After I wrote last week about my opinion that women with postpartum depression should try to seek out a specialist for treatment, I heard from a family physician in a major metropolitan city who told me that her patients now need to wait 5 months to get in to see any psychiatrist, not just a specialist.
My perspective comes from being a family physician in [major city]. Right now, in the health system I am in, we are booking into late April and May for a first appointment with a general psychiatrist. It does take “special clout” to get someone in sooner in my system … and that’s just to see a regular psychiatrist. As a physician I am someone with that special clout, and it still takes me multiple phone calls, begging, etc., to get a patient in any sooner. On top of this, my health system just cut psychiatric and counseling services by 30% because it wasn’t a money maker, and because leadership determined we were doing more than our fair share here in [major city]. Patients are coming in from other health systems because our wait lists are shorter than average.
If someone has an unrestricted insurance plan (and that’s a big “if”) or can pay out of pocket (bigger “if”) or is willing to drive to the inner city county hospital (many of my patients are not), they may be able to go outside the system and be seen sooner. I understand that you would want a loved one to get the best care. But from my perspective I have trouble getting my patients any care at all in a timely fashion.
I appreciated hearing from this doctor about her experience. Among other things, this made me think about how awful it is for a mom with postpartum depression or anxiety who has finally gotten the courage to reach out for help only to be told “Sorry. You’ll have to wait.”For months! I decided I’d ask some healthcare providers I know to provide Postpartum Progress readers with tips on what to do if you want to see a psychiatrist for help with postpartum depression but can’t get an appointment:
Jennifer Payne, MD, PhD, co-founder of the Women’s Mood Disorders Center at Johns Hopkins, suggests:
First, remember if you are having suicidal thoughts or thoughts of harming your baby, go to the ER. They will help you. Otherwise, you can seek immediate help from your primary care physician or OB-GYN. They can start medications while you’re waiting to see a psychiatrist [should you need them]. Also, call a therapist. They can often see you sooner and if they are concerned may have more direct access to a psychiatrist. Check to see if there are any postpartum depression groups at local hospitals or birthing centers for support. And finally, don’t give up. Keep calling around and ask to be on a call list for cancellations.
Ann Dunnewold,PhD, author of Even June Cleaver Would Forget the Juice Box, says that if you need medication for postpartum depression and can’t get in to see a psychiatrist, you should talk to your physician:
When a woman already has a good relationship with a physician (such as an OB/GYN, internist, family practitioner or even nurse practitioner), reaching out to that person can be a much quicker route to treatment. And while psychiatrists may disagree, I’ve seen that when a woman has a good relationship with her regular care provider, that provider often more readily considers the whole person (i.e. lifestyle issues, other underlying illnesses, etc.) Many of these care providers also are more comfortable prescribing medication if the mom is seeing a psychologist for therapy who is willing to be part of the treatment team and give feedback.
Diana Lynn Barnes,PsyD, LMFT,and author of The Journey to Parenthood: Myths, Reality & What Really Matters, suggests working with your therapist to try and get an earlier appointment with a psychiatrist:
I find a 5-month wait for a woman with postpartum depression unconscionable. I know for myself that I have developed a close, collegial relationship with a few psychiatrists in my community whom I know specialize in women’s reproductive mental health so that when I refer clients I can pretty well know that they will be seen within a few days. And I leave room in my schedule so that I can see a new patient within 24 hours.
Erika Krull,MS, LMHP,author ofthe Family Mental Health blogon PsychCentral suggests spending time with other moms for support and considering therapy:
Find a small moms group of some kind — MOPS, church group, library toddler time with some moms, a little weekly play group, quilting group, postpartum depression support group, whatever. Something with regularity and other moms so that relationships can develop and there is some level of obligation that gets you going even if you don’t feel like going. That social support is key. When I didn’t know what was wrong with me I happened to already have a habit of attending a young moms church group. Unbeknownst to me, that was what kept me going until I put the pieces together and got a diagnosis. Also, getting started with a mental health counselor might be quicker and certainly can help the mom start finding ways to cope with her symptoms. Just having that listening ear with a professional filter can also help give some direction, keep an eye on worsening symptoms, etc. Meds work best with therapy, but in some milder postpartum depression cases therapy alone may be enough.
Pec Indman, EdD, MFT, co-author ofBeyond the Blues and board member of Postpartum Support International,says it’s not unusual for women to be told they’ll have to wait a long time to get in to see a psychiatrist, especially those moms without private insurance or those who have medicare/medicaid for only a few months postpartum. Her suggestion:
Any healthcare provider (OB, family practice, etc) can call the University of Illinois at Chicago Perinatal Depression Project’s Toll-Free Consultation Line for Providers at 1-800-573-6121. It may not be as good as getting the patient in now to see a psychiatrist, but it’s better than nothing. Most OBs, family practice and internal medicine docs treat a lot of anxiety and depression. They need moreinformation, though,to rule out mania and information about medication during pregnancy and nursing. That can be provided through consultation with specialists.
In the meantime, Karen Kleiman, LSW, MSW, author ofThis Isn’t What I Expected: Overcoming Postpartum Depression, suggests making sure you don’t have an underlying physical illness that, if treated, would relieve the postpartum depression, thereby eliminating your need to see a psychiatrist at all:
Get a physical and rule out some of the conditions that can mimic depression and anxiety symptoms. Check for thyroid problems, anemia and general blood count.
I thought I’d join in and give you a tip of my own: If you are having a problem getting timely treatment for postpartum depression, or you have issues with insurance or being able to afford treatment, you should consider checking to see whether you are eligible for any clinical trials. If you find one in your area in which you are willing to paricipate, your postpartum depression treatment and related medical appointments may be free of charge and you’ll probably be able to get started right away. (Yesterday, as it happens, I posted of list of current clinical trials going on around the country!)
And finally, from the family physician who e-mailed me, an exhortation that medical schools need to do better to train all physicians on the identification and treatment of postpartum depression:
Training programs in the primary care specialties can and should cover these issues properly. If these programs could be convinced to do a good job with this (and I think they could be), this would go a lot further toward helping more women, no matter where they live, no matter what insurance, no matter if they have empowerment, no matter if they have clout.
Which meds can be used in pregnancy, in breastfeeding, etc., should not be special knowledge. It should be normal knowledge. With 15% of moms getting PPD this is not a special disease. It’s a normal disease. I want it to be a normal part of training for normal docs that a normal patient can access in a normal way. Then the specialists will be available to focus on the truly difficult cases.
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The hospital might also have support available as part of postpartum services-mine had a social worker who was quite helpful where she could be and was able to connect be to better services-as did the lactation consulatant. Working in the system seemed to yield more results.
And I second the go to the ER message. don't be afraid! They will help you and they won't take your child-a HUGE fear of mine, along with being locked up.
My god, I was DEVASTATED when told I was going to have to wait a week-and-a-half to see a psychiatrist to get help for my PPD. I coudn't imagine if I was told I would have to wait five months! I think if that was the case, I probably would have gone to the ER myself.
I had a trouble finding a psychiatrist and one tip opened up some doors for me was to call local universities. If you live near an urban area odds are that at least one of the schools nearby will have some sort of psychology or therapy program (if not an outright psychiatry program) that is looking for patients or has a list of resources they can put you in contact with. It might feel like the mental health equivalent of going to the beauty school instead of the salon when you need a haircut, but it is one more place to go for help.
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