I have an outpatient, 19 year old, who is in town living at a "residential mental health" program supporting him while going through college. Parents live in another state and are paying a lot of money for this program. While there are some MSWs on staff at the program, most staff is not mental health trained, and it seems more like a life skills program, but implies heavily it is focused on mental health and brings people in from all over the country to live her while going through school, and everyone in the program has pretty significant mental health struggles.
I've been working with the patient about 6 months. Patient is not very engaged in our appointments. Staff from the program have been inconsistent, hard to reach at times, not calling if patient will no show, and recently rude to one of our clinic nurses about a prescription refill. Parents are also somewhat concern, fairly intense bordering on entitled, and don't seem to get that psychiatric medications are not a cure all. One of my early concerns with this program was the patient did not have a counselor when we started working together. I thought for sure the program would have a counselor, but actually it's not a requirement and the MSWs on their staff don't function as weekly counselors. It took about 3 months before getting established with a counselor when it really should have been about 2 weeks because patient has commercial insurance local counselors accept, and I think parents just ended up paying the cash fee for a counselor.
Anyhow, at this point, I'm feeling uncomfortable continuing to see him. I am not involved with the program in anyway, they outsource his mental health med management to me and I'm billing his insurance. I don't feel a good connection with the patient. I have concerns the program is overselling what it is offering, and I have concerns parents are expecting too much from medications. This is a fairly high risk person, like all of the patients at the program. I am concerned if there is a bad outcome, even if it's something I have no control over, I'll be left holding the bag as the physician and the program will be quick to side step claiming they aren't providing mental health care. I may also be experiencing some counter transference with a patient of very affluent means, or it could be patient is just entitled and doesn't really care about his treatment with me. Either way, I'm considering discharging him and not accepting further patients from this program. Are there any pitfalls to watch out for?
I've been working with the patient about 6 months. Patient is not very engaged in our appointments. Staff from the program have been inconsistent, hard to reach at times, not calling if patient will no show, and recently rude to one of our clinic nurses about a prescription refill. Parents are also somewhat concern, fairly intense bordering on entitled, and don't seem to get that psychiatric medications are not a cure all. One of my early concerns with this program was the patient did not have a counselor when we started working together. I thought for sure the program would have a counselor, but actually it's not a requirement and the MSWs on their staff don't function as weekly counselors. It took about 3 months before getting established with a counselor when it really should have been about 2 weeks because patient has commercial insurance local counselors accept, and I think parents just ended up paying the cash fee for a counselor.
Anyhow, at this point, I'm feeling uncomfortable continuing to see him. I am not involved with the program in anyway, they outsource his mental health med management to me and I'm billing his insurance. I don't feel a good connection with the patient. I have concerns the program is overselling what it is offering, and I have concerns parents are expecting too much from medications. This is a fairly high risk person, like all of the patients at the program. I am concerned if there is a bad outcome, even if it's something I have no control over, I'll be left holding the bag as the physician and the program will be quick to side step claiming they aren't providing mental health care. I may also be experiencing some counter transference with a patient of very affluent means, or it could be patient is just entitled and doesn't really care about his treatment with me. Either way, I'm considering discharging him and not accepting further patients from this program. Are there any pitfalls to watch out for?