Advanced Psychiatric Interviews
An Advanced Psychiatric Interview is the best start for mental health care. During this interview you will be asked about your chief complaint(s), discuss when it began, what helps and makes your symptoms worse, and what treatment you may have experienced in the past. It is a holistic process evaluating your overall health; physical, emotional, nutritional, and spiritual.
At the end of the interview a diagnosis or diagnoses will be provided. Diagnoses are not a “label”, but a target for treatment. It is important to identify what it is you are working on, to gain clarity about your goals for treatment. In psychiatric care we encourage “people first” language, instead of saying Sally is depressed, saying Sally is experiencing depression or has been diagnosed with depression. A diagnosis does not define Sally or any individual but help give voice to what they are struggling with.
In addition, to discussing diagnoses, practitioner and patient will also discuss a “Plan of Care.” This plan of care might be developed by the practitioner but is decided on by the practitioner and patient. They come together and decide how best to approach the struggles the patient is experiencing. A Plan of Care could include various elements, including medication management, counseling or recommendations for resources. A patient must agree with their plan of care, a critical element that helps them to invest and move forward in treatment.
The entirety of an Advanced Psychiatric Interview is confidential. This confidentiality is bound by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which states:
“The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that required the creation of national standards to protect sensitive patient health information from being disclosed without the patient’s consent or knowledge. The US Department of Health and Human Services (HHS) issued the HIPAA Privacy Rule to implement the requirements of HIPAA. The HIPAA Security Rule protects a subset of information covered by the Privacy Rule.”
Practitioners at Blue Skies Mental Health make two exceptions in relation to confidentiality in which a practitioner might break confidentiality. These are periods in which patients are a danger to themselves and others. If a practitioner determines this is the case, they will discuss the situation with the patient, and provide recommendations for care. In most instances, this would be going to the nearest ER to be medically cleared and then placed in an inpatient facility.
Medication Management
Mediation management can be critical in treating mental illness. In some cases, it is recommended for the best outcome, whereas in others it might be helpful for treatment. Management should be “least restrictive”, meaning the least amount of medication or least restrictive environment and should be agreed upon by the practitioner and the patient. In all cases, practitioners at Blues Skies Mental Health Serices, PLLC work with patients to determine which medications that they have had a beneficial outcome with and would like to continue with. We work to minimize medication use, as much as possible.
Some individuals do not have a problem taking psychiatric medications, whereas others have experienced side effects or adverse reactions that make them hesitant to trial a medication again. If a patient is concerned about finding the absolute best fit, it would be best to discuss genetic testing with the practitioner. At this time a couple of simple swabs to your mouth can help identify which medication one might be the best fit for. At Blues Skies Mental Health Services, we utilize GeneSight. Cost depends on insurance; some paying nothing or as little as $25.
Aside from genetic testing, use of psychiatric medications is very commonly based on medication “trials.” Practitioners prescribe according to what medications are approved by the Food and Drug Association (FDA) for what they are treating, what the cluster or diagnoses might be, possible side effects and adverse effects, possible comorbidities a patient may have and patient preference. A practitioner will provide you with a time period that the medication should show effect. If the medication does not have a positive effect, a practitioner will discuss options with you. If for some reason the medication is simply “not a good fit” or the benefits do not outweigh the cost (physically, monetarily, etc.), the medication may be discontinued and another medication may be considered.
Counseling
Counseling has been shown to be incredibly beneficial, whether taken with medication or without. When it comes to counseling, there are several important factors necessary for success: #1 that you are ready for counseling (ie. ok with feeling uncomfortable and opening up to someone), #2 that you find someone that you feel comfortable with and able to open up to, and #3 that they are well versed in a type of therapy that treats what you are experiencing. It is like most things, at times you can hit the jackpot and find a great fit, whereas other times it misses the mark. In these cases, it is generally no one’s fault, but it is up to you to communicate what you need to that individual and find a good fit.
Unfortunately, counseling is not magic. A counselor cannot wave a want to “make things better.” Sometimes individuals can have a view that counseling is similar to the Wizard of Oz, that the counselor or Wizard is going to “fix” you. Instead, good counseling is actually letting Dorothy or that letting that individual behind the curtain to learn how to work with a counselor along their mental health journey.
As stated, the counselor will work with you, but first the individual must take the courageous first step of coming to counseling. An individual must see the need for counseling and be open to “doing things differently.” Its very similar to an old joke; “How do you change a lightbulb? You can’t, it has to want to change!” If an individual does not see the need or have the want to change, then most likely there will not be change. Unfortunately, at times, life must get so challenging that they feel they have to change. In counseling, you have the opportunity to decide what you can and can’t change in your life and how you would like to move forward.