[Nix]

I go to a clinic where, in order to receive my prescriptions, I'm required by the state to have an appointment with my Pdoc and also my therapist every 2 to 3 months.

Today at my therapy appointment, I was informed that they want to discharge me and close my case. They would like me to continue my meds by receiving prescriptions from my primary care physician. They said that once a person is stable, they don't want them to get stuck in the system. I assume that means continually coming in for appointments.

I am not sure what to think about this development. Is this a normal thing?

I am on 4 different medications for schizoaffective disorder. Last time I talked to my primary care physician, he said he felt it was the right decision to have me at the clinic being seen by a Pdoc, and that he wouldn't want to manage those prescriptions. (I initially got a mood stabilizer from my PCP to try to save money, but went to the clinic after hallucinations and other symptoms worsened.)

On the one hand, I would be glad to have fewer appointments, which would save me a lot of money and time. I don't feel I get a lot out of therapy; it's more of a "checking in" for health kind of thing. On the other hand, it seems like a good safety net to be "in the system," where I could call and get an appointment at any time should paranoia, hallucinations, or other life altering problems creep up again. I don't want to have some sort of crisis where I'm not thinking clearly or emotionally disturbed and be stuck filling out paperwork and waiting in line for an appointment. Also, I know from time to time medications need to be tweaked, and how would that happen when my PCP is not a psychiatrist?

There is another clinic 15 minutes in the other direction that I could check into, but the idea of starting all over with paperwork and not knowing how many appointments they require, how much it costs, etc. is kind of overwhelming to me. So I don't really know what I'm going to do.

Has this type of thing happened to anyone else before? Is it routine for this to happen?

[dillpickle1983]

I've been closed several times for rescheduling or cancelling appointments. Never heard of being stable "enough" and "don't want people stuck in the system". I would call your caseworker if you have one.

[*Laurie*]

I agree with dillpickle. I've never heard of such a thing, either.

[HD7970GHZ]

Hi Phoenix,

Was there some kind of warning about this or did they just blatantly say you were done treatment?

Are you attached to the treatment team? I know I get attached and a sudden loss of treatment would be VERY difficult to handle!

I think you need to do what is right for you, and who better than you to know what that is. If you feel you need more assistance, tell them. If they don't listen or don't validate it - get an advocate to help you. You should NOT be tossed aside until it is fair to do so.

I may be speaking from an entirely different perspective, but I have heard that being "stuck in the system," can be a bad thing. I wouldn't be quick to judge them as being unhelpful or malicious. Perhaps there is another reason for ending treatment that is outside the scope of your awareness. All you can do is ask.

I know there was a point in time (years ago) where I was told to take a break from therapy because the point of therapy is to get out of therapy... I became attached to the idea of therapy and of course the therapeutic relationships I was building, and so I didn't want to stop going... I suppose this could also be what they refer to as, "stuck in the system."

Thanks,
HD

[Pikku Myy]

If you are not ready to have a change or be on your own... please let them know

[Gus1234U]

i got away from my 'clinic' voluntarily, but i still see the pdoc 2x a yr to keep my benefits and to get my 'class 2' sedative,, valium. no GP will play the paperwork game to give those to me. maybe your clinic will see you just 4x a yr for meds ? it's worth a try~

best wishes, and congrats for being 'dischargable' ~~

[Nix]

Originally Posted by HD7970GHZ

Hi Phoenix,

Was there some kind of warning about this or did they just blatantly say you were done treatment?

Are you attached to the treatment team? I know I get attached and a sudden loss of treatment would be VERY difficult to handle!

I think you need to do what is right for you, and who better than you to know what that is. If you feel you need more assistance, tell them. If they don't listen or don't validate it - get an advocate to help you. You should NOT be tossed aside until it is fair to do so.

I may be speaking from an entirely different perspective, but I have heard that being "stuck in the system," can be a bad thing. I wouldn't be quick to judge them as being unhelpful or malicious. Perhaps there is another reason for ending treatment that is outside the scope of your awareness. All you can do is ask.

I know there was a point in time (years ago) where I was told to take a break from therapy because the point of therapy is to get out of therapy... I became attached to the idea of therapy and of course the therapeutic relationships I was building, and so I didn't want to stop going... I suppose this could also be what they refer to as, "stuck in the system."

Thanks,
HD

I don't really feel attached to my treatment team, necessarily, but I like the idea of periodic check-ins so that any kind of crisis would be less of a crisis. It took me years to agree to go to therapy and agree to get on medication, and I just got used to the idea that I would need to do this for the rest of my life, and now I guess I'm confused.

My Pdoc died suddenly of a heart attack, and right now they have a nurse practitioner prescribing. My Pdoc kept a crazy schedule and saw patients every 15 minutes, but they said up front that the new nurse practitioner wouldn't be seeing as many patients. I think they just have too many patients to fit in. Right after I found out he passed away, they asked me if I wanted to transfer to my PCP, and I said no. Yesterday was the only appointment I've had since then, and they just said I needed to talk to my PCP and we needed to have a plan for discharging me. So I guess there wasn't really a "warning," per se, and I don't feel "kicked out." They said I'm not "banned" from returning, but I do worry about how long it might take to get an appointment if I really needed one.

I have an appointment to discuss it with my PCP Monday. I'm wondering if I should call the other clinic and see what it would cost to go there.

[Nix]

Originally Posted by Gus1234U

i got away from my 'clinic' voluntarily, but i still see the pdoc 2x a yr to keep my benefits and to get my 'class 2' sedative,, valium. no GP will play the paperwork game to give those to me. maybe your clinic will see you just 4x a yr for meds ? it's worth a try~

best wishes, and congrats for being 'dischargable' ~~

They're required by the state to have therapy in conjunction with meds, which I guess is why they want me to go to my PCP. I'm wondering about looking for a Pdoc somewhere else where I could just check in for my meds, but I don't know what's available here. I live in a pretty rural area.

I guess it is good news that they find me stable enough to be dischargeable!

[mugwort2]

I would inquire about seeing a medical administrator. That is somebody in the position and ability to help you in your rights as a mental health consumer.

[Victoria'smom]

Drop down therapy don't just leave.

[eskielover]

I wouldn't accept being pushed out the door. I know that I am so much better than when I started with therapy but like I told my psychologist this week, I need someone to check in with & to be able to talk through things when they come up, someone who is totally unbiased. Also said that I wouldn't want to discuss some of these things with my friends because I wouldn't want to dump my problems on them or burden them with listening to the things that I am integrating on my own & then checking in once a month with my psychologist.

I don't have a pdoc because I don't take meds but honestly, with your DX....just because they find you stable now, it's so easy for some chemical imbalance to happen & you would be back needing help with med adjustment or worse end up in the psych hospital because you don't have the help you need.

Your PCP is wise to refuse providing psych meds. They have no knowledge of them or how they interact. That would be a huge mistake. Just because this clinic is tight on the help they need to provide for your care, you of all their patients should NOT be brushed off. They should be looking & deciding by Dx, not by how stable one is at the moment even if you have been stable for quite awhile. Hallucinations & paranoia are nothing to take lightly just because you aren't dealing with them at this time.....it's important to keep them monitored & have a place where close monitoring is available if the need does arise.

Don't let them push you out the door under the guise of being "caught in the system". It's their lack of appropriate staffing that is causing the problem, not the fact that you are "stuck in the system"

[emwell]

It is odd, but I may be leaving my place as well. For different reasons though.
Your second post tells a lot. In my opinion they are trying to cut their caseload down. But that is just my opinion. Also, this is something that should be discussed prior to anyone making a decision.
Recently my Therapist asked if I wanted to cut down to every other week. I was given the time I needed to make my own decision.

I agree regarding warning and a failure to communicate the expectations of the treatment.

I was in an outpatient program when I was discharged from the hospital late last year. My therapy and visits were weekly - they actually came to my home or we met in the community (coffee shop, grocery store, etc). BUT, during the very first meeting it was outlined the expectations of my participation and - more importantly - what the terms of completing the program would look like and entail. They check in with me and are in communication with my psychiatrist whereby I can renter the program if warranted.

It infuriates me when I hear (on here or in my support group) stories of people who haven't had the same communication - it only seems logical and common courtesy to me. Again and again I hear about people being cut off or having their care changed with little or no notice. When it comes to my support group my usual response is to point out that we should be proactive when it comes to our care. That communication of the plan goes both ways.

That's a tough one. My mental health team and I were at the point of firing one another when one of the pdoc's in the practice agreed to see me once every two months for 15 minutes to write my scripts. My PCP didn't mind writing the scripts but he believed that I needed to continue the therapy. We just started this new routine at the end of April and I don't know if it will work or not.

Things are so much different now than they were 31 years ago. Back then and through my hospitalisation I saw pdocs for 50 minutes and they provided therapy and meds. I'm still not comfortable with (what I started with) a Ph.D. Psychologist therapist and a nurse practitioner prescribing meds.

I haven't experienced any sort of "plan" coming from anyone. No goals, nothing. I talk to my therapist (usually) every two weeks, as he sleeps, and my mental health continues to get more and more bizarre and hopeless and I'm going up and down with no help in sight.

It seems as if no US State has anything in common with another in treating mental illness and I leave my therapist feeling much worse than when I entered.

It's crazy, man. Crazy.