frost, the voice of NAMI locally, explained that the local NAMI organizations are all run by volunteers, and that all of NAMI's programs are offered free of charge.