tag:blogger.com,1999:blog-8597101.post716490102909697814..comments2024-03-25T20:06:39.794-05:00Comments on Grits for Breakfast: Telepsychiatry at TYC: Can you imagine [a psychiatrist] having a paranoid person and telling them, 'Talk to the TV screen!'Gritsforbreakfasthttp://www.blogger.com/profile/10152152869466958902noreply@blogger.comBlogger36125tag:blogger.com,1999:blog-8597101.post-6750011451343224422008-04-29T12:03:00.000-05:002008-04-29T12:03:00.000-05:00Some of the best psychiatrist TYC ever had have le...Some of the best psychiatrist TYC ever had have left in the last 3 years due to the rumors of a UTMB takeover. If that doesn't speak loudly I don't know what does. Managed mental health care is not in any way an improvement. They will dictate what meds can be used and how much time is allowed for treatment. The bill will go up for this care and the treatment will go down. Who will pocket the money?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-8597101.post-70683076986680557542008-04-27T22:42:00.000-05:002008-04-27T22:42:00.000-05:009:48, What makes you say that the UTMB contract is...9:48, What makes you say that the UTMB contract is almost out? Are they working on a new one?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-8597101.post-26804351481995595612008-04-26T19:24:00.000-05:002008-04-26T19:24:00.000-05:00Grits, sorry, got a laugh out of your "quote." Whi...Grits, sorry, got a laugh out of your "quote." While many kids in TYC have a myriad of disorders Schizophrenia is generally not one of them. <BR/><BR/>If a TYC kid suffers paranoia it is generally well earned from living on the streets and fending for themselves. If any of the youth in TYC were to develop the paranoia to which you imply it wouldn't likely be until after there release from TYC.<BR/><BR/>Most of the youth who need serious psychiatric care are often a result of years of emotional, physical, and/or sexual abuse. Often these youth may be suffering from symptoms of PTSD but too often because the symptoms are similar the youth may be diagnosed with Bipolar so he/she can be treated with mood stabilizers and anti-depressants. This only treats the symptoms but not the source of the problem, the years of abuse. <BR/><BR/>TYC is not equipped to provide the treatment these youth need, unless you have some truly talented csws. <BR/><BR/>I really don't see a problem w/ tele-psychiatry since it TYC historically had trouble finding adequate psychiatric care at all of the facilities. It was a creative solution to meet a need TYC was having a difficult time meeting.<BR/><BR/>The question for each youth really is... are the the youth of TYC accurately diagnosed (diagnosing is more of an art than an exact science) and then are they receiving the appropriate Mental Health treatment.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-8597101.post-4327197048428687332008-04-25T21:48:00.000-05:002008-04-25T21:48:00.000-05:00The UTMB contract will be out soon and then you wi...The UTMB contract will be out soon and then you will see what this has all been about.<BR/>Money! = Managed Mental Health CareAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-8597101.post-91234326877797878112008-04-22T21:37:00.000-05:002008-04-22T21:37:00.000-05:00Watch the magic number of 1000 youth with "mental ...Watch the magic number of 1000 youth with "mental health issues" be magically reduced should UTMB gain control of psychology (the referral source).Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-8597101.post-8545917704355544182008-04-22T19:50:00.000-05:002008-04-22T19:50:00.000-05:00Well, I work at the Mart Unit and I can tell you t...Well, I work at the Mart Unit and I can tell you that the staff of the sex offender treatment center are jokes. They are not licensed and they are abusive and never show up for there kids. The black lady that was sent from San Saba is a complete and ignorant joke and is very abusive to those kids and broadcasts they business around so they end up beat up. TYC is a joke in the way of treatment but the judges are too. Somebody go and look at the kids in the treatment and 15 months to roll but extended they stay because TYC can't get it together - they need to be sued.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-8597101.post-43739208787279395632008-04-20T10:07:00.000-05:002008-04-20T10:07:00.000-05:00In reference to the sex offender treatment issue, ...In reference to the sex offender treatment issue, the real problem is that the licensing scheme of the Sex Offender Treatment Council has so restricted license professionals that enough licensed sex offender treatment providers do not exist in Texas and will not for the forseeable future.<BR/><BR/>As to UTMB taking over anything, they can not adequately handle TYC medical care on a cost plus basis. <BR/><BR/>Howard A. HickmanAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-8597101.post-73149336745575596182008-04-18T22:28:00.000-05:002008-04-18T22:28:00.000-05:00Sorry, I would take an Associate Psych Job over PA...Sorry, I would take an Associate Psych Job over PA any day of the week. <BR/><BR/>I agree that given the current profession that a pay raise would be appropriate but PA's tend to shoulder far more responsibility.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-8597101.post-52982871237332499912008-04-18T19:21:00.000-05:002008-04-18T19:21:00.000-05:00Let's look at this truthfully.......Thought you mi...Let's look at this truthfully.......<BR/><BR/>Thought you might like to know. A psychologist with TYC only make $36,000 per year (starting). It requires a master's degree and a license within 2 years. We all know what getting a raise is like, so that's about as much as they make. PA's make more (starting), and truthfully, most JCO VI's make more. You want treatment??? Pay them more. Right now, Mart is down about 7 psych's. I understand, why would they want to work at TYC when there are a lot of places that will compensate for their education and license. You get what you pay for. Oh yeah, then they have to be ADO, on call, and all the regular work too.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-8597101.post-31069240200333337292008-04-18T16:23:00.000-05:002008-04-18T16:23:00.000-05:00I find it interesting to note the tangential natur...I find it interesting to note the tangential nature of this discussion. The original questions were why is TYC not providing sex offender treatment and is there enough psychiatric services available to adequately provide for the youth of TYC. I think the second question is too colored by my opinion as a psychologist. I think they play too much of a role. The first question is much more interesting to me<BR/><BR/>The sex offender treatment issues is not just a TYC issue but also a TDCJ issue. The State of Texas passed legislation that requires anyone providing treatment for sexual offending behavior to be specifically licensed for that therapy. It does not matter that I am a psychologist or a psychiatrist or any other treatment provider to treat a sexual offender I must be licensed to do so and perform a specific type of treatment. Many professionals object to this and have examined evidence that reveals that completion of these prescribed programs are not useful in predicting sucess. So why do we have to be licensed to perform a treatment that the evidence suggests does not work?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-8597101.post-50015383062726137502008-04-18T14:02:00.000-05:002008-04-18T14:02:00.000-05:0011:44, I think the answer is NO to both questions....11:44, I think the answer is NO to both questions. Moving mental health care under UTMB will only further the divide between those providing "treatment" and those providing "custody." For proper rehabilitation, these processes need to be integrated. Furthermore, UTMB is a medical-model agency. Their focus will be on specific treatment interventions for specific youth with identified medical diagnoses. Those without a medically treatable diagnosis may not be considered their responsibility (watch how the contracts gets written). Rehabilitation services for behavioral and social problems, the largest issue for TYC youth, is usually not a priority in the medical model. I also don't see how they can save money without reducing services/providers significantly. UTMB could not get away with paying psychiatrists or psychologists what TYC currently pays them - it would not be internally consistent. I'm not saying paying them more is a bad idea, it just isn't the way to save money unless you spread them even thinner (say by only serving those with clear mental health diagnosis and getting to decide yourself who has that diagnosis vs. who is just "conduct disordered"...)<BR/><BR/>>Don BrantleyAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-8597101.post-66932009098373952202008-04-18T11:44:00.000-05:002008-04-18T11:44:00.000-05:00Will having UTMB over ALL treatment be a better op...Will having UTMB over ALL treatment be a better option? A cheaper one? Both?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-8597101.post-51633287481535186752008-04-18T11:12:00.000-05:002008-04-18T11:12:00.000-05:00Easy Don; I know there are professional mental hea...Easy Don; I know there are professional mental health care-givers working their butts off, attempting to provide treatment, regardless of how inadequate it is. As you stated the system (?) is broken.<BR/><BR/>You alluded to the cold, hard facts of mental health treatment in a Texas State Agency: medicate, medicate, medicate! <BR/><BR/>If the patient is incarcerated another cold hard fact that over-rides treatment is bed space. Isn't it amazing how someone that required acute care suddenly can be transferred back to an intermediate care bed (or sometimes even back to general population!)? <BR/><BR/>Psychiatrists are getting paid to provide the meds and the psychologists/treatment team members are going along to get along. And that my friend is leadership and ethical issues, NOT just poor management.<BR/><BR/>Let's just have a nurse turn on the tv and camera, give a local, and stitch the old neck up after a self inflicted injury. I mean it isn't the best but what the hell;it's better than nothing!<BR/><BR/>Retired 2004Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-8597101.post-75718865721214910292008-04-18T10:39:00.000-05:002008-04-18T10:39:00.000-05:00I just have to jump into the psychiatry debate her...I just have to jump into the psychiatry debate here. I'm a psychologist and I have worked with a lot of caring and competant psychiatrists throughout my career. It is true that their role in mental health treatment has become focused mostly on diagnose and medicate - because there is a need for that in many cases, they are the only ones who can do it, and that is all most insurance/agencies want to pay them for. I know some (mostly older)psychiatrists who are wonderfully trained in psychotherapy - but when you are expected to see 20+ patients a day, only see a given patient every few months, yet you still want to do something to help, then a good diagnosis and appropriate medication may be the best you can do. I do believe that medication is/was over-relied upon in TYC, often by well-intentioned psychiatrists who don't have the time or opportunity to do anything else and who realize that there are not enough other trained mental health staff, such as psychologists or social workers to help the youth either. Yes - the system is broken, but don't lay it all on the psychiatrists. I think telepsychiatry is a poor substitute and should be an option of last choice. But if you need a way to manage psychotropic medication in a rural setting that has no local psychiatrist, it may be better than nothing. Especially if there are some competant psycholoigsts and social workers on-site who can collaborate with the psychiatrist and provide those treatment elements you cannot provide by video. Psychiatrists aren't the problem nor is telepsychiatry. They are tools. Like any tool, they have their place. It's relying on them in situations where they don't fit or where there are better tools available that causes the problem. That's a management issue.<BR/>>Don BrantleyAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-8597101.post-72353661432388396492008-04-17T22:48:00.000-05:002008-04-17T22:48:00.000-05:00Whitmire is talking to the wrong group. The psychi...Whitmire is talking to the wrong group. The psychiatrist by telemed is provided by UTMB and are in charge of it on the facilities. The psychologist have to cowtow to the infirmary for any help.<BR/>Supposedly they were going to take over the psychology department and casework under medical treatment being part of pyschology...but with no signed contract, the kids get what they get.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-8597101.post-57832089648755467762008-04-17T21:03:00.000-05:002008-04-17T21:03:00.000-05:00Question for 7:18 PM: The "10 to 20 or more case w...Question for 7:18 PM: The "10 to 20 or more case workers at each facility" have what qualifications? Are they MSW's, Masters Level Psych Majors? What is their job title? Are they Case managers with a high school education or some general college subjects? are they clinicians or "paper pushers" (fill out the forms, answer the offenders questions concerning visitation, phone calls, how much more time wil he have to do before he can go home)? <BR/><BR/>Based on your statement concerning psychiatrists don't treat; only medicate; does this mean that Child Psychiatrists only medicate children??? Please! Psychiatry is the study and TREATMENT of mental diseases.<BR/><BR/>During the early 1990's I was the supervisor of a maximum security Intermediate Mental Health Treatment Facility for convicted adult felons. I saw first hand what type of treatment these people received. I thought it was lacking but the majority of the treatment personnel did the best they could with what they had to work with (I'm not talking about the inmate patients, I'm talking about the part time phychiatrists). <BR/><BR/>Industry Standard? We are not talking about objects, we are talking about human beings. I believe the term "National Standard" is used by true care-givers.<BR/><BR/>Retired 2004Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-8597101.post-54400383798935315382008-04-17T20:11:00.000-05:002008-04-17T20:11:00.000-05:00Sorry 'bout that, though if crude it's an essentia...Sorry 'bout that, though if crude it's an essentially accurate description of a modern psychiatric work. They're prescription machines, just as you describe. But what's the point of a psych M.D. if the job can be done in five minutes, and everybody already knows what the meds are for schizophrenia, bipolar, etc.? That's a racket, IMO.<BR/><BR/>The final straw for me on viewing this profession as wholesale legal drug pushers actually came recently, when they released the studies <A HREF="http://www.newscientist.com/article/dn13375-prozac-does-not-work-in-most-depressed-patients.html" REL="nofollow">saying SSRIs didn't work</A>, coincidentally, just as the patents expired and generics become available. But low and behold they've got a new round of (patented) drugs you can try. How many tens of millions of Americans did psychiatric drug pushers con into taking an expensive placebo? How much faith am I really supposed to have in such pseudoscience?Gritsforbreakfasthttps://www.blogger.com/profile/10152152869466958902noreply@blogger.comtag:blogger.com,1999:blog-8597101.post-79445069931039597182008-04-17T19:35:00.000-05:002008-04-17T19:35:00.000-05:00Gee Scott, that was awfully crude. What the hell ...Gee Scott, that was awfully crude. What the hell happened to taking it easy on the name-calling, and what about the stereotyping? Funny, You never struck me as one of those liberal a-holes that don't practice what they preach.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-8597101.post-75409026364227296302008-04-17T19:30:00.000-05:002008-04-17T19:30:00.000-05:00Well, by all means, if it's "standard" I guess it'...Well, by all means, if it's "standard" I guess it's not warehousing, then. (?)<BR/><BR/>The fact that most psychiatrists have become drug dealing quacks with little real function beyond pill peddling is it's own, separate issue outside the scope of this blog's purview. But TYC's mental healthcare is inadequate overall, <A HREF="http://gritsforbreakfast.blogspot.com/2007/08/utmb-mental-health-care-quality.html" REL="nofollow">and getting worse</A>, and I think overreliance on telemedicine has a big role in that.Gritsforbreakfasthttps://www.blogger.com/profile/10152152869466958902noreply@blogger.comtag:blogger.com,1999:blog-8597101.post-82170377876485826462008-04-17T19:18:00.000-05:002008-04-17T19:18:00.000-05:00Grits: Psychiatrists do not provide the treatment....Grits: Psychiatrists do not provide the treatment. Psychologists do. Psychiatrists deal with the medication issues. This is the case in any medical setting. Psychiatrists are not counselors etc., they essentially give a medical exam. Once a person has been placed on medication, a routine medicine check only takes a 15 to 30 minute appointment to ask the person how they are doing on the medication.<BR/><BR/>TYC has at least one pyschologist and 10 to 20 or more case workers at every facility. It is these folks job to observe the youth, interact with them, document their behavior, and counsel them.<BR/><BR/>The division of care between the psychiatrist, psychologists, and other counselors is industry standard.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-8597101.post-16408811243723921352008-04-17T18:25:00.000-05:002008-04-17T18:25:00.000-05:00Somehow I don't find it comforting to hear a profe...Somehow I don't find it comforting to hear a professional opinion that a psychiatrists' treatment of a psychotic or bipolar patient amounts to a five minute video conversation, concluding, "Yup, still crazy," then prescribing more meds. That sounds like warehousing of the worst sort, and if it's not medically unethical then I wonder what level of neglectful care would be?Gritsforbreakfasthttps://www.blogger.com/profile/10152152869466958902noreply@blogger.comtag:blogger.com,1999:blog-8597101.post-7582289771373593922008-04-17T15:26:00.000-05:002008-04-17T15:26:00.000-05:00I know when they "should" see the patient, I was a...I know when they "should" see the patient, I was asking when(or if) they did.<BR/><BR/>Retired 20404Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-8597101.post-20266466558498416032008-04-17T15:22:00.000-05:002008-04-17T15:22:00.000-05:00Gosh psyguy, I thought Medication was a part of th...Gosh psyguy, I thought Medication was a part of the treatment. So I guess the psychiatrist isn't part of the treatment team in TYC? Interesting, very interesting.<BR/><BR/>Retired 2004Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-8597101.post-49165974913579431912008-04-17T11:43:00.000-05:002008-04-17T11:43:00.000-05:00No, I'm not connected to UTMB.Again, Psychiatrists...No, I'm not connected to UTMB.<BR/><BR/>Again, Psychiatrists aren't providing the treatment, they are managing the medications. Big difference.<BR/><BR/>The number of days they are at a facility (either in person or remotely) really depends on how many youth are on medication. Most often, they are available once per week for medication changes. <BR/><BR/>They should 'see' a youth once per month when the youth is stable on medication. More often when the youth is placed on new medication or medication adjustments are being made.<BR/><BR/>Again, I can't say what happens everywhere. I can only speak about my personal experience. I have worked at HHSC, and MHMR before that, as well as TYC.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-8597101.post-70857794703502252762008-04-17T10:09:00.000-05:002008-04-17T10:09:00.000-05:00Another question for psyguy: If the psychiatrist p...Another question for psyguy: If the psychiatrist prescribes new meds during the TV interview; when (how many days will pass) before he/she again observes the youth?<BR/><BR/>Retired 2004Anonymousnoreply@blogger.com