...But I'm not READY to re-enter work/life

Hi - new here. While I've been under treatment for chronic moderate depression for years (and have had a lot of 'stable' times), I spiraled down several weeks ago into the blackest pit I'd ever experienced. Long story short, I had a short stay in the psych hospital and about 10 days in the adult day hospital therapy program which has really helped and some of the most horrible moods/thoughts have brightened a little due to the intensive therapy and aggressive pharmacology possible with every day visits with the psych.

Out of the blue I was told today that I was being discharged because my insurance company decided I was no longer sick enough to need a program of this intensity. My problem is that while I might be able to get the rest of the way up to 'stable' with just a weekly therapist, there's no possible way I am ready to handle returning to work yet. Work-related stressors are at least 50% responsible for my current depressive crisis, but the psych at my day hospital program seems only willing to write me a 'doctors note' for returning to work for maybe 3-5 days after the end of my program today. When I ask my self if I will have worked through the work stress/mental depression issues well enough to go back to work (I'm a public school teacher) after seeing the outpatient therapist for one single 50 minute session between now and being forced to go back, the answer is clearly no.

I've never been a malingerer nor the kind of guy who spends his life trying to bilk the system or make as much money while doing the least amount of work possible. In fact this is the first time I've ever accepted that committing to my own mental health recovery was more important than work (temporarily at least). I don't know how long it will take for me to work through the rest of the issues and make sure I'm chemically in a stable and appropriate place but I'm lost as what to do now.

Does anyone have experience with this? Ways to work, legally and withing 'the system' for a helpful solution? I'm afraid if I return to work too early, I'll founder badly for a couple days then end up right back at the psych E.R. on suicide watch again.

All thoughts are appreciated!
Gwydion

Hi, Gwydion, welcome to PsychCentral (PC).

Wow, sounds like you have stressors on top of stressors there!

Any chance, since work is 50% of your current stressors that you can take a sabbatical or medical leave of absence? Do you have a psych doc outside of the hospital that you "normally" see that might be able to help you with that?

If your particular job is so stressful, I might be tempted to fall back and regroup and change jobs when I was ready to start working again. Can you tell us more about your situation. What did the doctor's note guy say when you protested you weren't ready? I don't know what you can do if your particular insurance isn't on your side/is used up.

Thanks for thoughts, Perna!

Yes, I could take a medical leave of absence (with Dr.s ok, I think), but that would mean zero income while I have a wife, 2 kids, the mortgage, etc. I'm currently drawing on my school's sickleave bank which keeps my paycheck coming after I use up my own sick days. I'm 95% of the breadwinner in the family - can't just stop having money come in.

There MIGHT be a little more flexibility with the doc than I'd first thought. Upon talking to him about not feeling ready to be discharged from the day program, he instructed staff to contact my insurance who, grudgingly, granted three more days of that program (tomorrow, Friday and next Monday). Amongst other things, I can use the remaining days in the program to air my work issues more assertively (honestly?!?) with the staff and doctor so that there's a clearer path/pattern showing work to be the major stressor. I'll also then get my 5 minutes to talk to the doctor three more times as well - perhaps that will help clarify the issue for him.

If necessary, I could talk to the psychiatrist on 'the outside' who had been monitoring my meds for the past few years - no idea if he'd be amenable to 'helping' but at least it's another resource to consider if necessary.

Part of my fear comes from the recent realization that when I first sought psychotherapy for depression years ago, and, eventually, grudgingly accepted pharmaceutical assistance as well, I began to feel 'somewhat' better - I was still sad, still had bad times, but the meds helped some and I able to 'keep my chin up', 'take it like a man and don't show you're hurt', and all those other social programming issues society instills in boys. I realize now that I've been 'playing hurt' for ages and that there might actually be a different version of 'normal' function out there that I've still never encountered. I trust the cautious but more aggressive drug intervention my day hospital psychiatrist is using, and can see how the intensive therapy of the program is starting to dig into the deeply buried, 'real' issues on which I need to work. I'm terrified that I'm going to be 'patched' up 'just as good as I was before' and sent back out, when I now know that 'as good as I was before' was really just a tragically slow drowning.

Sorry, I'm rambling - I tend to over analyze!
Gwydion

(((((Gwydion))))) I am so sorry that I do not have any helpful information for you. You have hit one one of my buttons. I am SO fed up with an insurance company determining my course of treatment!!!!

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Gwydion said:
I'm terrified that I'm going to be 'patched' up 'just as good as I was before' and sent back out, when I now know that 'as good as I was before' was really just a tragically slow drowning.

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Now THAT cartoon is funny! (in the sick and sardonic way I appreciate so much)!!

Thanks for the chuckle!

Gwydion

i hear you about insurance...you would think they would want you better because it is better for them in long run...and you. Too bad they only see dollar signs by your name instead of knowing you as a person. I dunno what to say/do except give my support and lend an ear, shoulder, whatever you need... melanie

Hi Gwydion,

I have experienced your exact situation but I handled it badly because I was young, confused, and not aware how cold an insurance company (or doctor for that matter) could be. The first time I was admitted against my will and just wanted to get out. The second time I admitted my self and actually wanted help. Sure enough, two weeks, IT'S A MIRACLE YOU'RE CURED! They shoved me out the door despite my protest.

I just got pissed, threw away my meds, ditched the out patient and jumped back into work to bathe in all the stress again. Didn't take long for me to go down again either, but wait, more good news. My insurance only covers two, two week in patient psychiatric admittances - FOR LIFE. Happily I'm with a new company now and also have the wisdom to persue treatment before it gets out of hand.

The only things that come to mind would be one, get a second opinion from another psychiatrist and two maybe see a social worker. You might have to go "temporarily disabled" or something but it may buy you some time to stabilize and help with the bills. I had a girlfriend once who was declared disabled after attempting suicide (before I knew her) and was declared disabled. Only problem with that was, that to recieve disability, she had to have a very low amount of assets and was forced to cash a life insurance policy to qualify. Also she was limited as to how much she could earn, it was very little as I recall. When she went back to work though they just stopped her disability payments no problem. A lot of red tape as I recall her telling me but it helped. It may be an option for you friend.

I hope the best for you. Priority one for you is your family and supporting them I'm guessing but your mental well being is intimately tied to that obviously, so that by extension is also top priority. It might seem a difficult problem but I would really like to believe their is a doctor or social worker who would see this and the importance of keeping a family's father, husband, and bread winner healthy.

Keep us posted friend. We are all hoping the best for you.

Gwydion. . . about your "name" :-)

http://en.wikipedia.org/wiki/Gwydion

Yes, Celtic mythology is something I enjoy toying with from time to time and became attracted to the idea of the Welsh charecter of Gwydion as a magician-poet and son of a goddess.

If I said I 'identified' with Gwydion, I might be diagnosed with delusions of grandiosity, so I'll just say that in choosing to borrow his name for my psychcentral name, I was just following board-advice in choosing an online name I didn't use anywhere else..... :-)

Boy I felt like I was reading parts of my own story. I have always wrestled with depression anxiety and other stuff but in December 06 I stumbled upon the entrance of a very dark hole in which I am still trying to climb out. I was fortunate to be granted short term disabillity and now long term disability, but every day is a struggle.

Not to mention that while I was literally vegetative and stewing in my own unwashed funk, I didn't pay one bill, not that I know where the money is, and I did not attend to any thing that I needed to attend to.

But enough about me. While I was in one of the day programs, I met many people who also had specified periods usually six weeks to get it together and get back to work.

Maybe it has been suggested, but can you go to work part time and still attend some sort of program. Can you appeal to the insurance to ease you back into work to ensure a greater stability and endured mental health

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Gwydion said:
If I said I 'identified' with Gwydion, I might be diagnosed with delusions of grandiosity

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Well, coming from a guy who calls himself Cyrano, I'd say indulge your ego all you'd like.

What you're going through is a problem that's been facing this country (I assume you're U.S.) for years. Mental health issues can be as difficult and costly to fight as diabetes or, in certain cases, cancer, and yet we have a system that's inadequate to meet those needs. I'm glad that you sound together enough to wrestle intelligently with this problem but many mentally ill people are forced into the world only to end up homeless. Anyone who's walked around in certain parts of New York has seen it.

So, unfortunately, it does fall to you, the patient, to find solutions that you can manage. I am married with three kids and I know that I could see purple monkeys coming out of the walls to take me to the goblin king and I'd still have to go to work. My family depends on it. So get as creative as you can with work, resources, family, etc. Your support network may be more flexible than you think.

And if you land in a situation you can't manage and you are no longer safe, get help again. At least you tried.

Cyran0

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Gwydion said:
Yes, Celtic mythology is something I enjoy toying with from time to time and became attracted to the idea of the Welsh charecter of Gwydion as a magician-poet and son of a goddess.

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I thought I knew the name from somewhere, perhaps Lloyd Alexander's Chronicles of Prydain now that I think about it but as I read about the "real" Gwydion it reminded me of Susan Cooper's series, The Dark is Rising which I'm sure you've read?

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Perna said:
I thought I knew the name from somewhere, perhaps Lloyd Alexander's Chronicles of Prydain now that I think about it but as I read about the "real" Gwydion it reminded me of Susan Cooper's series, The Dark is Rising which I'm sure you've read?

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...if I had a nickel for every book waiting to be read in my house, my mortgage payment would be history! Sadly, while I was the child who checked out 15 books from the library each week, either depression (can't pick the book up) or anxiety (can't slow brain enough to read more than a couple words at a time) have dogged me for quite a while now and I read long books much less frequently than I used to.

They're young adult books; you should get one of your kids to read The Dark is Rising series to you :-) They're Welsh Mythology/Welsh King Arthur http://www.faculty.de.gcsu.edu/~dves...thur/welsh.htm tales and good over evil, etc.

hey i'm new here too. I don't know what state you live in but in california where i live you can take up to 85 days off for what they call FMLA which stands for Family Medical Leave Act. basically if you get too sick to work or someone you're responsible for(kids, parents, sibling) get sick and you have to care for them you get to take time off work as long as you have documentation and your work can't do anything about it. my friend just took three weeks off cause he had "headaches"(he had some child custody issues to take care of). i'm not condoning using this to get out of work to go on vacation but i am saying that if you can go see a doctor and they say for instance that you "have a sore neck from slipping in the shower" and you can't go to work because of the pain, then go for it. research your states laws and see if they have anything similar to FMLA. it might not help with your insurance but it might help keep you out of work till you're ready to go back. good luck

iLVcheez,

My brother is also a resident of Cali, and they have a better system there that in the rest of the country I think. When he was having problems, not only was he allowed the time off with pay, the state kicked in the rest of the money to bring him up to his normal pay scale. Since they're tax free dollars, he actually earned more on FMLA than when he was working. I was amazed!

We have the leave in the other states, but I haven't heard of another state picking up the slack for the person off before.

Sadly, the FMLA, while being a great thing in and of itself, does not provide any mandate regarding preservation of income. All it guarentees is that if the conditions are met, the employer is required to allow the employee to return to work in the same job capacity as before the leave began. I think if you did a survey, you'd find that most companies grant the leave by using up your acumulated sick leave (if any) first, then stop paying you until you return.....

.....yeah, that sucks. That's how it is in my workplace. I'm fortunate that my workers union negotiated a separate 'sick leave bank' that preserves your salary while out on medical leave (although they do spend down your personal sick days first).

Gwydion

i can totally relate to your situation, i constantly torture myself with 'if i had a job i'd be ok' i have periods of being well, at these times i forget how ill i become , i'm not consistantly well so i couldn't hold a regular job down, my mind seeks to destroy me. is anyone telling you you have to return to work? i know i'm the only one who tells me i have to work ,yet the mental chatter goes on. i have also physical problems too, i feel that no employer would give me a job, i'm not strong enough to work for myself so i stay on my benefits but feel frustrated at my situation, it is a stuck position which i feel is a reason for my recurrent depressions. i've done lots of therapy and did as i was told ,and took responsibility for my actions, what that did was to blame myself for being ill!! now i see that society /employers with its discriminationary attitudes are the real culprits, . i believe that when i'm well enough i won't be asking the question ,'if i had a job i'd be ok'---i'd go out and get one, take care

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jefftele said:
is anyone telling you you have to return to work? i know i'm the only one who tells me i have to work ,yet the mental chatter goes on.

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Great question. The couple times I've brought up my concern about when to return to work, my psychaitrist says things like, 'well you may need a couple days before your ready' which really freaks me out! Then, when I bring it up in group in my day hospital setting, the social worker tells me things like, 'don't worry about being forced to go back to work too fast - the doctor will work with you on that until you're ready'. Very confusing!

I think I hear 'Society' telling me to go back to work as soon as possible - I'm the 'man', 'head of household', 'father', 'breadwinner', 'provider', yadda, yadda, yadda. I know that this isn't a Leave it To Beaver world anymore, but I'm still imprinted with those 'expectations'.

On top of that the quality of the person my employer brings in to fill my duties is strongly related to being able to give them some idea of how much longer I'll be out. I'm a specialist in my work and it's not easy finding a temporary replacement who can do what I do. My employer is busy and lazy and won't go search for a qualified replacement if they think I'll only be gone another week or so. My guilt about that goes way beyond being concerned at the amount of work piling up that no one is doing.

Gwydion