New to this, I have a question

[mrsdz]

Some of you may have read my posts over in the Anxiety threads. For some reason I was very excited about finally getting in to a clinic for mental health help. Now, I am starting to get scared of going. I realized, I have absolutly no idea what to expect. I was given the option of going one day for an intake and coming back to speak with a psychiatrist or doing it all in one day. I am doing it all the same day. :eek:

Will someone please explain this procedure to me?

What is an intake?

What can I expect to happen?

How long does the whole thing usually take?

[gordian knot]

mrsdz,

These are GREAT questions and hopefully my response can relieve some anxiety for you and anyone else who reads this and wants to know what to expect during your "intake" and first session.

Intake is a fancy title for a basic question and answer session. Your first visit usually lasts anywhere from 1 to 3 hours, depending if the clinic requires you to do some sort of personality or mental health testing. The actual intake is usually around 45 minutes, which includes questions about your general medical history, family medical history, mental health history, basic questions about your life and activities, and what you are hoping to work on or achieve in therapy.

If that sounds like a stressful job interview, it is actually much more relaxed. The questions are straightforward and your intake interviewer is trained to be kind, professional and careful in the information they ask about you. Of course, all information you give is completely confidential* and you will have to sign waiver forms if you need your mental health information to be shown to anyone other than you, the doctor(s) or authorized clinic personnel.

*There are a couple notable exceptions to the confidentiality guarantee. If you have hurt a child, committed a violent crime, or if you are threatening to hurt yourself or a child, by law the doctor or clinic must report it.

The mental health portion of the intake usually includes questions about past doctors and diagnoses (if applicable), medications history, history of hospitalization due to psychological issues, previous thoughts or attempts of suicide, family mental health history, and any pressing issues you are struggling with the day of the intake.

In my opinion, you are quite fortunate to be able to see a therapist on the same day as your intake. At many clinics, the first session does not take place until weeks or months(!) after the intake. The psychiatrist who sees you on your first day may or may not be the same person who conducts your intake.

Since you are seeing a psychiatrist (M.D.), an in-depth conversation about medications and your medication history will be crucial. The psychiatrist may only assist you with medications, or may do psychotherapy with you as well, depending on his or her role at the clinic.

The best thing about the intake and your first therapy session is, you can totally be yourself. You do not need to dress up or speak in a respectful manner or try to maintain any type of professionalism. Just say what comes to mind (even if it seems scary or crazy or random), as long as you feel comfortable with the therapist. The more thoughts, feelings and information you disclose about yourself in your first session, the clearer it will be to you and your therapist what kinds of issues have been bothering you. The issues will not go away after the first time you talk about them, but you might be surprised how liberating the first session can be, even though the work is just beginning.

Therapy can be a comforting and enjoyable experience at times; mostly this depends on the bond you have with your therapist. If your personalities do not seem to mesh well, don't worry about it--it's not your fault! Just ask your therapist (or ask the clinic, if you are too embarrassed to bring it up in your session) to refer you to someone who might be a better match for your needs.

Finally, remember therapy is all about you. The people assembled at the clinic are all there to assist you. Your psychiatrist/therapist is there to find out how you are doing and they genuinely care to hear your thoughts and feelings, even if it does not seem you've been there long enough for them to care. Very few professionals get into the mental health field for the money, the hours, the power or the glory. Instead, many of them have traded more lucrative careers in medicine or research to be at the clinic and meet with you face-to-face, because they genuinely care about you and they have interest in being with people who struggle in the same areas you struggle.

I hope this was helpful. A few nerves are normal when going into any new therapy situation. Try to be as open and clear about what you want and need, and I believe you will find caring professionals who will see you as a person and help you reach your goals and dreams.

Will you let us know how your intake and first session went? We would love to hear about it!

Peace,

Sean

[Proverbs31:28]

Gordian Knot has done a great job of explaining what to expect. I want to assure you that the peope doing intake are well-trained and very aware that the people they deal with are tender and hurting and they will be very gentle and very understanding. Please be prepared to share openly everything you are feeling and need help for. They cannot formulate the best plan for you without all of the information. It is a lot of questions about how you are feeling TODAY, how you have been feeling over the past 2 weeks, family history (especially if there is any family history of mental illness), etc.

If this is a mental health facility, they may be trying to determine the level of treatment you need. Options may include inpatient treatment for a short time (3-7 days), outpatient treatment in a structured program 3-5 days per week or individual therapy 1-2 days per week.

Bring soft tissue with you. Write down any questions you may have because you will likely forget them inthe midst of everything. I am so glad you are finally getting the help you need. (((HUGS))) Please let us know how everything goes.

[mrsdz]

gordian knot, Thanks for the detail into the intake and new patient process. You have answered everything I was curious about and more. I will be happy to share my experience, after all I did find a new home here on these boards. Many very nice and helpful people about. By the way I did read your post on the twin and gordian knot thing the day you posted it. I found it intriguing and still has me thinking.

lifeless, This place is a mental health facility. As far as I know that is all this clinic offers. Thanks for reminding me to write any questions down, as I have many and tend to forget alot. ((((HUGS)))) Back at you! I need that

[mrsdz]

I went to my appointment today. This is how it went.

When I arrived I was told I was late... This had me in awe since I was ontime. I was then told (not over the phone) I should have arrived 30 mins prior to the appointment to fill out paper work. With that they revoked my psychiatrist appointment so, I was only able to speak with an intake person. The paper work I had to fill out was about 5 or 6 sheets but only took me a matter of 5-10 minutes to fill it out. The wait was not long, I was brought into an office and told I would be asked a bunch of questions. To my surprise there was not many questions other than name age birth and what brought me there. I was offered the option of psych/meds and/or counselor. I was suggested I should seek all of the above options. So, I said okay to all of the above. I was told I had to speak with the counselor at least one time before I spoke to a psychiatrist. With having said all that I have to wait on a counselor to call me back for an appointment and my psychiatrist appointment was bumped till a couple weeks into November.

My first experience with this sort of thing was bitter sweet. It felt good to walk into a place and say I have a problem, I need help. On the other hand these anxiety attacks I have, I must deal with for another 40 days without meds. I was disappointed that my psych appointment got dropped.

[Proverbs31:28]

Oh, hon, that really does stink! It seems to me if they didn't tell you to come early and the paperwork only took 5 minutes (meaning you would not have delayed the psych appt) they should have let you see the psychiatrist! Of course, coulda, shoulda, woulda, right?

I am glad you felt good about putting it out there. That is such a HUGE first step!

Hang in there, you really have gotten through the hardest part- just asking for help!

If you need anyone to talk to over the next 40 days, you know we are here to listen!

[mrsdz]

Oh, hon, that really does stink! It seems to me if they didn't tell you to come early and the paperwork only took 5 minutes (meaning you would not have delayed the psych appt) they should have let you see the psychiatrist! Of course, coulda, shoulda, woulda, right?

That was the bitter part! I couldn't understand why, I suppose everything happens for a reason.

I will definetly be around. Btw I tried to post on your snake encounter but it went poof. How is that going for you?

[Proverbs31:28]

That was the bitter part! I couldn't understand why, I suppose everything happens for a reason.

I will definetly be around. Btw I tried to post on your snake encounter but it went poof. How is that going for you?

Its still a daily struggle. I still cannot go near the trash can (where my brother put it after killing it), cannot walk in the grass, cannot leave my door open. I keep seeing it, feeling it, imagining it will be there when I open a door. I was actually kinda doing better until church last night when a missionary kept saying the word over and over. I started getting light headed and my neck started twitching. My kids looked over at me as soon as they heard him say it and they knew something wasn't right.

I see my T Thursday and I am sure this will be discussed.

Thank you for asking about me, though. I truly appreciate the support I have found here.

[Mark]

I keep thinking that health care ought to be available without bureaucracy. I keep being disappointed

It's not optiimal that your appointment was not complete with a visit to the psychiatrist, but then again, you are now in the system, and that is the hard part for many. Now that you are on the schedule, once you are slotted, so long as you show up for the appointments, it ought to work out that you get attention.

Keep in mind that your visit with a psychiatrist will probably be measuable in minutes. The psychiatrist will likely size you up within the span of 10 minutes and write you some scripts. You will find more attention from the counselor, who is there to talk with you on a more intimate basis. This is not because the psychiatrist is a terrible person and the counselor is a great person. It's just how the system operates. The medical doctor treats the body/brain and the counselors treat the person. This is a schizophrenic sort of system - that much is obvious to all who think critically about it - but that is what is available today. Just be prepared for it and it won't be so weird when it happens.

[gordian knot]

mrsdz,

Thanks for your kind words about my previous post. I am so proud of you for going to your intake! I'm also baffled and very sorry to hear about the dismissive treatment you received, even though you were on time. Many people do not like to 'rock the boat' when it concerns someone who will potentially help them, but I would encourage you to call a supervisor at the clinic (go as high up as you can) and explain that you were denied your psychiatric appointment because of 10 minutes of paperwork--this seems really egregious to me, and I bet a supervisor could authorize an appointment for you much sooner than 6 weeks from now.

If you would prefer not to go that route, or if the clinic will not budge on their time frame, are there any stop-gap measures you could take? For instance, could you get a same-day appointment with your family doctor or General Physician, explain what happened, and see if they will prescribe you some meds now that will take the edge off your anxiety and/or depression? Also, many larger communities have a free or reduced-fee walk-in mental health clinic for the homeless, but these clinics often offer a sliding scale for people who are not living on the streets... something like that might allow you to see a psychiatrist or therapist if things get really bad. You would just need to go to the clinic when they open and wait--maybe all day--because homeless people and children are usually prioritized first. I went to a clinic like that for several months when I was out of a job, and the people were so decent and caring.

I agree with Mark about government bureaucracy and the continuing stigma of mental illness. I would definitely include insurance companies in the poor assessment category as well. Here in Oregon legistators just passed the Mental Health Parity Act, which means insurance companies in the state will no longer be allowed to discriminate against mental health patients by limiting their number of covered visits. Changes like that are exciting, but most places still stigmatize and alienate mental health patients with limited services and long wait times.

One other thing that related to the stigma. I used the phrase "mental health patients" in the last paragraph. It is so easy to use a phrase like that and not even realize the labeling that is going on. A few months ago, in a moment of despair, I told my therapist that she must feel like she needs extra layers of security from all of the 'psych patients' she works with every day. She responded, "Actually, I prefer to think of everyone as normal people who have pain I can assist with." Touche. The great thing is, I know she really sees people that way. If we could all be so fortunate to have such caring professionals in our lives...

"My blessings on your house," that's what the wizard said.

Peace,

Sean

[Guest ASchwartz]

Hi mrsdz and everyone else,

Oh, yes, Mark is quite correct in talking about bureaucracy. I spent many yeaers in psychiatry working in hospitals and not for profit agencies. I would would say that my experiences are organized into two categories: Category 1 is pre managed care and catergory 2 is managed care. Prior to managed care anyone could see a doctor, psychiatrist, therapist, go to a clinic, an emergency room, etc. and be fully treated. Insurance companies paid with little hassle.

Most of us professionals characterized the advent of Managed Care as Mangled Care. Time and experience has proven all of correct. While the managed care insurance companies rake in billions of dollars, patients face a constant crisis of having to get referrals from their primary care physician or not be seen. They must also get prior approval from insurance before treatment will be approved. Often, approved treatment consists of tweny mental health visits per year for no more than two years in a row.

This has affected all the clinics because, before they can be paid by insurance companies or by Medicare or Medicaid, they must prove that they are efficient. Efficient means that they limit visits and follow vigorous guide lines.

How does all of this affect us (those of us who need and want treatment)? Well, just read what mrsdz has written.

Mrsdz, I am so sorry that this has happend to you. It's the same old story: those with money can pay to see their private medical doctors, psychiatrists, psychologists, etc. with no problem. The remainder of us, the over-whelming majority, must wait in line.

You see, it's not that the psychiatrist refused to see you. NO, NO, NO!!! It's that his schedule (which he does NOT make) is filled to the brim and more, because his salary relies upon billable hours from which the clinic or hospital makes money. In addition, I would guess that the psychiatrist is there only Part Time with no other psychiatrist to fill in.

Oh yes, its a great health system.

Nevertheless, do not take it personally, try to be patient and remember, it is not you, it's just the way things are. I have seen the same situation as yours thousands of times over the years. In fact, in one hospital out patient clinic I worked in the clock was wrong and no amount of pointing it out did any good.

Allan

[mrsdz]

lifeless, In the post that went poof I let you know of an odd tactic I use with my fear of mice. Same feelings you have towards the other things( no I will not say the word). This may sound strange but oddly enough it has helped me to sleep at night from the mice. Basically, I divide my age by the amount of times I had unwanted encounters with them, an apply a percentage to that number. The percentage I figured out by the amount of times myself and other people have had run ins with them, people I know. It helps me to know I have a 6-8% chance of running into one in 7.25 years.

Mark, Thank you for sharing what to expect now that the initial intake has taken place. The attention is not something I want. I am able to open up here on the boards because well, I am not sure why. I am still a bit terrified on the inside about all of this.

Gordian Knot, You are quite welcome! You are correct in the observation of not rocking the boat, that is just how I feel. It is funny you ask about a General Physician, I just was talking about that with my husband today. Yesterday, someone my husband knows used to be in the mental health field and knows of a psychiatrist, he claims to be a very good one or a "realist" in his words. After contacting this new place the reception said about a month but since it was a referral from someone they know and that I have been now with these anxiety attacks for sometime without meds they will be calling me back with an earlier appointment (I will keep you posted on the outcome).

ASchwartz, Thank you! I was not going to touch on the subject but since you have, I must. I was uninsured many years ago, I had a very hard time finding a gyno (for a pregnancy). As my insurance kicked in I found a doctor, when arriving at the office the woman called the wrong number on my insurance card which told her I was not covered, when in fact I was. She then told me the doctor could not see me because I had no coverage. When I tried to explain to her what was going on, she walked around the counter wrapped her arm in mine and escorted me out of the office. I stood outside as it rained to call my insurance company who verified my insurance was good, I then walked back in and let the receptionist speak with them. They were then glad to have me as a patient after that. I seen then just how different people get treated without insurance.

Our insurance dropped us about a year ago because of lack of hours. Since then I have had Medicaid. I will not say all places are terrible or people that work in these places but I do see a big difference in how we (my family is treated) weither it be the system or people in general. As far as the Clinic I was just at, when my appointment was dropped my husband straight up asked them "Is this because the type of insurance we have" "If I came in here with cash would I be able to get a sooner date" the reply to that was no, this is a place where people go that do not have anywhere else to go.

I can not help but feel after what I have experienced and after reading many posts on the internet that this area of health is greatly overlooked. Now I could be wrong, just seems as though there could be a better way for a system to be set up. I will admit myself before having issues or shall I say being in denial about having them, didn't give mental health a second glance.

Someone said it here on the boards the same thing I have been saying myself, if you are not bleeding or it doesn't show up on an x-ray you are tossed aside. With having said that, I think it is great to have a place to come to on internet to be able to read, share and relate experiences.

Chapter 2 coming soon... lol