[amandalouise]

recently an issue came up on the boards. I thought it would be nice to address it but in a positive way.

recently I posted that in my location we dont do paper work when a client comes to us needing forms ie social security forms filled out. one replied asking what kind of people are we and accused those professionals including me where I am of denying someone support.

So I thought it would be nice to show each other that its ok to be different and its ok to have mental health services that are set up differently. There is no right or wrong.

Here where I am the mental health community, physicians and hospital are in the middle of a recession. we have had to make hard decisions.

Some mental health agencies, physicians offices, schools, businesses have had to file for bankruptsy

others have had to shut their doors due to lack of funds.

Some have had to lay off their employees.

others have had to make the hard decision of deciding which clients with what mental disorders they could no longer see in favor of not cutting services and not laying off their treatment providers.

others have had to make the hard decision of cutting the least used services and in favor of keeping their doors open for all their clients.

the hospital and crisis center where I am opted for the last one because it affected the least amount of clients, and those that it does affect we offer a new way to do those things.

example we cut out doing paper work in favor for computers.

it frees up three hours per client per session of manually signing in to the file room, manually locating the clients file among hundreds of thousands of files, and then manually writing up each session,

when agencies like welfare and social security need information for their forms we used to have spend anywhere between 3-3 hours to do all the above then read through the persons whole file, some of which have been coming to us for years, and then summarize that persons vast problems and diagnoses into a Brief" diagnosis, and treatment being used, the persons GAF (Functioning level)

with the recession and lack of funds and more people needing mental health services because they lost their jobs we now dont do paper work, our alternative is -

we converted all those paper files to computer files. now that three hours of manually updating someones file is converted into a bout 5-10 minutes of sitting down at the file rooms computer, logging in to the mental health data base, typing in clients name then using the computerized form type up the session.

Having our clients files on computer also better serves the client because we can right then when the client asks to see their file locate the file by doing a computer search on the data base, do a computer search of their file for that one item they want, then press print. client has their file or item they asked about in a matter of one to 2 minutes vs three hours of our time. converting our filing system to computers is also cost effective to the client at no charge to them.

now with a computerized filing system when clients need forms to be filled out for their physicians, welfare, social security and others all we have to do is sit down at the computer, log in to the data base, do a search for the clients file, then click on fax to the other agencies fax number and they have the clients complete file in a matter of minutes vs the three hours of locating the clients file, reading the file, summarizing and hand writing on the form what is needed then send it through the united postal service (what is now commonly called snail mail for a reason it can take days to weeks for people to receive stuff this way,)

by converting our vast paper files on each client to computer files we can better help our clients, spend more time with those clients and offer better services that they may need. for example before when we had to allocate time for filing and paper work we can now offer advocate services such as accompanying the client to hearings, take a client to a food shelf if they need food and other hands on advocate type things.

I know to some doing things by computer vs paper trails and paper filing, paper forms can be scary because its a change and confusing to those who dont have this kind of system,

but arent we all different and dont we all have different mental health systems that are set up in different ways than each others?

this person sees a private treatment provider, that one sees a county treatment provider, this doctor doesnt prescribe this and that doctor says I have that not this, and this country uses this term when we use another one.

so how is your mental health system set up?

[Leed]

It sounds like a great system to me!

I wouldn't pay attention to ANYONE who attacks me for doing my job! For one thing, you don't make the rules! For another, this makes your job easier, thank God. And lastly, you can't please everyone! Sheesh.

You made alot of very valid points. I'm sure whoever attacked you didn't think of ANY of them. So just consider the source.

Best of luck, and God bless!! I hope you have a better day. Hugs, Lee

[amandalouise]

Originally Posted by Leed

It sounds like a great system to me!

I wouldn't pay attention to ANYONE who attacks me for doing my job! For one thing, you don't make the rules! For another, this makes your job easier, thank God. And lastly, you can't please everyone! Sheesh.

You made alot of very valid points. I'm sure whoever attacked you didn't think of ANY of them. So just consider the source.

Best of luck, and God bless!! I hope you have a better day. Hugs, Lee

thank you for your concern. everything is ok.

lets remember please this thread isnt about being attacked by others. it is a thread about having different mental health systems that we attend for our mental health services or work at.

now I know Im not the only one that either attends therapy or works at mental health agencies that have gone computerized and I know that there are folks out there that havent converted to computers, I also know that there are mental health agencies that do both paper and computerizing.

theres bound to be many other differences in each of our mental health systems.

I read posts here all the time that say to people don't judge others so lets do just that.

lets celebrate our differences and our sameness in regards to our mental health systems without judging each other.

so lets hear it how are your mental health systems set up?

is there something that you dont like about your mental health system that you work with or attend?

is there something in particular that you enjoy about where you work or receive mental health services.?

anything you want to let us all know about your mental health system?

[KathyM]

I'm sorry, but it sounds like you're caring for cattle instead of people. It might make your job a little easier, but you could be ruining someone's life. I'm very thankful my doctor took the time to fill our my forms when I applied for disability due to amyloidosis. She understands my illness and prognosis better than anyone at the Social Security office. If the person filling out the form knows the patient, it shouldn't take that long to fill out.

Sending out a person's private medical records to another organization, as opposed to having a doctor/therapist fill out the required forms, sounds a bit lazy - and dangerous for the patient.

[pegasus]

Well, my service users are people and I truly care about every single one of them. Yes we did go electronic but we also hold information the good old fashioned way in a file, on paper!

And if any of my clients need help to fill out forms I'm always happy to help them.

Not sure why you felt the need to write the above post amanda, discussing someone elses thread, to prove what? That you don't judge?

Be well!

[pachyderm]

Originally Posted by amandalouise

the hospital and crisis center where I am opted for the last one because it affected the least amount of clients, and those that it does affect we offer a new way to do those things.

example we cut out doing paper work in favor for computers.

it frees up three hours per client per session of manually signing in to the file room, manually locating the clients file among hundreds of thousands of files, and then manually writing up each sessionby converting our vast paper files on each client to computer files we can better help our clients, spend more time with those clients and offer better services that they may need. for example before when we had to allocate time for filing and paper work we can now offer advocate services such as accompanying the client to hearings, take a client to a food shelf if they need food and other hands on advocate type things.

It sounds to me like what the US federal administration is advocating, that computerization of records will save money and make things better to boot!

Thank you for the explanation, amandalouise. What you told us about what your agency does is certainly different than informing a client he/she is on her/his own.

Also, I would like to apologize to you for responding in a knee jerk fashion. I have no doubt you care a great deal about the clients.

Be well.

[(JD)]

Thanks for that, it took quite a while to put that together.

I don't know how all those files got onto the computer in the first place... maybe it was all scanned, but even so, scanning takes me forever!

I just saw my neuro opthamologist and though not mental health care doctor, they were having to re enter all of my medical history onto a computerized form because of the Obama health care initiative. It took her (and me) 24 minutes! That's huge to me. And costs the doctor in the number of patients he can see, or the cost of the additional person to create the computerized form. (And I didn't even give all my data, since it was going to the government for RFID chip info for later on tagging of a human (me!))

Imagine having to enter data each session? But if it is working for your community, I'm glad something is!

[amandalouise]

Originally Posted by TheByzantine

Thank you for the explanation, amandalouise. What you told us about what your agency does is certainly different than informing a client he/she is on her/his own.

Also, I would like to apologize to you for responding in a knee jerk fashion. I have no doubt you care a great deal about the clients.

Be well.

thanks and everything is cool

[Rhiannonsmoon]

Originally Posted by Leed

It sounds like a great system to me!

I wouldn't pay attention to ANYONE who attacks me for doing my job! For one thing, you don't make the rules! For another, this makes your job easier, thank God. And lastly, you can't please everyone! Sheesh.

You made alot of very valid points. I'm sure whoever attacked you didn't think of ANY of them. So just consider the source.

Best of luck, and God bless!! I hope you have a better day. Hugs, Lee

I don't think anyone attacked amandalouise but invariably these types of "responses" are taken that way and so someone attacks someone else etc etc.

I don't know of any system thesedays that is not computerised. But I also do not know a therapist who doesn't take notes first before they do the data entry (another job that takes just as much time for the therapist), it is simply relpacing paper for keyboard, and at some time that may need to be printed out. So in actual fact it is a money saving move so that there is need for 85% less paper.

I also do not think it unreasonable for a therapist to fill in forms. I still do it, I do reports for court cases whether they are written or typed makes no difference. I do know a number of therapists and pdocs who charge a sum for doing the reports. There are also in 99% of practises a secretary or office assistant who retrieves files for the therapist, especially doctors.

Maybe a compromise would be an idea? for instance in this case we were discussing where one of the members here at pc, she was told "the doctors have enough to do without filling in forms" thereby voiding the members claim for assistance leaving her wallowing in a no mans land as far as her claim and treatment is concerned.

I don't think filling in forms would cause a therapist to go into bankrupcy. The way a practise is set up allows time for form completion during the highly expensive therapy appointment where most clients spend at least 10 minutes silent or upset; if a therapist has an hour with the patient then they do have time. It takes no extra time to fill out a form.

It is fine for those therapists who can get someone to fill in a form because they are a colleague but for clients needing the same help don't get it? That is highly non-patient focused, and highly focused on dollars. I don't see any of that as an attack at all. Simply a discussion where I put forward certain personal thoughts, and some facts.

Genuine regards to all

[amandalouise]

Originally Posted by pegasus

Well, my service users are people and I truly care about every single one of them. Yes we did go electronic but we also hold information the good old fashioned way in a file, on paper!

And if any of my clients need help to fill out forms I'm always happy to help them.

Not sure why you felt the need to write the above post amanda, discussing someone elses thread, to prove what? That you don't judge?

Be well!

why? because I thought it would be a cool topic some have been asking me to take my off topic replys to other threads and some people have asked me to start threads too not just reply to threads, I didnt see any threads discussing how different or the same our mental health systems are, and whether or not our mental health systems have had to make changes to survive the recession..

we all discuss we see mental health people and some of us discuss being mental health care providers but no where is there a discussion thread about how different, whats the same, if any of our mental health communities had to make hard decisions about the agencies and their clients., what we like and what we hate about our mental health systems where we work and receive services so why not give it a try.

that is so cool that your agencies are able to do both paper and computers. sometimes I wish mine did too at times.

[amandalouise]

Originally Posted by KathyM

I'm sorry, but it sounds like you're caring for cattle instead of people. It might make your job a little easier, but you could be ruining someone's life. I'm very thankful my doctor took the time to fill our my forms when I applied for disability due to amyloidosis. She understands my illness and prognosis better than anyone at the Social Security office. If the person filling out the form knows the patient, it shouldn't take that long to fill out.

Sending out a person's private medical records to another organization, as opposed to having a doctor/therapist fill out the required forms, sounds a bit lazy - and dangerous for the patient.

thanks for your opinion but please remember we are not judging each others mental health systems we are sharing what our own mental systems are like.

when I needed my short term disability form filled out social security faxed by computer the form to my doctors then my doctors using their computers filled in the form right there on the computer then faxed it back that day. our doctors are different but with the same out come.

[amandalouise]

Originally Posted by pachyderm

It sounds to me like what the US federal administration is advocating, that computerization of records will save money and make things better to boot!

thanks for your opinion. so whats your mental health system like. is it paper oriented or is it computerized or both. what do you like or dont like about your mental health system, have they had to make any changes because of the recession?

[Rhiannonsmoon]

I agree with Pegasus. It is not a recession response it is a money worshiping response. To cut ANY service to mental health is asinine. To drop certain patients is money grubbing. I don't know of any mental health service that has cut back on this vitally important and much needed network. Private ones may have but there again they are all about money not about the patients, they are businesses not services.

Look at this service and it is not funded with public money, DocJohn deals with this himself, with the help of the admin and mods. It's getting bigger and bigger by the day but there are no cutbacks; DocJohn keeps it going (kudos to him).

This post was directly related to the other thread, however you wanted it to be clear and standing alone. Intimating that you were being attacked when you were not is not reasonable.

We all have opinions, not all of those opinions will be agreed upon or accepted by others, that is something we must accept and then move along from.

[amandalouise]

Originally Posted by amandalouise

why? because I thought it would be a cool topic some have been asking me to take my off topic replys to other threads and some people have asked me to start threads too not just reply to threads, I didnt see any threads discussing how different or the same our mental health systems are, and whether or not our mental health systems have had to make changes to survive the recession..

we all discuss we see mental health people and some of us discuss being mental health care providers but no where is there a discussion thread about how different, whats the same, if any of our mental health communities had to make hard decisions about the agencies and their clients., what we like and what we hate about our mental health systems where we work and receive services so why not give it a try.

that is so cool that your agencies are able to do both paper and computers. sometimes I wish mine did too at times.

I just realized re reading my post that I made a judgement - saying something is cool is making a judgement of something being good or bad about someone elses mental health system so lets change that -

my new reply without judgement is

sometimes I wish we were both paper and computerized too.

[amandalouise]

Originally Posted by Rhiannonsmoon

I agree with Pegasus. It is not a recession response it is a money worshiping response. To cut ANY service to mental health is asinine. To drop certain patients is money grubbing. I don't know of any mental health service that has cut back on this vitally important and much needed network. Private ones may have but there again they are all about money not about the patients, they are businesses not services.

Look at this service and it is not funded with public money, DocJohn deals with this himself, with the help of the admin and mods. It's getting bigger and bigger by the day but there are no cutbacks; DocJohn keeps it going (kudos to him).

This post was directly related to the other thread, however you wanted it to be clear and standing alone. Intimating that you were being attacked when you were not is not reasonable.

We all have opinions, not all of those opinions will be agreed upon or accepted by others, that is something we must accept and then move along from.

so tell us how is your mental health system set up, are there things you like about it, hate about it, have they had to make any changes or decisions because of the resession?

[amandalouise]

Originally Posted by (JD)

Thanks for that, it took quite a while to put that together.

I don't know how all those files got onto the computer in the first place... maybe it was all scanned, but even so, scanning takes me forever!

I just saw my neuro opthamologist and though not mental health care doctor, they were having to re enter all of my medical history onto a computerized form because of the Obama health care initiative. It took her (and me) 24 minutes! That's huge to me. And costs the doctor in the number of patients he can see, or the cost of the additional person to create the computerized form. (And I didn't even give all my data, since it was going to the government for RFID chip info for later on tagging of a human (me!))

Imagine having to enter data each session? But if it is working for your community, I'm glad something is!

Same here. they got into our medical and mental health database by scanning each page of the clients paper file. We didnt have access to the files during the process. it was a pain in the behind but well worth it for us.

[pegasus]

Originally Posted by amandalouise

I just realized re reading my post that I made a judgement - saying something is cool is making a judgement of something being good or bad about someone elses mental health system so lets change that -

my new reply without judgement is

sometimes I wish we were both paper and computerized too.

Computers have a habit of crashing, not to mention the electricity used and having it on paper aswell means it is there to hand. Personally I feel it is good practice to have the data on both and actually unavoidable in some instances. ie a computerized form that is also written on. I spend much of my day doing paperwork and spend a good deal of time with clients also.

I do feel that the client/patient needs must come first and if they ask me to advocate for them, help them to complain about something or fill out a form it is empowering and personal for them.

Lets remember who we are working for and treat people with the dignity and respect they deserve, not a number, a person in distress.

Regards.

[sunrise]

If I need my T to fill out paperwork, he does it during my session, so I am paying him for this service. I try to keep requests to a minimum as I don't like to waste my session on paperwork. I wish he would do the paperwork on his own time, but he would be uncompensated for that, since he is private practice, and I understand if he did these things for all his clients uncompensated, it would add up to a lot of hours of time he doesn't have as well as lost income.

I had a situation with my family doctor recently where I needed her to certify I was in good health as a requirement for my beginning nursing school. This was a major, major hassle and almost caused me to drop her as my physician because she was so uncooperative. This almost cost me being able to enter the nursing program because she wouldn't do the paperwork, which was not that extensive--a brief letter was all it required. I gave her 6 weeks advance notice. Still makes me grrrrr to think about this. And I have been a longterm patient of hers and given her many dollars for care of myself and my family. At one point, because she didn't want to write the letter, she asked if she could just send a photocopy of my chart. Hell, no!! I looked at what she proposed sending and it was over a dozen pages long and had all sorts of info I didn't want my program administration to know and that they were not asking to know--all sorts of confidential stuff, like number of sexual partners. Honestly! She was soooo lazy and then seemed really put out when I told her I did not want a photocopy of my chart. I wonder who filled out her forms for entrance to medical school? I guess she's forgotten how it was when she needed help. It's also disturbing she would so freely give out all this unnecessary confidential information about me--this was not a requirement of the nursing program. Since this doc was not forthcoming with the letter and I worried I would get it in time and not be able to start nursing school, I went to see my gynecologist, also a longtime provider of mine, and asked her, in person, if she would write a letter. She was very understanding and said yes she would and agreed to send it right away--deadline was only 1 week away. I was very grateful to her. I didn't know if the school would accept a gyno letter but I figured it was better than nothing. Anyway, I did end up getting the letter from the first doctor (the day before it was due), so I didn't need the gyno's letter after all. But here's the thing--3 weeks after the deadline, I received the gyno's letter in the mail! She had totally put my request for a letter on the back burner. If I had depended on her, it would have been way too late. What is with it with these doctors? It makes me appreciate my T's system better. He does the paperwork on the spot in our session and then hands it to me personally. No chance for him to forget or blow it off.

[splitimage]

I think there are a few issues going on in this thread, all of them interesting
1. How agencies keep track of patient info -electronic, combo, or both
2. Willingess of Dr.'s Therapists etc. to fill out forms, write letters, on behalf of clients.

The two main hospitals I go to, one for addictions treatment, but it's a full service hospital, and my psychiatric hospital, have both gone to electronic record keeping. I love it, particularly at the psych hospital, as I frequently have to deal with multiple departments care providers, everything is stored in one file, so all my treatment providers can see what I'm on, who i've seen for what, and a brief summary of what was discussed. For example when I was IP this summer, I was scheduled to meet with a dietician, who looked at my file, saw I'd been treated for a blood clotting disorder 10 years ago at a completely different hospital and was therefore able to recommend that I not take Omega 6 or 9 since they could potentially interfere with blood clotting. Imagine doing that with paper files.

The other issue - paperwork. Up here Dr.'s are publically funded, psychologists and other T's are not. But OHIP (provincial health care plan) will not reimburse for writing letters or filling out forms, they only pay Dr's for direct patient time. So my family Dr. has a fee schedule for all services not covered by OHIP - one time I needed an assessment done regarding my driver's licence, she charged me $40. The more complicated the paperwork, the more she charges. My addictions Dr. doesn't charge for letters, but only writes them when you're in a meeting with her, so she can bill for patient care. If letters are needed around completing treatment or abstinance and they don't require a Dr's signature and a nurse can do them, then there's no charge. I don't know what my psychiatrist's policy is on charging for things like forms / letters as I haven't needed any from him. My last psychiatrist didn't charge and she sent a few letters on my behalf to the ministry of transportation. But as far as I know most Dr's - especially family dr's charge extra for letters / forms.

--splitimage

[amandalouise]

Originally Posted by splitimage

I think there are a few issues going on in this thread, all of them interesting
1. How agencies keep track of patient info -electronic, combo, or both
2. Willingess of Dr.'s Therapists etc. to fill out forms, write letters, on behalf of clients.

The two main hospitals I go to, one for addictions treatment, but it's a full service hospital, and my psychiatric hospital, have both gone to electronic record keeping. I love it, particularly at the psych hospital, as I frequently have to deal with multiple departments care providers, everything is stored in one file, so all my treatment providers can see what I'm on, who i've seen for what, and a brief summary of what was discussed. For example when I was IP this summer, I was scheduled to meet with a dietician, who looked at my file, saw I'd been treated for a blood clotting disorder 10 years ago at a completely different hospital and was therefore able to recommend that I not take Omega 6 or 9 since they could potentially interfere with blood clotting. Imagine doing that with paper files.

The other issue - paperwork. Up here Dr.'s are publically funded, psychologists and other T's are not. But OHIP (provincial health care plan) will not reimburse for writing letters or filling out forms, they only pay Dr's for direct patient time. So my family Dr. has a fee schedule for all services not covered by OHIP - one time I needed an assessment done regarding my driver's licence, she charged me $40. The more complicated the paperwork, the more she charges. My addictions Dr. doesn't charge for letters, but only writes them when you're in a meeting with her, so she can bill for patient care. If letters are needed around completing treatment or abstinance and they don't require a Dr's signature and a nurse can do them, then there's no charge. I don't know what my psychiatrist's policy is on charging for things like forms / letters as I haven't needed any from him. My last psychiatrist didn't charge and she sent a few letters on my behalf to the ministry of transportation. But as far as I know most Dr's - especially family dr's charge extra for letters / forms.

--splitimage

thanks for sharing sunrise and split image.

[sunrise]

Originally Posted by splitimage

But as far as I know most Dr's - especially family dr's charge extra for letters / forms.

I offered to pay mine for the letter but it still didn't help. (She did not accept my offer.) I'm really not sure what her problem was. (She never revealed to me why she was not being helpful.) I think it is good for providers to have a system for doing paperwork and just tell the patient their system (like my T does--he fills out papers during our sessions) instead of dragging their feet and being unhelpful. Work out a way to deal with it and then do it--it's all a part of doing business, and whether docs like it or not, a medical practice is a business.

[Rhiannonsmoon]

Originally Posted by amandalouise

so tell us how is your mental health system set up, are there things you like about it, hate about it, have they had to make any changes or decisions because of the resession?

Our mental health system set up is not perfect no system is, but the funding for ours increases each year rather than having to penny pinch with the same or lesser budget than the year before.

There are accountability guidelines to ensure that money set down for mental heath is not funnelled to other projects which is commonplace in many health systems. We also have 3 government funded hospitals with designated mental health facilities with beds and services for all levels of mental health.

The system is set up much like the system Pegasus works with and uses both hard copy and computer as well as backup systems. Any forms which need completing are done by the attending therapist and are signed off on by being copied and kept on file so if the original goes missing we can fax the copy on behalf of the patient.

There's an intake process which deals with hotline reports, GP reports, and court schedules. These are supported by Home, emergency response teams, clinical and hospital services and some satellite services through different high profile charities. There is also mental health legal support.

Practices not services have been reviewed and accountability has delivered the provision of better services and support for more patients.

For instance we had a PhD who would give out her personal theraputics and bill the department for an extra hour of work. This was very unethical and effectively fraudulent, wasting money which could have helped another client, or 4 clients at least 4 days a week saving the service at least $760 a week. That PhD no longer works for the service.