Meds necessary for inpatient care?

midnitelpn · Mar 3, 2005

Hello. I am an RN student. I was wondering if anyone can tell me if it's absolutely necessary for people who are inpatient for suicidal ideation/attempt and depression to be put on long term meds(such as antidepressants) in order for insurance to pay for inpatient services? I heard someone say that before, but what if the patient wants/needs help but is against taking psych meds? I am asking because someone close to me is dealing with these problems and really needs to be admitted for her own safety but is currently against going in to a facility because she thinks they're going to "drug her up" and make her take antidepressants. She currently takes xanax for anxiety, which she is OK with, but doesn't want any antidepressants. If anyone could help me out here I would appreciate it. I would love to be able to tell her that she won't have to take meds in order to get the help she needs. Thanks!

s/i/i/p is VERY serious!!!!! being suicidal is a side effect of being acutely mentally ill!!! let the dr. decide if she needs tx. & what the tx. needs to be!!! i lost my brother-in-law to suicide 6yrs ago. my husband lost his only brother & my niece & nephew lost their daddy. and i lost a dear friend when this happened! never never NEVER take threats of suicide, suicidal ideation or what you feel is a cry for help lightly.....let the professionals handle it, pick up a phone if you have too...now

stuRN6 · Mar 3, 2005

s/i/i/p is VERY serious!!!!! being suicidal is a side effect of being acutely mentally ill!!! let the dr. decide if she needs tx. & what the tx. needs to be!!! i lost my brother-in-law to suicide 6yrs ago. my husband lost his only brother & my niece & nephew lost their daddy. and i lost a dear friend when this happened! never never NEVER take threats of suicide, suicidal ideation or what you feel is a cry for help lightly.....let the professionals handle it, pick up a phone if you have too...now

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The crisis hotline has been called. They talked to her and she has an appointment with a psychologist tomorrow. I live in a different state and so cannot be there with her right now. Fortunately, she was honest with the crisis people about her situation. I am on the phone with her constantly but this issue of meds is really a big thing for her now. I'm afraid that she won't agree to be admitted. Maybe I should just tell her that she can always refuse meds so she'll just go. You know just to get her in there? This is my mother that I am talking about, and she has made it clear that she would be severely angry with me if I called someone to go to the house and get her without her permission. It's putting me in a bad situation. I know if I don't and she follows through, I will regret it for the rest of my life.She has promised me she will not do anything until she talks to the psychologist tomorrow morning. Should I believe her?

CAG12345 · Mar 3, 2005

A clt can refuse meds at a hospital unless they are a danger to themselves or others in a very emergent sense at the moment, in which case a prn (needed at that time) can often be used just to calm them down enough physically so they can be prevented from assaulting others or harming themselves. But I would say it would be very rare that someone who is depressed with S/I and is not highly agitated, paranoid and assaultive would ever be in a forced med situation. There are laws that prevent that from happening. And as far as I know in most states, to go against those laws, a hearing has to occur before a judge and it would only come up if someone was completely unable to function on their own (and I mean completely) over a long period of time and was not expected to improve. Highly unlikely. In addition to meds, there are other types of tx available at the hospital, groups which help clients learn how to communicate about feelings, cope with symptoms, develop a better support system. Problem-solving regarding whatever has triggered the depression can also be helpful.

Often people are nervous about antidepressant or other meds. That's something the nurses and counselors and doctors have experience working with clts about, educating them about the risks and benefits. But ultimately, it is the clt's choice, w/the exceptions noted above.

stuRN6 · Mar 3, 2005

What about insurance payments? I know the facility would have to justify the reason the person needs inpatient services. Do meds need to be part of the tx as far as those companies are concerned?

Thank you for all the good information!

elkpark · Mar 3, 2005

There is a short and long answer to your question about insurance coverage. The short answer is, yes, it is v. likely that the insurance company would refuse to pay for hospitalization of a person who refused to take any meds. I base this on my general experience of dealing with insurance companies while doing UR for an inpatient psych program.

Here is the long answer: People do not get admitted to inpatient psychiatric units unless they are seriously/acutely ill. The general consensus of the psychiatric community is that illness of that severity is best treated with a comprehensive treatment approach that includes medication to stabilize the acute, dangerous symptoms as rapidly as possible. The client certainly has a legal right to refuse medication. However, I would expect that it would be v. likely that any of the insurance companies would interpret continued refusal of medication on an inpatient unit to be a lack of participation in treatment by the client, and would refuse to pay for continued inpatient treatment for that reason (shoot, I've had insurance companies threaten to refuse to pay because the clients weren't going to the community groups and educational groups on the inpatient unit, and they called that lack of participation in treatment!) Keep in mind that the insurance companies are always looking for reasons to justify not paying ...

BTW, it's v. interesting that she's okay with Xanax, which is highly addictive, but not with antidepressants which might actually help her underlying depression ...

stuRN6 · Mar 3, 2005

Thank you. I basically just told her that she could refuse meds so she might consider being a voluntary admit. She has now told me that she is dead set against being admitted. She threatened that if she thinks that I'm going to call the crisis line and have someone go over there she WILL commit suicide. I'm sorry I know this may not be a suitable place for me to be discussing this. If I call a hotline to talk to them about this, will they automatically try to go find her? I'm just afraid that if I do this and she was really going to go see the psychologist tomorrow that she'll not trust me anymore. I'm one of the few people she can talk to and trust..I don't want to break that for her but isn't that better than the other possiblity? I don't know which direction to go in here. Maybe I should call someone to talk to myself to try and figure it out...anyone know a hotline I can call as a family member to get help for this?

CAG12345 · Mar 4, 2005

If you call the hotline to talk about the situation and your feelings, I doubt they will automatically call the police to bring your mother to the hospital, especially given that they recommended an outpatient psychological assessment.

I am not tx'ng your mother, and you cannot either, as you know, but what you're reporting sounds a lot like a "help me, don't help me" kind of dynamic that some people who are depressed and/or anxious can get into in their relationships with others, and which can be very hard, even for professionals to handle.

I agree with your assessment that it's important for you to find someone for yourself to talk to. A suicide prevention hotline in your area might be one place to start, and they may have some local resources to recommend for inexpensive counseling to help you cope with this extremely distressing situation. There are usually sliding-scale therapy agencies available and your school may have some counseling at the health service center also where you may be able to get in quickly.

For something free and superquick for support, you might want to check out an Emotions Anonymous or Codependents Anonymous meeting. And this is not to say that there is anything WRONG with you. It's just that these groups are really good at supporting people in taking care of themselves in really tough relationship situations. You can usually find these meetings by looking up Codependents Anonymous in the phone book, or Emotions Anonymous. Depending on where you live, there could be a meeting this evening where you'll be able to get some support from people who have experience struggling with difficult relationships. These are not professionally led, but rather self-help groups.

stuRN6 · Mar 4, 2005

If you call the hotline to talk about the situation and your feelings, I doubt they will automatically call the police to bring your mother to the hospital, especially given that they recommended an outpatient psychological assessment.
I am not tx'ng your mother, and you cannot either, as you know, but what you're reporting sounds a lot like a "help me, don't help me" kind of dynamic that some people who are depressed and/or anxious can get into in their relationships with others, and which can be very hard, even for professionals to handle.
I agree with your assessment that it's important for you to find someone for yourself to talk to. A suicide prevention hotline in your area might be one place to start, and they may have some local resources to recommend for inexpensive counseling to help you cope with this extremely distressing situation. There are usually sliding-scale therapy agencies available and your school may have some counseling at the health service center also where you may be able to get in quickly.
For something free and superquick for support, you might want to check out an Emotions Anonymous or Codependents Anonymous meeting. And this is not to say that there is anything WRONG with you. It's just that these groups are really good at supporting people in taking care of themselves in really tough relationship situations. You can usually find these meetings by looking up Codependents Anonymous in the phone book, or Emotions Anonymous. Depending on where you live, there could be a meeting this evening where you'll be able to get some support from people who have experience struggling with difficult relationships. These are not professionally led, but rather self-help groups.

Thank you for all your info and suggestions. Now I have to try and mentally prepare for clinical tomorrow! I will find someone to talk to about all this tomorrow. I just talked to my mom and she says she's ok right now. We'll see how the meeting with the psychologist works out tommorow. Thanks again!

CharlieRN · Mar 11, 2005

She currently takes xanax for anxiety, which she is OK with, but doesn't want any antidepressants

So you have a person who wants to continue on an addictive substance but is unwilling to try a therapy that might make the addictive substance no longer be needed. Hmm.

If someone is threatening suicide if you call the crisis line and refuses to go for treatment, don't call the crisis line. Call the police. The police have the right and responsiblity to lay on hands and use force to compel treatment.

stuRN6 · Mar 11, 2005

My mother has been seeing a counselor and also has an appointment with a psychiatrist. For her, this is a huge step. She is getting help. She also has been calling the crisis hotline herself whenever she feels severely depressed. I have consulted with my family that lives with and near her and they are now being hypervigilant and know what to do if she gets bad again. I have given them crisis numbers along with the dispatch number (no 911 up there). Thanks to everyone for their info and advice.

I know it is weird that she will take xanax but not antidepressants. Although, she has now expressed an increased willlingness to try one. She has a lot of other health problems (poorly controlled HTN and kidney failure) that might interact and she has a tendency to have a LOT of side effects with any med she takes. She has also witnessed family members have a really bad reactions to ADs including increased ideation and worsening of symptoms. Well thanks again to everyone.

elkpark · Mar 11, 2005

Thanks for the update -- I had been thinking of you and your family, and checking back with this thread now and again to see if there was any new info. I'm glad to hear things are going ok with you mom so far. Best wishes.