There aren't many appointments out there right now as far as I can tell. People are calling multiple times every day trying to get in. Case managers are calling lists of providers looking for appointments. Insurance companies are calling directly asking for the first available. Nothing but waitlists......
Historically, access to mental health care in Virginia has been a challenge. Add a pandemic and you have reached (quite possibly) the definition of impossible. Is anyone finding it exceedingly difficult to get an appointment? With the right therapist? For the right client age? That accepts the right insurance? That lives in the right town? Experienced in the right specialty?
The whole point of Telehealth was to increase access. Now everyone is doing telehealth and our access issues continue as the demand for services exceeds the number of clinicians.
There are some strategies though to reduce some of this burden....
YOU CAN GET IN!
Look on the back of your card and call member services. Ask the following.....
1. Does this insurance plan cover telehealth outpatient mental health visits? If so, what is your cost sharing responsibility and does your costs apply to telehealth appointments?
2. What is your co-pay amount for outpatient mental health telehealth visits.
3. Ask for a list of in network therapists and get their phone numbers, addresses, and whether they are doing telehealth or in-person.
1. Call every provider given to you by your insurance company.
2. Do a Psychology Today, Black Girl Therapy and/or Therapy Tribe Directory searches. Add the filter of your insurance company and any other filters that may apply to narrow down your search. If you want to increase the likelihood of getting in sooner, search statewide.
3. Start calling: First ask if the practice is accepting new patients. If yes, ask if they accept your insurance. If yes, ask if they are doing telehealth or in-person. Schedule.
If the practice is not accepting new patients, ask if they have a waitlist. If yes, add your name to it and ask for a call when they have an appointment available. Put an asterisk next to this practice so you know you are waitlisted here.
4. Expect to make many, many, many calls. Get on as many waitlists as you can. Keep track of the names and numbers of these places. Call them back once per week to express continued interest in receiving services. At some point, you are going to get a call from one of them to schedule. If others call later and you have already gotten scheduled, that's okay, you can just let whomever calls know at that time that you no longer need an appointment. They will just take you off their list and proceed to the next person.
If you are in need of medication to alleviate symptoms, please schedule with your PCP. PCP's can prescribe many psychotropic medications, especially if they know that you are actively seeking an appointment with a psychiatrist. Plan for an appointment with a psychiatrist to take approximately 4 - 6 months, longer for children. There is a shortage of psychiatrists in Virginia.
More on appointments with psychiatrists (which probably should be a whole post all by itself): when you finally get that appointment with the psychiatrist, take a list of questions you need answered. Eliminate all idle chitchat and social pleasantries. The appointment will be time limited and will focus on your symptoms, previous history and side effects. Psychiatry and medication management is not therapy! So, don't expect a lot of discussion about your current life situation outside of your current ability to function and ongoing symptoms.
There is a lot to say about access to mental health treatment. Here at OCSV, we are committed to helping anyone access treatment regardless of whether you are able to to schedule an appointment with us or not. We will refer you to any clinicians or practice that would be appropriate for you or might be in network. We will call you back when you leave a message or send an email. And if we speak to you directly we will give you some coaching on how to get an appointment effectively and efficiently to eliminate as much frustration as possible. If you have any questions or need help, reach out. And if you found this post helpful, please share it around because there are lot of frustrated and hurting people out there that haven't been able to get in. Some of them have even given up trying. Tell them, don't give up.
Trust and Perseverance,
No doubt you have been home during this period of lockdown for about 40+ days by now. It is understandable if keeping your kids on track, entertained, with some semblance of a healthy schedule is beginning to take its toll.
Maybe you have had a blow up or two or ten. Maybe Susie has permanently escaped to her bedroom and phone. Maybe you have wanted to pull out your hair, scream or wring someone’s neck. Not that you would of course, but are you going through the day feeling resentful about all you do around the place with little to no help or contribution from your dear loved ones??? Are you sick and tired of your child’s backtalk and sassy mouth? Have you had it up to here with Johnny’s refusal to take responsibility for his own actions?
If so, You. Are. Not. Alone.
If your head is filled with frustrating and negative thoughts about your kids that just seem to spin around and around and never go anywhere you are not alone. Everyone else is talking about beautiful family together time. Working puzzles together. Learning a new hobby together. Landscaping together. Going on walks. Homeschooling. Organizing. Adjusting fine to the new normal. Not you? You’re just trying to survive the Teenage Thunderdome of Quarantine?
There is a way to reset.
It’s not too late. Things can and will get easier.
Here is how you do it, in this order:
Take Responsibility for Yourself. I know. This is not fair and a huge pill to swallow. You are doing everything already why should you have to own up to anything at all? After all, you are not the person with the bad behavior. Trust me. Do it anyway. Take some ownership of something you have been doing lately that you know, deep down inside, has been driving everyone crazy. Nagging? Shouting? Using harsher than normal words? That’s okay. We all reach our breaking points. Just own it. Yes, face to face, with your teenager. Tell them what you’ve been doing and how you’ve been feeling. Be honest. This step is best done one on one. One parent to one child.
Avoid the Argument. After you take responsibility for yourself, you might be on the receiving end of some blame and criticism. If it’s respectful and you are not an emotional punching bag, that’s okay. Listen. Don’t throw anything back. Your teenager really does need to purge their negative feelings on a regular basis. Think of it like a pressure valve. Releasing this pressure is going to come back to you in so many positive ways so help them let it out.
Find Out What They Need. After they have sufficiently discussed what was bothering them, ask them to identify three things that they feel would really be helpful. This is not cart blanche to have three things exactly they way they want it. It must work for everyone. See if you can work out a compromise. Then follow through. Meeting these needs cannot be an empty promise or your relationship will not repair.
Ask for what you need. Pick three things you really need. You probably need a hundred things, or maybe a thousand. You need people to clean up after themselves, show appreciation, do their schoolwork without complaint or excuses, and get out of bed when you ask them. But just pick three. Three realistic, concrete and specific things. The more specific, the better. If your child is resistant and can’t get bought in helping you achieve these three things, return to step 2 and try again.
Warm It Up. No doubt, your negative and ruminating thoughts have seeped outside of yourself into your relationships. It might not have been an overt act. You might consider yourself pretty good at keeping yourself under wraps. Guaranteed, your kids feel this negativity around you on a daily basis. You are going to have to work towards pointing out the positives you see, complimenting the things you like, and trying a more playful and easy going approach. Try doing something out of the ordinary, or something pleasantly surprising. You will be amazed at the mileage you get out of it. If your child is amenable to it, a tickle fight, or a pillow fight, usually does the trick.
Spend time outside of problems. Let’s face it. It’s hard to want to spend time together when that time is consumed with arguments, bickering, or sullen silences. Once you’ve successfully completed steps 1 through 5, now is the time to do something together “outside of a problem.” The goal is to provide enjoyment for everyone. If this is a challenge due to difficult behaviors, start small. Do something for one hour together. Maybe it is just one on one time with your child or maybe you will need to include others. Whatever you decide to do it and for however long it lasts, commit to making the time problem free.
Let them have the last word. This will help you at all times, not just during relationship repair. Just let them have it. They want it. They are great at it. For you to win this battle, the ensuing escalation will cause the exact opposite of relationship repair. You don’t just have to suffer in silence. You can still make your point without all the back and forth. After they have just contradicted what you have pointed out, just say these words “I’m glad to hear that.” You can still make your point without receiving agreement and you can sidestep the argument.
For example, you have just told Johnny that he needs to clear his dishes from the table and put them in the dishwasher (something he never does without being asked no matter how many times you ask him) and Johnny responds with an attitude saying “I knowwwww,” or “I willll.” You now have a choice to launch into a tirade about how he never clears his dishes and you either have to tell him 20 times or do it for him. Or you can simply choose to tell Johnny, “I’m glad to hear that.” Johnny has gotten the message. He will want to have the last word and tell you that he “always clears the dishes.” You can respond “I’m so glad to hear that Johnny” and then let him be the last person to speak on the matter. Escalation of problem averted, provided he gets around to clearing his dishes.
Repeat. Repeat these Relationship Repair steps frequently and apply liberally to smaller and smaller problems for best results. Letting bad feelings build up over time will cause the relationship repair process to be more challenging. If neglected completely you are in danger of losing your relationship altogether and may need to seek temporary outside help to fix.
Get Help. If you are feeling like the relationship with your child is broken beyond repair, seek professional help. If you are feeling like you are living in a war zone with your child a ticking time bomb, please seek help. If your child is routinely disrespectful, defiant, verbally or physically abusive, please consider making an appointment with someone who specializes in adolescent and parenting issues. These behaviors can also be corrected with effort combined with the right type of expertise.
Get a consult: If you're not sure whether you need to seek help or not, give us a call for a free consult and a referral.
Breathe in for a count of 5, hold for 1 second, breathe out for a count of 5. The slow exhale tricks the body into relaxing. This is also an excellent exercise for your lungs during this particular respiratory virus. Do this repeatedly throughout the day as needed.
Start at your toes. Tense your muscles as you slowly and deeply inhale. Relax those muscles as you exhale. Work your way in small muscle groups from your toes and ankles, up your legs to the rest of your body to the top of your head. Don't forget your facial muscles! You will physically feel stress and tension leave your body.
Notice 5 things you can SEE
Notice 4 things you can FEEL
Notice 3 things you can HEAR
Notice 2 things you can SMELL
Notice 1 thing you can TASTE
Get distracted by activity. Do something that makes you feel satisfaction or a sense of accomplishment. Clean something, organize something, make a craft, read, walk, weed, or make a list.
Create a Schedule, Develop a Routine
A schedule helps us feel more in control: Make sure your schedule includes something:
Take breaks and switch activities
Eat regular meals
Go to bed on time, wake up on time.
Control What You Can
Remind yourself what you are doing to control the spread. Repeat:
Mental Health Apps
CBT icoach for insomnia
Take a Break
Domestic Violence: 800-799-7233
Crisis Text Line: text CONNECT to 741741
Substance Abuse: 800-662-HELP (4357)
Mental Illness: 800-950-NAMI (6264)
Schedule an appointment: If every strategy seems difficult or futile, or if your best efforts have failed and you are having difficulty functioning, you may need the help of a professional that can provide you with additional coping mechanisms and help to live comfortably during this difficult time.
Here is the scenario: you've got teenagers at home and have gone from a super busy, on-the-go, constantly Pressed For Time sort of life to one of 14 or 16 hour days of unscheduled time during this Covid19 voluntary quarantine.
It has already been recommended by many sources to keep your kids at home and supervise their social distancing compliance. If that is what you are doing right now, are you find the days getting longer and longer?
Are you really ready to have 2 months of unscheduled time, if that's how long this thing lasts? Day after day, hour after hour, of attempting to fill up time with things more meaningful and necessary than Snapchat, Captain Sauce, Xbox, and frequent trips to the fridge for more cereal milk?
If you need it, here is a blueprint for keeping your kids successfully goal oriented and focused while simultaneously keeping the family peace. Much easier said than done. Structure is everything. Everything.
Your teenagers don't need their hand held. They need basic parameters, expectations and responsibilities. Then you need to back off and let them achieve those things that you have set out for them. Provide them with a list of expectations and let them carry these out one by one on their own. They can ask for help if needed. Screen time may need to be limited until expectations for the day have been completed, especially for younger teens that are less self-directed or for kids that are less responsible. A 17 year old who is goal directed and self-driven may not need any of this at all.
1. Morning Routine: get up at a reasonable hour. It does not need to be at the crack of dawn or follow the high school schedule. But sleeping til noon isn't going to work either. 9am is a good time or even 10am. Especially if kids have gone to bed at a reasonable hour and have gotten a full 8 or 9 hours of sleep. Most teenagers are sleep deprived on a normal day Adequate sleep is critical for mental health and well being (for more on this see the blog post on coping with social distancing) and will decrease everyone's irritability. Lack of sleep might be the single most routinely damaging thing for adolescent mental health that exists. Get dressed. It is tempting to lounge around in pajamas all day and never shower. But, as previously mentioned, structure is everything. Eat breakfast, preferably something more nutritious than a bowl of Lucky Charms, but hey, something is better than nothing.
Pick a set time of day to begin and this must be consistent. From this point, in no particular order, your child can....
2. Read: one hour of reading, at grade level, something of interest. If your child is a bookworm and reading is an escape, perhaps they can be expected to complete the other tasks on their list before reading for pleasure.
3. Complete Schoolwork: In Virginia, our Governor has cancelled school for the rest of the year. That means kids will be at home from March through August, or just about 6 months. Teachers may have set out work to do for each class. Clear guidelines and expectations regarding school should have been outlined. If you child is struggling with this aspect of being home, make sure they are in close communication with their teachers via email and asking questions. If your child is older, researching or working on college applications, career education, or SAT prep may be in order.
4. Do A Chore: Each child is required to do one chore to help the family and the household.
5. Exercise: You are best equipped to decide what is an appropriate amount of time and expected exercise level. Is your child an athlete? If so, they will need to work to maintain their base fitness level. Is your child a couch potato on a normal day? If so, maybe some Wii fit, zumba youtube videos or a brisk walk outside may be sufficient. Exercise is a key component to maintaining mental health during this period of quarantine for everyone, child or adult, and best achieved by being outside if possible (see the exercise component of coping strategies for social distancing).
6. Get Some Fresh Air: Can be combined with the exercise component if needed, kids need to be outside every day. Playing sports, riding bikes, or jumping on the trampoline. If none of these things are options for you, consider just going on a walk together for positive family time, fresh air and exercise all rolled into one.
7. Participate In A Project of Interest: leave this purposefully open ended and vague. Your kids might surprise you with what they come up with! Perhaps a website that teaches coding, perhaps an activity long forgotten found in the garage, perhaps it is sewing masks to help hospital workers. Maybe they will rekindle their love of art or take one of the many virtual tours of a museum or park that is being offered right now for free. Whatever it is, it must be a special project of interest at least one hour once per day. It can be a different thing each day or carry over from one day to another. Of course, doing this for longer than one hour is acceptable also. As long as it is brain food, it will work!
Here is a hint: More than one kid at home? Rotate, so that they are doing each task independently and individually with the exception of exercise and outdoor time which should be done together and as a family if possible.
Another hint: you've got younger kids that are not so self-sufficient? Go ahead and try this structure but modify it or shorten the time frame. Finding an age appropriate project of interest right now should not be difficult. Check out Mo Willems drawing class for an idea of one thing an elementary student might enjoy. Practicing writing and penmanship can be accomplished by writing to elderly in nursing homes or assisted living facilities. There is an endless source of activities but you may need to get creative in order to mix it up to keep it interesting.
After each of these tasks has been completed to your satisfaction, let them be free to do what they want and have their free time to use as they see fit (abiding by social distancing requirements of course).
Set your expectations consistently each day and follow through. Remember, Structure is everything. You may experience resistance at first but this does not last usually more than one week. Before you know it, you will have a structured day, with meaningful activities, that your child can move through mostly on their own. Hopefully your period of quarantine will fly by in the most peaceful way possible. Good luck and if you need help, comment below.
Now offering a free group for anyone needing support during this time of "social distancing" during the Coronavirus Pandemic. It is critical that we remain physically apart from each other as much as we can right now in order to flatten the curve and protect the most vulnerable and elderly among us. But that doesn't mean that need need to isolate ourselves emotionally.
These are challenging, scary and unprecedented times. Sometimes it can help to just talk it out, realize that we are not alone, that what we are feeling and experience is normal and very similar to what other people are going through.
If you would like to participate in a small group for additional support, please email, or give us a call so we can get you signed up.
Strategies to reduce anxiety during Covid-19 Outbreak
1. Limit screen time: when you limit your screen time your mind gets a break and you have a chance to think about and do something else unrelated to the virus. You might consider turning your phone off or giving it to a loved one for a pre-set period of time. Can you limit scrolling to a half hour in the morning and a half hour at night for at least one day? Can you do that for more than one day in a row? Limiting screen time, even for just an hour or two allows us to focus on other happier and more productive things.
2. Sleep Hygiene: It is important to be well rested. For some, this can be a challenge, especially when faced with the increasing anxiety of this virus outbreak and potential for economic downturn. Getting enough rest is critical for boosting our immune system and simultaneously strengthening our mental health. Do you find that you can't turn off your mind once you lay down to sleep? Make sure you are going to bed at the same time each night. Turn off all screens at least one hour, preferably two, prior to going to bed. Deliberately think about things that keep your thoughts away from disaster. Plan a vacation, figure out how to spend the money you win in the multi-million dollar lottery jackpot, imagine what your children are doing in their careers when they grow up or any other topic that you find enjoyable thinking about. The point is not to tell yourself you shouldn't be thinking about current events. That is like trying not to think about a pink elephant in the room. Instead, let your mind free associate on a topic that you find interesting and enjoyable as you are drifting off to sleep.
3. Get moving: The weather is very nice in Virginia right now. Get outside. Breathe in some of that fresh springtime air. Take a walk. You can maintain social distancing and still get out of the house. Is there a new trail somewhere nearby that can simultaneously keep you away from others while giving you new experience? Research has shown that fresh air and sunshine is a natural disinfectant in pandemics that have occurred in the past. Get your Vitamin D.
4. Be aware of your catastrophic thinking: are you spending time creating "what if" scenarios in your mind? How much of has this type of thinking taken over? These are scary times and being scared can sometimes save your life. That is why we are social distancing. But if you have prepared for this as best you can, mentally re-creating worst case scenarios is not helpful and tends to be a mental cycle that can become difficult to get yourself out of. If you find yourself experiencing this, please see steps 1 thru 3.
5. Be grateful: see if you can develop a list of the things that you have to be grateful for. Perhaps the youth and vitality of your children? That this is not a mass extinction event? Use the things you feel grateful for to intentionally combat that catastrophic thinking you may be experiencing and to balance out those worst case scenarios driving up your fear and anxiety. Sometimes thinking is like a muscle. You must make a decision to change it by actively and intentionally exercising.
6. Do more of what makes you happy: See if you can identify a list of things that make you happy. Is it finally catching up on something on your to-do list? Is it returning to activities you once enjoyed before life got so hectic? Is it having quality conversations with someone you love or catching up with old friends? Whatever those things are, see if you can identify them and spend time doing them each day.
7. Connect: There are many options to virtually connect with others right now whether it be through Netflix Party, a video conference with Zoom or calling long-distance relatives that you haven't spoken to in a few years. Connection and relationships is the antidote to anxiety and isolation.
8. Try something new: There are many opportunities right now to participate in something for free. Take an online class, watch an art demonstration, read a new book, listen to some new music. Go an an internet exploration of new music and the arts. Take a virtual trip of a museum you have never been to. Try a new recipe. Try a new look. Re-arrange the furniture. Try developing a new hobby.
9. Coping Skills: think back to a time in your life when you have successfully weathered a storm. What got you through? How hard was it? Probably pretty tough. What strategies did you use then? What are your "go-to" coping skills? See if you can identify exactly what it was that helped you through that difficult time and compare it to what is possible for you to do right now. Sometimes realizing that we have already been through very difficult times that we navigated successfully can give us the confidence to get through what we are dealing with right now.
10. When all else fails: perhaps you have struggled with your mental health even prior to Covid-19 and this has exacerbated pre-existing symptoms of depression and anxiety. If you are having difficulty functioning day to day you may need to seek some individual counseling. Not forever, but to help get you through this stressful event without becoming deeply debilitated. Asking for help is perfectly acceptable. Most individuals are struggling right now to cope with what we are facing. Most outpatient therapists are moving their practices to tele-health. If you are already in therapy, see if your appointments can continue in this way. If you don't have a therapist, book an online appointment. Frequently, all it takes is just a few sessions to get you back on the road to wellness.
We launched just before we had heard the words Coronavirus and Covid19 for the first time. Social distancing was not the motivator to start this 100% telehealth practice. It was for many other brick and mortar practices now scrambling to get set up online.
Getting started, the motivator was accessibility and convenience. We are able to address some very unique and difficult barriers to care with this platform and that is exciting.
Making it possible for mothers to get counseling from the comfort of their home while their children are small was a driving factor.
Talking to the man with panic disorder having difficulty leaving home inspired us to provide e-therapy.
The idea of talking with a depressed person who has a hard time getting up, dressed and showered pushed us forward. In the past, those tasks may have been a barrier to care. Now, it is our hope that even if you are depressed and still in bed, you can find the energy to log in to the patient portal and attend your session. We really don't care what your house looks like, whether you are sitting up or lying down, or even if you're in your PJ's. We are going to work with you until you are well enough to be able to get up and look forward to starting your day. Yes, with the right combinations of treatment it is possible. Very possible.
Before going public with this practice, we got certified in telemental health practices. We read and studied up. Combined, we have a great deal of experience working remotely already so this is a natural blend of skills for us.
For many people, the idea of online counseling is new.
We hope you will give it a try. We are looking forward to meeting you.
Check out our next blog post for ideas on what to do with teenagers stuck at home during this period of "social distancing" we are facing.
All my best,