Difficulty Obtaining Treatment for my Depresion

As I've recently blogged about, I had an intake appointment with RPC to try to get back into treatment. I met with the director (who holds a MSW) and a psychiatrist (who would become my psychiatrist if I were accepted). During the intake, they ask a number of questions to try to get an overview of your current and previous mental health issues. During the "interview" (for lack of a better term), I was asked about prior treatment, prior hospitalizations, and current feelings.

As I've previously mentioned, I've been hospitalized on a number of occasions for my depression, usually when it gets to the point of my becoming suicidal. Over the past few years, I've been getting better about knowing when I need to put myself into the hospital to keep me safe -- when these suicidal thoughts become overwhelming and I feel like acting upon them. Right now, I don't think I'm at that point, but the Dr. asked me if I was having any of these thoughts, and I told him the truth: I had some the other night, but I called some friends and got my mind off it.

Because of this, the Dr. felt that I should be hospitalized. I told him that I really didn't think that was necessary at this point (in a month or two, if I continue without treatment, that might change). The thoughts aren't constant, and I haven't had an urge to act upon them. It was more of a contemplation than anything (even though it's not something good to be contemplating). So the Dr. contacted Stony Lodge Partial Hospital Program ("PHP") to see if they would take me back, and it was agreed that I would go there the next day (which would have been today) for an intake appointment, and possible entry into their PHP.

This morning, the Director of the Stony Lodge PHP told me that, in addition to having to pay the outstanding balance I owe them from prior treatment with them, they want me to go to and comply with a 3-day/week intensive outpatient treatment ("IOP") program before they would take me (and if I was successful at that and IOP determined I needed a higher level of care then they would consider me at that time), and recommended the IOP at Westchester Medical Center's Behavioral Health Center, which is the only IOP of which she is aware (I've later found out that New York Presbyterian Hospital provides an IOP).

I've previously tried to get into treatment there (WMC BHC outpatient) in the past and, because I owe WMC (in general) a HUGE amount of money (Medicare only covers part of one's astronomical health care costs), they said that they would only take me if I paid them some ridiculous amount of money (I believe it was around $150) in addition to the Medicare co-pay that I would have to pay, for each visit. So in essence, I'd be paying around $200 per visit, which would be three times per week, which would come out to between $500-$600 per week.

Not to mention, I don't know how I'd get up to WMC (or NY Presbyterian Hospital, for that matter) 3x/week or whatever (lack of transportation and my difficulty in getting around are additional issues with which I must contend). And, my last experience at WMC BHC has left a sour taste in my mouth. I was inpatient and had to fight with the doctor who headed the unit I was on the entire time I was there, because he didn't believe that I needed to be inpatient even though I know/knew that I did, in fact, need to be inpatient. His belief (that I didn't need to be inpatient) was based on his contact with me four or five years prior thereto, when I was heavily sedated on painkillers. I don't think he considered the possibility that my circumstances were different, that I'm a different person now than I was then, and that things change. In other words, I think he took his evaluation of me from four or five years ago and applied it to me last fall, even though he'd had no other contact with me in the interim.

So what am I do to? RPC won't take me because they believe I need a higher level of treatment than regular outpatient (seeking a therapist once or twice a week, maybe some groups, and monthly medication management with a psychiatrist). Stony Lodge PHP won't take me because of funding issues and previous difficulties complying with their five day per week attendance requirement, so they suggest I go into an IOP, which I either can't get to (transportation wise) or can't afford (Stony Lodge provided transportation; they're the only mental health provider in Westchester County that does so for Medicare patients).

I called my case manager and asked for her input, and she made a few calls and got back to me. Basically, it comes down to the fact that unless I go into the hospital for inpatient treatment, I won't be able to get into treatment. I don't believe that I'm at a level where I need to be inpatient but, apparently, getting into treatment without doing so is not going to be possible, for the following reasons:

1. transportation issues (it's hard for me to get around; I don't have a working car, and it's difficult for me to walk far, and public transportation where I'm staying basically sucks);
2. financial issues (I have a lot of outstanding medical bills with a lot of facilities, as Medicare only covers a portion of the astronomical costs of today's health care); and
   
3. lack of good treatment facilities (there are a few places I've been to before that would take me but I wouldn't go back to them if I were paid to do so, as I've had really bad experiences there (being misdiagnosed, treated poorly, etc .) and there are one or two other places I've tried to get into in the past but they make it nearly impossible to do so (not returning phone calls, not setting up an appointment, not taking walk-ins, etc.)

Shortly after I spoke with my case manager, the Dr. I saw yesterday called me (as I'd notified the director of RPC, via e-mail, about my difficulties) and after discussing it with him he said he'd try to get me into St. Vincent's, where he works (St. Vincent's is one of the places where I'd rather not go back, due to misdiagnosis and poor treatment and breach of privacy rights) but I'd agreed to do so if he would oversee my treatment there. I'll most likely go in on Saturday morning, when I get out of work (I want to go into work this week (Thurs/Fri night) for a few reasons:

1. I'm already booked/slated to go in and the firm where I'm scheduled to work might not call me back in the future if I cancel,
2. I think I'll be OK, even out of treatment, for at least another few weeks,
3. if I do get worse before I complete my scheduled work, I can promise to take appropriate action to get help (go to the ER, etc.) before acting on any impulses to do harm to myself, and
4. (least importantly) I need the money.

And on a somewhat related note, the housing that I thought I was going to get didn't happen. I spoke with my worker at Cluster Community Services who is handling my DCMH SPOA housing application, and was advised that the two beds that were available in the house (essentially, a group home) where I was slated to go in were taken by two other individuals who are on AOT status (which is the only thing above where I am (Enhances Services Program ("ESP") status) in the priority list) and that it would be approximately 3-9 months before anything else opened up with them, if not longer. I left numerous messages with a Team Coordinator at Pathways to Housing and hadn't received any return calls. So I finally went there in person yesterday after my appointment at RPC (as it's practically right next door). The receptionist at Pathways said that if Cluster had already picked me up there's not much more they can do to help me. I told them that Cluster is willing to send my application back to DCMH if another agency could provide services to me in a more timely fashion (this is what my worker told me, and said she would look into this).

So in addition to the difficulties I'm having in getting (and staying in) treatment, my housing difficulties continue to dominate my life. One of the reasons that my uncle gave for causing my homelessness last year was that it would cause my housing to come through faster. I knew that this was bullshit, and that it wouldn't have that effect. And since it now looks like I'll be homeless for about another year or so, it looks like I was right.

How Depression Can Affect The Mind

I've been off my meds for three months now. I have an intake appointment tomorrow morning with Rockland Psychiatric Center's Mount Vernon Clinic, where I hopefully will get back into treatment and back on my meds (Paxil, Buspar, and Remeron). In the meantime, as I'm not currently in treatment, my depression, and the symptoms I'm exhibiting, are getting progressively worse as time marches forward.

The depression has started to affect my thinking processes and comprehension abilities. I just finished reading The Last Precinct by Patricia Cornwell. It took me over a week to finish the hardcover book, which is about 445 pages. Normally (that is, when the depression isn't this bad), it would have taken me a mere two or three days, tops, to read the book at a leisurely reading pace. This is just one indication that, currently, my ability to focus and concentrate isn't so great.

If I continue to go without treatment, it could get to the point of my not being able to read anything at all. This has happened to me once before but, at the time, I blamed my inability to read based on the narcotic pain killers (various opiates) I was taking. Now, however, I realise that it was my depression that was interfering with my inability to read. I came to this conclusion because after I stopped taking the narcotics/opiates for pain control, I still had difficulties reading: I would look at the words on a page, see them, and just not be able to put the words together into anything that would have held any kind of meaning for me. Thus, my ability to concentrate was nill.

I can only imagine what people with Alzheimer's go through. The loss of mental functioning is frightening, to say the least. This is especially true for me, as mental ability was the one thing I thought that I could always count on. It was the cornerstone and foundation of my self-confidence. Whatever my insecurities, I almost never had to question, or be insecure about my mental capacity (which by most accounts usually is quite above normal). And, we don't even have to mention writing -- fuggeddaboudit.

This may seem like an intelligent, lucid post to most; however, I can tell the difference, compared to what I've done in the past, and especially in how I'm writing. For starters, I've been writing this for a little over two hours now. When I was in law school, I could write legal memoranda and briefs off the top of my head. I edited my writing very little, mostly due to the fact that, in essence, my writing, the process of which always has been stream of consciousness, needed little editing.

My "stream of consciousness" came out as well formed, grammatically correct thoughts, phrases, sentences, and even paragraphs. Now, however, I not only have to think about what it is that I want to write and organise it but I also must do more editing than I've ever before had to perform, and I'm not used to doing that.

Adding to these intellectual deficiencies is the fact that the ability for me to maintain my composure is getting much more difficult: Tears form in my eyes at the slightest provocation. For instance, I was watching law order on the tele and began crying when the verdict was announced. Another example is that I would be reading something in a book or magazine (while I still have the ability to do so) and I would break down, crying.

When I'm reading and find it difficult to concentrate, it's not that I'm thinking of other things. In fact, it's quite the opposite: my mind just goes blank. I just can't think, period.

Additionally, memory is affected by depression, too. I went to work the other night and spent a good ten minutes trying to remember how to do something that, normally, I wouldn't even have had to think about (resetting the base style back to defaults). If I don't write things down or, more realistically since I'm such a tech geek, enter it into one of my online accounts (address book, calendar, etc -- I still haven't been able to get a replacement for my computer and PDA that were stolen from me when I was beaten & robbed last fall ), more often than not I not only will forget the event but events surrounding the event, and if prompted with reminders after the fact, it still will be difficult for me to remember anything about it....

For me, it's the loss of memory of things that usually are second nature to me that really perturb me. I doubt abilities I presumed I possessed that I once thought were concrete and infallible. Self-doubt leads to isolation, as I don't want to be around people in such a fragile state.

If I didn't know that depression could cause all of these things, I very well could picture myself thinking that I was losing my mind. It's amazing that the number of people who have severe depression and survive are able to do so without losing whatever sanity they have left.