When t Worry about a teen?

No, you can't "hold him down."  But that's a red herring. Just get him there. Leave it to the therapist to make it work.

Sent you a pm. 


I know these warnings are necessary but when I read the last few posts it's terrifying.  Most teens handle anti-depressant meds just fine.  Here's is some info from the NIH

http://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health/antidepressant-medications-for-children-and-adolescents-information-for-parents-and-caregivers.shtml

"In the FDA review, no completed suicides occurred among nearly 2,200
children treated with SSRI medications. However, about 4 percent of
those taking SSRI medications experienced suicidal thinking or behavior,
including actual suicide attempts—twice the rate of those taking
placebo, or sugar pills."

===

I wouldn't talk to him about medication - let the therapist or psych handle that if appropriate.  


This is reassuring.  Thank you eliz.  No, certainly not even going to mention medication.   That's for the doctor and him to decide but I wanted to consider the possibility and start with an MD so he doesn't have to go to someone else if that is what is recommended. Really, truly.  Thank you all.


Agreed...one of the real hassles of the mental health world is that so much care is done by people who can't prescribe medication.

conandrob240 said:

This is reassuring.  Thank you eliz.  No, certainly not even going to mention medication.   That's for the doctor and him to decide but I wanted to consider the possibility and start with an MD so he doesn't have to go to someone else if that is what is recommended. Really, truly.  Thank you all.

Update.  100% right- these psychiatrists don't take insurance.  A few, including one referral from here was, wait for it- $300 an hour!!!! Sister found one through the guidance department at his school who comes highly recommended for male teens at a much more doable rate and they have an appointment in about two weeks. In the meantime, a discussion about school and making more of an effort for the last 3 months went well.  The class he is failing has an amazing teacher who is going to work 1on1 with him 2x a week and allow him to do some extra work to bring up his grade.  I am feeling a bit of relief already!


Don't have anything to add, just wanted to say good for you for staying on top of things. I come from a "suck it up" kind of family and in hindsight I probably could have used a little help as a teen. Even though I would have given my Mom hell for it. 


oh, I am quite sure he'll raise hell about the psychiatrist/therapist part. He may very well refuse to cooperate but at least it's "on the books" and the immediate school issue is somewhat addressed.

Frankly, I'd love to see this kid raise hell about ANYTHING and stand up/shout out what he wants!


He's probably holding back a huge storm of emotions. It might be scary for everyone when it is released but so important for him to get there. Hang in there! Even kids with relatively "normal" dispositions and problems can break your heart when they are struggling.


Yes, fore sure. Personally, I want that fire! His mother wants him to listen to everything she says and sees any back and forth as an affront to her mothering skills.  She has stifled him his whole life and I want him to break out of that.


On another note, I love the spunk of her little ones.  They won't be held down or back by her. They are sweet and polite but they aren't afraid to say exactly what they want and push back when she makes no sense or is being irrational.  Poor older nephew was just broken by that- always just said "ok" because he has such a gentle , non-confrontational personality. He's never been his own man


Was it my referral that was $300/hour?  I'm thinking it was. It's a shame that only people with the funds can get access to top-notch care. Compare credentials. Check board-certification in child & adolescent psychiatry. Not just regular psychiatry. Check if they are certified by an institute of psychotherapy. Not many psychiatrists are these days. Of course, the credentials don't make it any more affordable. But it explains the pricing differential. 

Although sometimes the more expensive one ends up saving money in the long run if the provider gets to the bottom of it faster. 


yes, it was. And the school recommendation is a board certified MD in child/adolescent psychiatry and has an especially good reputation with male teens. Credentials and experience were equal. I am sure the excellent school provides good referrals so she was completely comfortable trying the option that charges 1/3 of the others. But thanks anyway.


shoshannah, do not feel bad. $300 per hour for psychiatrist is quite moderate these days. That is why most use psychologist or MSW or counselors. Although a good psychologist runs around $200. If one is using psychiatrist for medication monitoring, then if you find the right meds, you're probably only going 4 times a year. At least it wasn't the $1500 consult we paid for a second opinion for my daughter. 

The important thing at this point is that he connect with someone who he feels gets him and his confusion and rage. Then he can get started. 


No one should feel bad at all.  I appreciate all the suggestions and referrals.  It did seem to be a common rate.  The school works with this other psychiatrist who has great credentials and who charges much less so that's the first choice for her.  If his credentials didn't seem as good, we would have sucked up the $300 but since they are stellar, he moved to top of the list based on that and his lower price.


Although the psychiatrists do NOT take insurance, patients can send every single invoice to their insurance company and (after the deductible is met) get paid back a percentage of their medical costs. The psychiatrists and therapists are considered out-of-network providers but most reasonable insurance policies have coverage for behavioral health issues including hospitalization etc. 


Okay, will let the father know that.


Kmk, I was just about to add the same info concerning rates and out of network coverage for psychiatrists and other mental health professionals.  Some plans reimburse as much as 70 or even 80% for Out of Network.  (This is true for some of my clients so I would ask folks not to panic about up front rates.)  Also some of us practitioners are willing to negotiate a rate that is satisfactory to both parties once we've had a chance to meet face to face.  YMMV.


kmk said:

Although the psychiatrists do NOT take insurance, patients can send every single invoice to their insurance company and (after the deductible is met) get paid back a percentage of their medical costs. The psychiatrists and therapists are considered out-of-network providers but most reasonable insurance policies have coverage for behavioral health issues including hospitalization etc. 

Actually, many plans nowadays have NO out-of-network coverage at all. Which means no reimbursement, and the OOP doesn't get counted toward any deductible. Hope that is not the case with them.

conandrob240 said:
yes, it was. And the school recommendation is a board certified MD in child/adolescent psychiatry and has an especially good reputation with male teens. Credentials and experience were equal. I am sure the excellent school provides good referrals so she was completely comfortable trying the option that charges 1/3 of the others. But thanks anyway.

I am glad to hear this. A lot of adult psychiatrists will see teens, but they really don't have the training that a board-certified child & adolescent psychiatrist has. I am shocked that he is charging only $100/hour (yu said 1/3). That is lower than most MSWs. 

gerryl said:
shoshannah, do not feel bad. $300 per hour for psychiatrist is quite moderate these days. That is why most use psychologist or MSW or counselors. Although a good psychologist runs around $200

I don't feel bad. But is IS a lot of money for most people.


Yep $300/hour is right on target for child psych.  A very highly recommended child psychiatrist in Livingston charges $275/half hour session.  Most psychiatrists really only do medication management.  Oh and many insurance either don't have any out of network behavioral health benefits, or the out of network deductible is so high that it might as well not exist.  The only child psychiatrist in our area that I know of who accepts insurance has a horrible reputation.   It really is a shame how broken our mental health care system is.


it really is. The referral for the guy under $100/ hr is great but even that would be out of reach of many people. And $300?!?? A roadblock for the majority- even laying it out if it were to be reimbursed would be near impossible for many. It's really a sad situation.


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