To those of you in New Jersey, I could use some assistance in understanding their system. I know someone that is under the care of a psych nurse practitioner there. Currently only being treated for ADD, though there is a history of serious depression as well. He is in a bad way. I'd suggested contacting his psych, as that is what they are there for, and that maybe an AD needs to be put back on the plate. (He has been been dx'd MDD and prescribed various ADs over the years, so that should all be in his records. Don't know if that is a relevant factor or not, so included it to be thorough.) He assured me that he has an appointment lined up. But he doesn't hold much hope on that front because...

He is under the impression that the state requires months of counseling sessions before med changes (or maybe it is additions?) are allowed. This makes no sense to me. Is he misinformed? Is it because the psych is an NP? (Their parameters there are different from what my state has, which is why I ask that.) Does one need to go inpatient to get prompt meds help? (Is the thinking that if it's so bad they can't wait that they should be in a hospital???) Or am I just way off? Like I said, the diagnosis and medications are in his files from here, so it's already there in the history. It's not like it's something new.

What is the deal? And more importantly, any words of wisdom on how to handle this?

[Victoria'smom]

I assume he's on medicaid if the state is regulating it not his HMO. If he has other insurance to contact his hmo to find out. I can't find anything stating that in the medicaid provider guides for NJ medicaid. I would say he's mis-informed but it could be NP's practice. I've lived in several states on medicaid and have always been quickly ripped off medication and switched. It doesn't make sense that NJ would require that given Dr. don't have that requirement for any other chronic illness.

Most of the time when one moves or transfers Dr.'s a new evaluation is done. I would not be surprised if his past record was barely looked at. At least that's what I've experienced. I would urge him to tell his PNP what is going on. PNP may want him to get re-evaluated or hospitalized.

No medicaid, no insurance. It is through a charity care system of the local hospital. (Didn't even think to mention that.) I think you are correct that the past files were not studied. That's another story though. They did do their own eval, IIRC. Your suggestion that it might simply be that NP's practice (or the group she's part of or whatever smaller division of authority than the state) did not occur to me either. Hmmm, there could be something there... Thanks, Mm!

QUICK UPDATE

Bringing up that it might have been the specific place was exactly the ticket, Mm. Go to the source, right? Of course, they were thoroughly closed at the time, so today I made a bunch of calls, starting with the NP's office. Which was doubly good, because I was able to clue them in on just how bad it's been. Sometimes it can be hard to say aloud when one is feeling like that. Personally, I've never been able to do it. Figured some advocacy was in order. It's so hard being so far away. Also, was told about some other resources available. I've seen the names in researching before, but it was good to get a better sense of how they work by actually talking to someone.

So... hopefully we've got enough tools in the toolbelt now to get him through this.

[Victoria'smom]

Pdoc told me anyone can call with information. He just can't tell them that person is a patient. He also assured me that he does use that information.

Oh good. I'm pretty sure I'm listed on his release permission papers too, so double bonus.

[supernova001]

Originally Posted by Innerzone

To those of you in New Jersey, I could use some assistance in understanding their system. I know someone that is under the care of a psych nurse practitioner there. Currently only being treated for ADD, though there is a history of serious depression as well. He is in a bad way. I'd suggested contacting his psych, as that is what they are there for, and that maybe an AD needs to be put back on the plate. (He has been been dx'd MDD and prescribed various ADs over the years, so that should all be in his records. Don't know if that is a relevant factor or not, so included it to be thorough.) He assured me that he has an appointment lined up. But he doesn't hold much hope on that front because...

He is under the impression that the state requires months of counseling sessions before med changes (or maybe it is additions?) are allowed. This makes no sense to me. Is he misinformed? Is it because the psych is an NP? (Their parameters there are different from what my state has, which is why I ask that.) Does one need to go inpatient to get prompt meds help? (Is the thinking that if it's so bad they can't wait that they should be in a hospital???) Or am I just way off? Like I said, the diagnosis and medications are in his files from here, so it's already there in the history. It's not like it's something new.

What is the deal? And more importantly, any words of wisdom on how to handle this?

I live in jersey and am on medicaid/medicare. NJ mental health care system sucks. But that is ridiculous that he needs to wait so long before seeing a doc and getting his meds. I've never heard of that. In my experience, depending on clinic, they'll have me get an intake from a therapist once, then an intake from a pdoc. If you need meds, they will not make you wait that long as far as i know. All clinics are different and the quality of care varies from county to county. Do you mind telling me what county he's in? (if you want to keep it confidential, pm me) Clinics here are usually pretty "conveyor belt". Given the incompetency at some of these clinics, I would suggest he contact an advocacy organization such as mhanj dot org

what a difference an advocate makes when they show up at the clinics with you. I hope he's not in hudson county nj. Clinics there suck.

(I PM'd the county to you, supernova.)

He had an intake and has had appointments ever since with the PMHNP (psych nurse practitioner) he was assigned. So she has already been handling his meds. As it happens, it has been the same med and dosage as he was being prescribed in his previous state of residence at the point in time at which he moved. Not sure if that has anything to do with this idea of "no change allowed". And at that point, it was just the ADD med. Due to... who knows what, let's call it a "clerical error", there was a delay in having his old files. (They were sent in a timely manner, but they kept saying they hadn't rec'd them.) I seem to recall that the NP did not want to make changes before having the old files in hand. (Maybe she had said something at that point about it limiting her ability to treat till she had them that put this in his head.) At any rate, there was an air of slow wheels. Between that and how kooky (to my thinking) things are run there, it left just enough doubt to harbor the notion that it might indeed be true(!) I often said, "If it makes sense, that won't be how it's done there!" Lol. (Nobody get upset now, ok? That could be said of a lot of places. It was just trying to find humor when being exasperated at every conceivable turn.)

Heh. Just realized that I never said the result of my call to that office(!) Oops. I talked with someone that works with his NP. She said the months of counseling was not necessary.(I was not surprised of course, it was just good to hear for real.) When I relayed the info (as in "good news, not necessary!"), he got... defensive/worked up, saying essentially,"Well, I don't know who you talked to, but it IS required!" Ok. Pointless to argue. His appt is this week, so he will have it from the horse's mouth (so to speak) soon enough.

[Victoria'smom]

Can you have him request his file for himself and bring it to appointments until they are in the system?

Oh, they are in there now, but that would be a good idea. (I just re-read my post. So spacey. Didn't actually say they arrived(!) But they did. Eventually!)