Poety said:
Ok, my question regarding changing or "upgrading" the diagnosis in someone so they can get benefit coverage is this: What about the ramifications of carrying this diagnosis for the rest of your life?
We all know how being diagnosed with a mental illness can have negative effects such as the person using maladaptive behaviors and blaming it on their "illness" or worse yet, someone who wants to shed their diagnosis but can't because its so severe. I mean a child diagnosed with bipolar d/o may never actually mature into whoever they would have without the diagnosis since they'd be funneled into the system so early with treatment and meds -
I should also state that I'm one of the people that would tend to err on the safer side of med administration to children in the sense that I would want to avoid it at all costs - I've had No experience with child psych yet but my instinct tells me that if we mess with the chemistry too early - it DOES effect the outcome - and we don't know enough about the brain to do this safely - ack if I get flamed, please understand I'm coming from a naive standpoint here ok?
OPD, Zack, and the above poster - do you have any thoughts on this?
Poety,
I hear you on the "marked for life" issue. For my company, I'm sure that cost was a factor in making us bear down on justification of diagnosis- ie, if it's really conduct DO-which they didn't have to pay for- but the facility is trying to say that the "impulsivity" or "risk-taking behavior" was part of a "manic episode"- which they do have to pay for. But for we non-bean counters, it's the difference in arranging appropriate treatment- if it is true bipolar, med management would be prioritized, with supplemental psychotherapy after stabilization. But for a behavior problem, behavioral mod (or perhaps a referral to juvenile detention) would be prioritized; med management might be used, but not in all cases.
I've also seen clinicians underdiagnose, which can also limit access to benefits- though less harmful in the long run, probably. (And in this instance, I'm largely omitting psychiatrists and referring to a few psychologists and mostly masters-level therapists.) For example, a therapist was angry no additional sessions were authorized for a client she'd seen for over a year. She didn't want to stigmatize or label, so she'd diagnosed an adjustment disorder and never changed it. By their definitions, adjustment disorders don't even last a year, so we had a little chat about how if the client was still symptomatic, perhaps she needed to review the accuracy of the diagnosis based on current symptoms and resubmit her treatment plan.
I always loved doing an intake on a patient at an academic facility- it was usually a resident who called in the clinical, very thorough, concise, accurate. The worst was the facility (actually a rural academic free-standing psych hospital) which didn't have an intake staff except for the phone operators and perhaps an LPN.
Most intake departments in my area are staffed by MSWs/MAs, some licensed, some not, some excellent assessors, some... not.
Regarding the meds issue, I cheer on psychiatrists who are cautious with prescribing, especially to kids. I'm with you- a firm believer that although there are some kids who are truly ill, there are many more who need more structure and positive parenting instead of pills. I'm a big proponent of trying behavioral mod first, and going to meds as a last resort; however that doesn't offer the quick fix that the parents (or just as often, the schools...) want. I have occasionally told parents "let's start with least-invasive measure, and work our way up if it's needed." Sometimes it works, sometimes not so much. A few parents are dead-set on medication, and will doctor-shop until they get one who will do it. I once had to tell a mother that per our system, she had taken her child to every child psychiatrist on our panel within a 50 mile radius of her home and I had no additional referrals to give her.
On the adult end, there are a few psychiatrists I specifically refer to because they prescribe minimally, and frequently do med washes when they get a new patient with multiple meds. This goes along with my "enough but not too much" philosophy.
