What I'd tell you if you were looking for a therapist

some basic tips on navigating the mental health system (for mania, psychosis, etc)

People call and email me sometimes thinking I am a psychiatrist or therapist and asking if I’m taking new patients. It happened again today! I am not; I can’t take clients in any sort of licensed way and even if I could I think it’s better for me to be working on the problem of improving the whole system, rather than working with people 1:1.

What I recommend you do instead:

Visit the ISPS website and navigate to the member directory; this is a list of mental health professionals who are a part of ISPS. Use advanced search to look for members in your area and call those people instead.

Why do I recommend ISPS? This is a professional network for MH professionals who are interested in a psychosocial (read: non-medication) approach to psychosis. If you are trying to call me, probably your situation involves psychosis, mania or suicide risk, and many therapists and psychiatrists (like the ones listed on psychologytoday) don’t explicitly deal with those or if they do they mostly prescribe you medications. The clinicians on the ISPS list are likely to use other modalities first or instead of medication (if they are psychiatrists they likely still will prescribe meds if you want). Also, these clinicians are motivated enough to join this slightly niche professional association which tends to be a good signal. I know none of the clinicians personally, and haven’t evaluated how good they are or how good they are for you. 

(Note: if you know your insurance will cover psychiatry and or therapy and you need to save money on this, you’ll probably need to look at your insurer’s clinician directory first. Plenty of specialist therapists don’t take insurance, and plenty of insurers don’t cover non-mainstream therapy, though–although the chances are higher with psychiatrists.)

If your problem is that a family member or friend is behaving in a way that makes you suspect they are psychotic, and particularly if they say they don’t want treatment or you’re finding it hard to come to agreement with them, normal therapists and most normal psychiatrists won’t be of much use because they only work with someone who is willing and able to show up to appointments. 

In this case, in order of preference, I would google in your area for:

• Early Psychosis Programs (generally only for young-ish people and people whose psychotic experiences have only started in the last 2 years)

• Full-Service Partnerships

• Assertive Community Treatment

All of these types of programs involve a professional team figuring out how to connect with the person as part of the treatment, so they tend to be okay with including someone who has misgivings about participating, changes their mind a lot, or forgets to attend things. Some Early Psychosis Programs may not accept anyone like this; it depends on the program. I put ACT last because they can at times be more coercive than the others and focus only on forcing people to take their meds rather than using multiple strategies and getting to the root of why someone refuses to take meds, but again, this varies by region. 

However, in many cases these programs will either have long waiting lists or require that the person have already had many hospitalisations and possibly court orders to take meds before they can be enrolled. If there is a fancy psychiatric hospital nearby (like, it does well in hospital rankings), you could call them and ask if they have any ‘outpatient’ programs for psychosis. Some of these may require at minimum a referral from the person’s primary care physician; some may need as many as multiple hospitalizations before the person meets their criteria.

If you find yourself in an unsustainable situation with your loved one or you need help -right now-, google ‘mental health crisis team’ with your city name to find the direct line. 

This is a team that will come out and evaluate the situation. In most cases they are choosing between doing nothing and carting  your loved one off to wait in an emergency department before being admitted to a psych ward, but in some cases, they are actually skilled at building connection with someone who is in a very disorganised or distressed state (which helps) and/or they might follow up in a few days with an option that isn’t just hospital or nothing (that depends on your area). If you tell the person on the phone that your loved one has been violent they will not send the mobile crisis team; they may tell you to hang up and call the police (which gives you the option to not do that) or they may transfer you or even dispatch the police without you asking (calling their direct line should avoid this though). 

If you are looking for a longer-term solution to an otherwise intractable mental health problem and are capable of spending $100K+ on it, reach out to Windhorse. They have a residential program that lasts a minimum of six months, but I think it’s the best option out there if you or your loved one are even somewhat spiritually inclined (and probably even if you aren’t). They have options to stay in Portland, Oregon, Northampton, Massachusetts and in San Luis Obispo, California. No insurance will cover this program though, which is why it is so expensive.

If you have time to read something longer and want to try more things yourself (rather than finding professional help), read our mania guide–it is somewhat applicable to psychosis too. 

Good luck, and godspeed.