coercion as standard “best practice” (vent/rant)

I thought about this all weekend.  I finally worked up the courage/resolve to call the IOP  that had refused to let me back.  In speaking with the case manager (who had never actually met with me in the 2 days I had been there), I was told that any consideration of readmission would depend on my agreement to take psychotropic medications.  She heard/listened to nothing beyond me refusing meds. I tried to explain that I have had really bad experiences on meds, and they tend to de-stabilize me more than I can do on my own.  I tried to tell her that I am better able to control my impulses and urges to harm myself when I am not taking anything. She brought up the meds I was discharged on from my inpatient stay.  I reminded her that I had only been given something for sleep.  I told her the only medication I was willing to take would be something as needed (for sleep or anxiety).  She tried to tell me that antidepressants were not PRN meds, to which I responded that I was not willing to take antidepressants.  She clarified that I was looking only for a program to provide support and not med management, then reiterated that I would not be accepted back to their program if I did not agree to take medications.  She asked if I had kept the med appointment the hospital discharged me with.  I told her again that I was not willing to take medication on a regular basis, so I did not want to waste my time (and a doctor’s) on a useless appointment.  The case manager told me she will call the original program she had mentioned to the hospital social worker to confirm whether or not they accepted my insurance.  She said that she would get back to me by the end of the day.

After I hung up with her, I thought of who I may be able to contact about my change in presentation once off meds.  Clearly, because I have an mh diagnosis and am refusing medications, I must not know what I am talking about and simply be resistant to treatment.  I need a professional with credentials to tell them that I tried way too many meds, and they all just mess with me.  I think I may contact the IOP I attended several times and ask for my records.  I may also contact my old therapist and see if she would be willing to speak with whichever service provider I end up trying to utilize…

When the case manager called back with some referral numbers for me, we again spoke a bit about medication options and the things I had tried.  She spewed one of my most hated lines: “There has to be some combination or med that you have not tried that would work, you just have to find it.”  Why is it so difficult to understand that I am no longer willing to put my life on the line to go through more chemicals that make me worse instead of better?  Why is it so difficult to believe that meds do not work for everyone, and sometimes people just need support and talking?  The other numbers she gave me also all have a med requirement… ugh!  Maybe if I just tell them I am willing to sit down with a psychiatrist to talk about options, I will be able to get in somewhere?  The issue then becomes whether or not they discharge me for refusing to take anything.  L had suggested I accept a prescription for something along the lines of citalopram (Celexa) and just never fill the script or take the med.  I don’t want to lie to my providers.  That just seems counter-productive.  I may end up having to do that though.  I really still want the added support of a day program at least through the holidays.

The practice of forcing people into a corner to get them to take medication is very frustrating, and I will argue also very unethical. Why is it so common practice in mental health?  A physician could not coerce me this way if it were for a physical ailment.  I am allowed to search for non-medical alternatives to physical ailments, but it is out of the question for mental illness.  I hate that they are allowed (and encouraged legally) to force unwanted treatment, even to the detriment of the client/patient…

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