Psychiatrists, medication and diagnosis, oh my.

[Paul2019]

Quick background, I have always been a bit "dweeby" and I'm an IT professional by day. I've struggled with anxiety-like symptoms for about 20 years. I've been to my GP more than once, started on anti-depressants, but they made no difference to my day to day life, anxiety medication was better but felt like I was using the wrong tool for the job in the sense that, it dealt with the majority of the symptoms, but I wasn't getting "better". That is, I just felt like I was maintaining. I've also done the free medicare health plan, but honestly, the psychology had little to no effect on my overall feeling of well being.
My GP said that the next step is a psychiatrist, which isn't covered by Medicare, so before I go out and shell out a whole bunch of cash for more treatment, I'm looking for some other forum users who might have gone down this path.

What condition were you going to get help with? (Feel free to omit this if you feel you'd prefer)
What was your experience like?
How did it compare to seeing a therapist or psychologist?
How much did you pay (if you don't mind) and how many sessions did you need (or want, if you couldn't do all that you wanted)
If you stopped, why, and would you go back?

I know it's a rather generalised question

[White_Rose]

Dear Paul

Welcome to the forum. I hope we can provide some answers for you.

First of all Medicare does cover psychiatrists fees. There is usually a gap cost which you pay. There is the Medicare safety net but I do not know how much out-of-pocket money you need to have spent before it kicks in. When it does Medicare will pay 80% of the gap fee in addition to the usual benefit. A quick call to Medicare will tell you the total you need to reach. You can also look on the Medicare web site.

I think you or your doctor is confusing psychiatrist with psychologist. Psychologist fees have no Medicare rebate other than the visits via a mental health plan. So do not be too concerned. If you were able to pay the gap when you saw the psychologist you should be OK with the gap payment to the psychiatrist. You may also find a psychiatrist who will bulk bill, but don't hold your breath.

I was depressed, majorly so. I was suicidal for a while and needed to see the psychiatrist twice a week. My experience with the first psych was good to start with but became difficult after a couple of years for all sorts of reasons. I went to another psych who was very different and very good.

Psychologists are therapists just the same as psychiatrists. I found the psychiatrists much better then the psychologist. Don't know if this was due to their training or what but it was better seeing a psychiatrist.

Last fees I paid were $250 per session and my rebate meant I actually paid about $90. This dropped to $17 when I reached the safety net.

I am about to see another psychiatrist. The first was very good.

I would like to talk more to you but I must fly.

Good to meet you.

Mary

[Paul2019]

Hi Mary,
Thank you - exactly the response I was looking for. I had searched a bit for reduced cost psychiatry but until I had the term "medicare rebate", I couldn't find what I was looking for. Lucky for me, I'm in a position to be able to pay up front and claim back, so thank you again for that info. (My biggest concern was spending such a large amount of money on myself - and not the kids).

I only used the sessions with the psychologist on my plan. I'm a bit scared to say that here because people might be like "you didn't give it enough time" - but I thought 10 sessions was enough to see if there would be improvement, and after a chat with the GP he said go talk to a psychiatrist.

Thank you again, Mary, for all that good info. Feeling buoyed by the fact that there's a rebate program out there and I can keep trying to push forward.

[romantic_thi3f]

Hi Paul2019,

Mary has given you some great advice so I'll just try and answer your questions.

What was your experience like?

I have seen a few psychiatrists now and they have constantly been a hit and miss. I've also seen a few therapists now who have been a hit and miss. I currently see one now who I think I'd be lost without. Ultimately I think it depends on whether you click with them.

How did it compare to seeing a therapist or psychologist?

Psychiatrists are very much focused on diagnosis/s and medications, which psychologists tend to steer away from. While they can provide therapy, they often don't. I've found that therapists like psychodynamic approaches - having long conversations, letting you talk freely about what's going on - where as psychiatrists can be more about information. My current psychiatrist does a little bit of therapy but due to the time constraint (30 minutes) it goes up pretty quickly.

How much did you pay (if you don't mind) and how many sessions did you need (or want, if you couldn't do all that you wanted)

I was very lucky in that I found a psychiatrist who bulk billed, but in contrast my psychologist costs a fortune! I see him every month although at this stage it's mostly for medication tune-ups. I can't afford my psychologist at the moment. Other psychiatrists that I saw I had to pay out of pocket - between 50 and 150 from memory.

If you stopped, why, and would you go back?

I stopped with another because they were abusive towards me and telling me things about my life that weren't true. One told me I was an alcoholic because I used to sometimes drink on the weekends with friends (which is not an alcoholic!). If I couldn't see my psychiatrist, I might go back again.

I hope that this helps! I think if I can share anything with you about my experiences is that one doesn't represent them all. Just like psychologists, you can see so many and have so many different experiences. It's very easy to discard someone or a profession (i.e. psychologists don't help) when you have only seen one.

You can also try filtering by 'bulk billing selected patients' here - https://www.yourhealthinmind.org/find-a-psychiatrist or doing a google search with your location and 'bulk-bills' to help you.

Sidenote: even though it's expensive, it's an investment on you. By getting some help and support you get to be an even better parent to your kids 🙂

Good luck,

[White_Rose]

Hello Paul

I will answer your other questions. I felt the most pressing need was about costs.

What condition were you going to get help with?
I had a major depression which started about a year after I left my husband. I think the euphoria of leaving sustained me for a year before reality set in. However we are still separated after nearly 20 years and I think I did the best thing. The worst part was my children's distress.

What was your experience like?
At first it was good. The psych insisted I see him twice a week (I was very unwell). He wanted me to go to hospital but I had no medical insurance then and the public system would not have admitted me. I did get insurance and later he sent me to hospital for a week. It was the best thing he did. He gave me medication which had bad side effects so we spent the next 18 months or so trialling many medications to find something that worked without these horrible effects. He never did come up with anything. He only tried SSRI meds. It was my GP years later who prescribed meds from the TCA group which helped enormously.

How did it compare to seeing a therapist or psychologist?
I had been to the office EAP and saw a couple of psychologists there. Mixed feelings. I would have stayed with one of them but had used up the office financed limits, much like the ten mental health visits. By the way, no one would never say you did not try hard enough.

The psychiatrist was a much better option for therapy and I did get much better with him. At least for a while. He used to fall asleep when I was talking. When he swore at me because he was frustrated (at least I think so) was the last straw. Not all psychiatrists do this. I went to another psych and did very well with her.

How much did you pay (if you don't mind) and how many sessions did you need (or want, if you couldn't do all that you wanted)
This was 20 years ago and I cannot remember the cost but he charged the bulk bill cost. He then raised the cost every year I think by $5 out of pocket. The actual upfront cost was more as Medicare increased their rebate every year so he had that as well. I went to him for about six years.

If you stopped, why, and would you go back?
I stopped because our relationship was falling apart. I objected to him sleeping and being sarcastic and he objected to me doing something. The swearing was the last straw. I would not go back and I suspect my GP would not give me a referral.

Hope that is useful.

Mary