Mastering the Health Care System
As a caregiver or assistant to a person with schizophrenia, you have the opportunity to not only help your loved one obtain the best medical care available but also to help him protect his rights. The National Mental Health Information Center, the Schizophrenia Society of Canada, and other organizations have compiled comprehensive lists of the rights and considerations every patient is entitled to. Some of these are laws and others are recommended rights that all consumers of mental health care should expect.
A patient undergoing psychiatric care and his caregiver should receive a complete explanation of his illness in understandable, nontechnical language. He should be told what symptoms his medications or treatments are meant to treat. This should include information about the risks and benefits of the recommended treatments as well as information about alternative treatments. He should have access to an interpreter if needed.
Right to Information
Patients should also expect the right to:
Have a trusted family member or friend present during examinations, treatment, consultations, and other procedures
Know why a psychiatrist is making a referral and whether the referral is for a second opinion or to get a more experienced opinion
Have the opportunity to choose a treatment with which the patient and family agree
Give informed consent to treatment, including prescribed medications (informed consent means the patient and/or his guardian has received full information about the pros and cons of treatment in understandable language)
Learn the nature of communications between the psychiatrist and the physician who referred the patient
Discuss topics related to the condition, voice concerns, express opinions, and make comments in addition to what the psychiatrist asks about or expresses interest in
Have access to health records
Obtain additional information about the disease from mental health care providers, including appropriate written information such as brochures and contact details of support groups
Voluntarily stop treatment or medication at any time, provided the treatment is not mandated through a court order
Sources: the Schizophrenia Society of Canada and the National Mental Health Information Center
Essential
Everyone has the right to know how a doctor reached a diagnosis. Ask if a diagnosis is confirmed or is provisional, meaning the doctor is awaiting test results or more information. Find out what the implications of a provisional diagnosis are. Be sure to discuss the diagnosis with your psychiatrist and tell her if you disagree and why. Get a second opinion if you think it will help.
You should expect all of these rights and privileges during treatment. Realistically, that won't always be the case. A major problem faced by all caregivers of modest financial means is the shift in the last thirty years toward quick care.
Quick Care
The introduction of medications that can control psychotic symptoms has caused many insurance companies, HMOs, and government health plans to cut back on the amount of money they approve for treating mental illnesses. Long-term hospitalization is often seen as too expensive even if it would benefit a patient. It is more cost effective for health insurers to approve prescriptions for drugs and then follow up with short office visits. Some medical care providers and insurers follow this pattern. Others provide comprehensive services.
The best hospitals and treatment centers provide thorough, caring treatment, including therapy and medications. Standards of care differ by location. Caregivers report that it takes time, effort, and patience to find the best care, given their often limited resources and geographic restrictions.
Getting Good Psychiatric Care
In addition to feeling comfortable with a psychiatrist, a patient and his family have the right to a high level of care. Expect to be included in the plan for treating the person who needs help. All of your questions should be answered in language you can understand.
Choose a doctor who is experienced in treating people with schizophrenia and who appreciates the need to combine pharma-cotherapy with different types of psychotherapies. In addition to knowing about the latest antipsychotic treatments and medications, the doctor should be thorough and organized. He should obtain a complete medical history by interviewing the patient and family. You should expect that both physical and mental concerns will be checked and treated. Follow-up visits and treatment sessions should be organized and arranged to fit your schedule and the patient's schedule as much as possible.
Alert
Your mental health care team may include some combination of psychiatrists, clinical psychologists, psychiatric nurses, psychiatric social workers, and a case manager. Their duties and roles in providing treatment and services should be clearly defined. If it appears there is any problem coordinating treatment, be sure to mention your concerns to whoever is leading the treatment.
Be sure that prescriptions are reviewed on a regular basis and adjusted as needed based on side effects and patient preference.
It is essential that your doctor care about the patient beyond the act of writing prescriptions for medications. If the psychiatrist sees the patient as an individual in need of help, he is more likely to refer you to outside sources of assistance, such as outpatient clinics and social aid groups that can help with housing, social support, and even financial aid. A consumer is more likely to respond to treatment offered by a thoughtful, empathetic health care provider.
