Looking for Intensive Outpatient Programs for Depression (or other resources) for my wife

temp071620temp071620 Registered User new member
I'm looking for advice to find resources that can help my wife. She has, for as long as she can remember since high school, battled depression and anxiety. She is typically able to cope, but she recently experienced a traumatic event, which has caused the depression and anxiety to become amplified.

She had started seeing a therapist in one-to-one appointments before the traumatic event. As her symptoms have increased over the past two weeks, her therapist suggested that we get some additional help (she suggested an Intensive Outpatient Program).

I reached out to our health insurance company and received a list of approximately 30 locations that might offer those services. I've called all of those locations and either spoke to their admissions services or left messages on their answering machines. We need an evening program, since she needs to continue with her job. She feels like she can't take the leave that would be required to attend a 3-5 day a week program during the morning or afternoon.

Out of all of the programs I called, only a handful offer an evening program. We found one that seemed promising, she did the initial evaluation, and the facility will only offer a partial hospitalization, which would require her to attend in-person for 5 days a week from 9am-2pm. Their concern is that she's had passive thoughts of dying (along the lines of wishing she was dead or that she did not exist, NOT actively seeking to die). This was extremely disappointing, as we're trying to get her that additional help ASAP.

Can anyone recommend any other options or resources? I desperately want to help her, but she NEEDS the help to be in the evenings. She feels that any sort of program that requires her to take weeks off from work jeopardizes her career, and it's only making her anxiety and depression worse as we're only finding resources that would require that.

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  • EncEnc A Fool with Compassion The Land of Flowers (and Dragons)Registered User regular
    It would help us to know what country and/or state you are in.

    @Gnizmo

  • temp071620temp071620 Registered User new member
    Enc wrote: »
    It would help us to know what country and/or state you are in.

    @Gnizmo

    We're in Southern New Jersey (about 30 minutes outside of Philadelphia), in the US.

  • EncEnc A Fool with Compassion The Land of Flowers (and Dragons)Registered User regular
    I only know relatively local resources down in FL, unfortunately. I think several folks on the forums work in-field and might have some advice to give though.

    temp071620see317
  • GnizmoGnizmo Registered User regular
    For background for this information I will let you know I am a counselor who has worked in a few IOP programs, and a PHP program as well. I am specifically not giving my clinical opinion on this situation as that would not be ethical, legal, or within the rules of the forum (in order of importance to me). I am happy to offer whatever help I can though.

    So starting from the top. I would look to see if your wife qualifies for FMLA. The guidelines are roughly a year of work. There is an hours worked requirement as well, but rough memory tells me the pure time requirement is the tougher choice. Legally, FMLA time cannot be used against you in anyway what so ever. If you have a sketchy work place it might still because that's the reality of it, but the answer there is to switch companies to a place that will have zero knowledge of the FMLA business.

    IOP is going to require 3 days a week minimum almost certainly. That is non negotiable with the place unless you want to pay out of pocket. Insurance will pay for 3 hour groups, and you need 9 house of "programming" per week to keep a patient in IOP. I am not thrilled with 3 hour groups both as someone who leads them, and on the therapeutic efficacy (They absolutely help but 2 hours would help just as much based on current research). This is the world we live in though. Night programs are a rarity because people rarely go through the schooling to be a therapist and then want to work odd hours.

    The biggest problems IOP have right now is that the pandemic makes the idea of group really bad right now. Zoom groups are absolutely a thing, and for those actively seeking help they are just as good if the clinician is adept at making it work. Sad reality is that isn't guaranteed, but that's what life is right now unfortunately. There are exceptions made for Partial Hospitalization Programs though which has led to what you notice.

    Passive suicidal ideation does tend to get the reaction you describe by a lot of clinicians. I can't say I agree with them, but I also understand the rationale. Part of what might be driving it is that PHP programs are allowed to operate in person right now due to their admission criteria being much closer to what is required for in-patient treatment. This should probably set an alarm bell off in your head, and if not hopefully this sentence will. It tells me the place to assess her was extremely concerned about her current safety.

    Here is what I can say personally. I went through something similar a few years back. I went through a lot of shit and kept pushing because I knew I needed to push forward. Trauma, and anxiety can put your fight or flight drive on 24/7. That does not lead to rational decisions, but quick assessments of what might be a threat. The biggest threat right now is the trauma pulling her down.

    I know a few weeks off sounds like a lot. Yes it absolutely can cause some career difficulties. What causes bigger problems is poor performance because of the trauma she has gone through. I know when I hit it I did not have the perspective to realize how shitty my work had become. The additional stuff I went through fighting treatment had a really negative impact on me. It set my career back years rather than a few months to be perfectly honest.

    We view mental health as if it is completely different from physical health when really the two function very analogously. Right now she needs to take time off to fix an injury. Pushing through doesn't mean she keeps working at 100%. It means she does worse work, and makes the healing harder.

    dispatch.oceresThegreatcowUsagiFuzzy Cumulonimbus CloudShadowfireEncElvenshaeLord PalingtonRingoPlaty
  • ceresceres When the last moon is cast over the last star of morning And the future has past without even a last desperate warningRegistered User, Moderator mod
    My sister did an IOP (still is? I don't know, we... don't talk) and it was absolutely necessary. I imagine every program is different, but once she enrolled she got to choose exactly zero things about her program or when the sessions would be. Possibly due to the nature of the thing, she was completely forbidden from communicating with other patients in the group outside of session hours and wasn't even allowed to know who they were or over-communicate during them. They were considered the best in the state for her issues, and they were completely unforgiving about attendance. She went and basically if she missed and didn't have a doctor's note she would be dropped and they would not have taken her back. It was a huge commitment and they were clear at the outset that, again I think due to the nature of her particular program, she wouldn't be allowed to make excuses and they would not be forgiving of rule-breaking or absences. She wasn't in for trauma, though.

    My completely uneducated inclination is always to say that mental health must be a priority, because it affects everything you do to the point where it's better to just take the time and do it right than continue for however long being semi-functional and potentially ruining the things you're trying to protect anyway, just slower and in a way you might never be able to fix.

    And it seems like all is dying, and would leave the world to mourn
    UsagiGnizmoFuzzy Cumulonimbus CloudRingo
  • Fuzzy Cumulonimbus CloudFuzzy Cumulonimbus Cloud Registered User regular
    Take it from someone who put off mental health for the sake of career and crashed spectacularly anyways. There is not going to be a right time to get better while still working. The only right time to get better is right now. I hope she takes off time and does the in patient work ASAP. It pays off in the long run.

    CornucopiistGnizmoRingo
  • CornucopiistCornucopiist Registered User regular
    edited July 17
    Anecdotal close personal experience: some programs are good, others are bad, and that doesn't even include the fit of both programs and group. The first program tried may be utterly useless for your wife, which is bad news, but that's how it is. At that point she should know that it can work better elsewhere.
    One definite piece of advice I can give from experience: work on her career concerns. I would advise you both to sit down and look at what would be possible in terms of taking leave, getting sick leave, or even a sabbatical. Look at her fears too; what would happen in different scenarios from her getting fired up to her having a long term burnout? This happens to people all the time and it's more manageable than you'd think.
    Focus on who (providers, government, employer HR, unions) could help out in each case, who to contact, etc. If it makes her too anxious to think of these matters, you can do the work yourself. Get your financial ducks in a row.
    Turning a black hole into practical options on a road map will do a lot to ease the situation for both of you.

    Cornucopiist on
    Fuzzy Cumulonimbus CloudLaOsRingoMulletude
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