The clinics we need to worry about aren’t necessarily dirty back-room operations. They have nice-looking websites, use all the right buzzwords, and offer convenient services in comfortable offices at reasonable prices.
Consider the following quotes from a website advertising a new clinic:
The (clinic name) offers exciting and cutting-edge IV infusions for the treatment of Depression, Bipolar Disorder…. administered by .…a highly experienced ….anesthesia provider that holds a national board certification in anesthesia by the NBCRNA.
Currently we do not require a referral for most cases of unipolar or non-rapid cycling bipolar depression…..We are Now Accepting Appointments. We welcome same day appointments, call us today to schedule…. Introducing our NEW Membership pricing option. Buy a membership for $(price) per month and receive discounted infusions…. If you are currently suffering from suicidal thoughts, please contact your local crisis center or call 911.
When the provider from this clinic advertised their services on a ketamine-related message board, I replied with the following question:
Please explain how a clinic can claim to ‘treat’ psychiatric disorders without requiring that their patients be properly diagnosed and monitored by a qualified mental health professional. I mean, if your patients are self-medicating a condition they self-diagnosed, how is that different from recreational drug use? And if your patients really have serious psychiatric disorders, wouldn’t they actually need mental health services, and not just whatever you’re offering?
I’m not saying this just to be obnoxious — I would really like to understand the logic behind a clinic like this. And I’d also like you to understand my serious reservations about it as a patient who is doing well receiving ketamine for severe, treatment-resistant depression.
I want the treatment that saved my life, and the lives of so many others, to be given safely and taken seriously. I don’t want psychiatrists to continue to refuse to work with patients who are benefiting from this treatment. I want the treatment to someday be covered by insurance, and I want people to stop acting as if patients like us are just taking stupid risks to get high. For these reasons I am concerned that clinics like yours are hurting people like us.
The provider quickly answered:
We understand your concern….Here, we do not diagnose mental illnesses and we make that very clear to all of our patients. We require that every mental health patient is diagnosed by and remains under the care of a mental health professional. In fact, we mandate that they provide us with the name, address and phone number of their mental health provider.
…we aim to offer an ancillary ketamine infusion service that most mental health providers support but are not willing to provide themselves. We are able to confidently administer a GENERAL ANESTHETIC in any setting and we are trained to manage any and all possible serious life threatening complications including acute tachycardia, severe hypertension, cardiac dysrhythmias and loss of patient airway…
I completely understand that mental health professionals rarely administer ketamine themselves (for good reasons) and think it is great that specialists are stepping up to provide ketamine to psychiatric patients on a consultant basis.
But given that this treatment is for patients at high risk for suicide, psychosis, mania, and other dangerous/severe symptoms, I do have an issue with advertising same-day service with no referrals required, even if you do ask for an address/phone number. There is a difference:
– A referral indicates that a mental health professional who has thoroughly evaluated the patient agrees that ketamine is appropriate for their diagnosis and treatment history, knows the patient will be receiving ketamine, and is on board to monitor the patient’s mental health and coordinate their care throughout this process.
– An address and phone number indicates that the patient has a mental health professional’s address and phone number.
The provider replied:
Thank you for your response. I would like to respond to your comments above which are based on assumptions and not on our current policies or procedures. Let me clarify, at (clinic name) we only treat uncomplicated unipolar and depressive phase of bipolar disorders without referral. We do NOT treat patients that are actively suicidal nor do we treat any patients without referral if we feel we may be putting them at risk of further mental health complications. We perform mania, psychosis and suicidal ideation screenings on all patients prior to Ketamine therapy. These type of screenings do not require mental health certifications or degrees to conduct. Patient safety is our priority and we are extremely confident that our current policies and procedures that are in place ensure the safety and continuity of care for all of our patients.
I was speechless. But here’s what goes unsaid:
No, I’ve thoroughly read your website and what you’ve said right here about your policies and procedures. My concerns aren’t just “based on assumptions.”
You said: “Currently we do not require a referral for most cases of unipolar or non-rapid cycling bipolar depression,” which implies that you consider “most cases” of unipolar or bipolar depression to be “uncomplicated.” But patients with these disorders ARE at high risk for mental health complications by definition. Just because someone denies manic, psychotic and suicidal symptoms before their infusion doesn’t mean they won’t encounter these or other serious mental health symptoms before or after they leave your office. And why would someone with truly “uncomplicated” depression require an experimental treatment like ketamine infusions anyway?
That you are “extremely confident” making complex clinical decisions based on a few screening questions shows a profound lack of judgment. Mental health screening questions are just tools, and how much training is required to use them depends on what you’re using them for. People don’t need specialized training to use a knife as a tool for spreading butter, but they sure better have that training if they want to use that tool to perform brain surgery! While you say you will not treat patients if you “feel” you may be putting them at risk, you are making this decision with neither the necessary patient assessment data nor the necessary expertise to able to use your feelings as a gauge of mental health risk.
A clinic like this is a tragedy waiting to happen.