Rejected and/or “kicked-out” of treatment

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By Max Guttman

Finding the right treatment fit can be difficult. Not only are therapists important to try on, so are facilities, programs, and treatment centers. This article evolves out of my experience in St. Vincent’s Hospital in Harrison, New York. St. Vincent’s was my treatment center for seven years. I began treatment directly after coming home from upstate New York and my discharge from the state hospital center in Binghamton. Shortly after arriving back home, I began treatment at St. Vincent’s.

I started in the partial hospitalization program. The idea was, this program would be a step-down from the state hospital unit. I was successful in completing the program within the usual length of stay of two weeks. My experience in the program was pleasant enough. The staff were friendly and skilled, and I was moved through the program quickly enough, making the progress I was after.

Upon discharge from the partial program, I was referred to the hospital’s out-patient mental health program. There, I would do a seven-year stint with various therapists and psychiatrists, over the better half of a decade of recovery.

Incredible gains

During the initial phases of treatment, I made incredible gains. I had a motivating therapist, and a brilliant psychiatrist. I was adherent to treatment, medication, and therapy. Don’t get me wrong, there were set-backs, but they were my own learning moments. Eventually, I learned, and after about a year I returned to the classroom. And after three, I began graduate school.

Commuting back and forth from the clinic to obtain medication was problematic only where traffic was concerned. I had a reasonable new psychiatrist who cooperated and supported the distance in treatment. After all, the waiting lists up north, where I was going to school, given the length of my graduate program and ultimate return home, didn’t make sense. I fulfilled my end of the treatment bargain, and returned home periodically for therapy and routine psychiatric monitoring. So I was able to complete graduate school and remain connected to St. Vincent’s without any issues.

Not on my team

After returning home, and beginning working as a social worker, and practicing in the community, I was assigned a new therapist and psychiatrist. Both were very much team players, but neither of them were on my team. Bi-monthly therapy appointments were littered with complaints about my attendance and speculations regarding my adherence to medication. I was stable, and working, and living independently, with supports in the area. So I was baffled as to why I was under the radar of the treatment team at all times.

It seemed as if therapy and psychiatric monitoring were completely adversarial, and nobody was hearing me. That was when my doctor began to build an argument that I was beginning to display signs of hypomania. I explained to her that my combativeness, or rather, assertiveness in session wasn’t due to mood disorder but rather stigmatization and misdiagnosis. I was stable for a long time. But, as soon as I had a different idea on how I wanted my treatment to take its course, I was noncompliant, and a problem.

To make matters worse, my doctor began playing around with my medication to justify her hypomania claims. She lowered my medication to the point where it interfered with my capacity to perform at my job at work. I requested a medical leave, with which my employer was willing to be complicit. But my doctor at the clinic refused to sign off on my FMLA. She stated I was not in crisis or acutely symptomatic (but, hypomanic enough to lower my medication) because she didn’t like my tone or demeanor in session.

No help

At this point in time, I sought the help of the clinic director, who was familiar with my case and work in the community. He was unwilling to do anything. He wouldn’t change my doctor, or review her work to ensure my treatment wasn’t affected by her wanton dislike for me or her clear motive to have me discharged from the clinic so I wouldn’t be her problem anymore. And indeed, after I lodged a complaint with the director, the doctor’s tone changed again. Not only was she speaking with an accent and labored speech, but she was so cold I felt I needed to bring in a family member into session.

In the end I was told by my social worker, who was new and unfamiliar with my case, that if the doctor was not willing to sign my FMLA I could admit myself to the hospital. This, in hopes they would complete the paperwork. So I admitted myself to New York Hospital, and was discharged within 24 hours and referred back to St. Vincent’s.

No longer welcome

When I arrived at their E&R I was taken into a room and told I was no longer welcome at the clinic and needed to go elsewhere for services. No plan was in place for my ongoing, injectable medication or my oral meds. No appointment was put in place with another provider. As a result of this mismanaged care, I had to resign from my position at work, given I had no doctor to sign off on my FMLA. I was discharged into the abyss.

As bad as no treatment was, it reminded me of the importance of the early recognition of the signs a person may need to leave their clinic and find a new provider. If it doesn’t seem right, it’s probably not, and if you aren’t allowed to ask questions, go somewhere where you can.

Reproduced with permission, originally posted on mentalhealthaffairs.com