So let’s say you needed mental health treatment right away. Let’s say it’s an emergency — so much so that you sought out help at the local emergency department, and the doctors there said that you absolutely needed to get into treatment immediately — within a week or two.
Now, let’s assume you’ve got good private insurance. You know, something like Blue Cross Blue Shield Massachusetts Preferred Provider Organization. This is one of the best insurance policies you can buy in Massachusetts.
What sort of chance would you have in getting to see a mental health professional within two weeks? 90%? 80%? 70%?
How about just over 6%? Welcome to the American healthcare system.
That was the finding of researchers who decided to undertake a real-world experiment to understand how hard or easy it was to get access to timely mental health treatment when they posed as patients who needed care within 2 weeks.
In each call, they claimed to be patients who had been diagnosed in an emergency department with depression and told to see a mental health professional urgently, within two weeks.
Only 12.5% of the mental health facilities offered an appointment — and the appointment was within the requested two weeks in only 6.2% of cases, the researchers reported.
A total of 23% of calls were never returned — even when callers left two messages — and another 23% of callers were told that they needed to have a primary care provider within the system.
The researchers telephoned all 64 Blue Cross Blue Shield in-network psychiatric facilities within 10 miles of the center of Boston. The response rate noted above is just astounding, not even receiving a return telephone call from nearly a quarter of all the facilities they contacted.
Blue Cross Blue Shield should be proud of themselves — this is the quality of their provider network. Not filtered through some marketing BS, but the honest truth in an objective sample. Mental health providers have long known of these problems, but being able to illustrate them in a way that catches anyone attention has always been challenging.
“This result confirms our suspicion that even for patients with private insurance, mental health services in the Boston area are severely limited,” Nardin and colleagues wrote.
Multiple factors are likely to contribute to the failures of the mental health system, including large numbers of mentally ill patients being homeless and in jail. Insurers also severely limit patients’ access to care.
“As our study shows, this is often covert; insurers provide lists of in-network providers, but most are unavailable,” they observed.
Reimbursements also fall short, and mental health clinicians in private practice often accept no insurance at all. […]
“Health insurers know that and yet, thanks to their restrictive provider networks and their low reimbursement rates for psychiatric services, they’ve created a situation where a patient with a potentially life-threatening disorder, such as the severe depression portrayed in our callers’ scenario, is essentially abandoned at a time of great need,” [noted one of the researchers].
Luckily, most people seeking mental health treatment don’t need it in 2 weeks’ time.
But it would be nice, wouldn’t it? Especially in a country that seems to live in the delusional world that it has the best healthcare in the world. This study demonstrates quite the opposite.
Read the full article: Medical News: Barriers High in Mental Health Care
19 comments
It’s an unconscionable situation. Progress in making good treatment available for all with mental illness continues at a snail’s pace.
After watching “Sicko” I will never complain about Australia’s private insurance system again.
Well, let me tell you as a provider who has worked fairly much in most elements of mental health in my career, this article is an indictment of what is wrong with not just mental health, but health care in general, and thank the insurance “business” for most of this, as alienating providers has not done much to motivate clinicians to triage referrals as should be done.
Let me end on this little test a few patients shared with me in the past couple of years: they called for appointments to see one of several different psychiatrists and noted they had insurance A or B, and were told they could not be seen for 6, 8, one provider even had the gall to say no availability for 12 weeks; then the same patients called back a few hours or a day later and said they would pay out of pocket, and guess what, they could get an appointment within a couple of weeks most. For all these providers, even the 12 week wait doc.
All I could say is, wow. How much you want to bet the doc who said no availability for 12 weeks would be in the face of a provider, saying the same to said doc or someone in said doc’s family, demanding, not asking, for an appointment today, if not yesterday!!?
Yeah…it’s amazing how the doors of treatment swung open once I mentioned the word “private pay”.
Sadly this is very true. Many psychiatrists and psychologists have unspoken quotas for how many insurance patients they will take on. They can’t outright ask the patient with the insurance they accept to pay out of pocket, because it’s a violation of the contract, but it the patient offers all of a sudden there is space.
I have insurance, but pay out of pocket and get reimbursed and disregard if they are in or out of network. When I tried to do otherwise it was impossible to get an appointment. Everyone I’d call on the insurance list would be full. Sadly most people can’t do thing because it requires putting a lot of money up front that insurance may not repay, because of some technicality.
Yeah my insurance plan won’t reimburse an out of network person AT ALL unless its an emergency. At one point I switched to another insurance plan that did cover out of network mental health professionals but after the deductibles, co-sharing,etc, the higher premiums weren’t worth it. Better to save money on premiums and then apply that money to paying out of pocket for therapy.
The problem is that usually the amount the insurance company reimburses for a therapy session is significantly less than what the therapist is charging. For example, the insurance plan that covers any therapist reimbursed ~$100 per session (of which I had to pay a $20 copay), but the therapist charges $150 (she’s part of a clinic which sets the fees), so I still had to pay the difference. So ultimately even with insurance, I would still have to pay $70 per session. And that was AFTER I met the $300 calender year deductible. And the reimbursement checks usually came several months after the session. If I had been seeing my therapist every week, then I may have kept that insurance, but as it was an extra ~$3000 a year, I would have had to see my therapist more than 35-40 times a year, to save money.
(Plus of course it didn’t cover phone sessions)
Yeah you basically have to pay out of pocket if you want to get treated immediately. My family pays out of pocket for my care and I get appts whenever I need it. It’s kind of sad though. We can cut back on luxuries and use our tax sheltered health savings account to pay out of pocket for therapy. When I tried to find a therapist who I knew could help me within a reasonable amount of time, it was nearly impossible, even though I live near a big city.
Whoops. I should say that it would be nearly impossible IF I needed to find a therapist who takes my insurance.
Another perspective from a provider – I am unable to get on any insurance panels due to “oversaturation” in my geographic area (Los Angeles). I am not even allowed to apply to get on a panel. I’m not philosophically opposed to taking less money to provide services, but I am basically locked out of the system from the other side of it. So I definitely feel for clients trying to find providers who accept their insurance since it’s obvious that at least some of them are so disenchanted with working with the insurance carrier that they dissuade new clients from utilizing their insurance.
So I say – consider paying cash for services and work with the therapist to obtain services at an amount that you can afford. I do that with my clients and it’s worked reasonably well. Since I probably will not be going to a less geographically congested area anytime soon, I will continue to be the type of therapist a client wants to refer other people to, and I will continue to work with them financially. In other words, a win win.
I am glad that there are therapists like you around. If I become a therapist, I would probably follow that model.
And yes, as a P.S. – I can see new clients within a few days, usually, even the next day in some cases.
I recently wrote to my doctor: I tried to contact both branches of the your Family Counseling service several timesand didn’t get a response from anyone. I’m in crisis. I’m angry at EVERYBODY and destroying friendships at an amazing clip. I’m having repetitive ideation of suicide. I need a psychopharmacologist stat+ plus therapy.
My doctor wrote back: The only way to get everything you need right away is to go to the mental health crisis center at the ER. Otherwise you will be waiting.
Good points, all. In addition, it points to the fact that the MH system responds to the less mentally ill while leaving those in crisis or with more severe forms of mental illness untreated.
This happened when I had a bad reaction to a zoloft/dexedrine mix. I called county mental health, who never returned my call. I called 2 facilities, who wouldn’t talk to me because I only had medi-cal at the time.
I tried to emphasize that I was in the car, considering driving it into something. Or drinking a mass quantity of something.
Nope. Sorry. Have you contacted county mental health?
This is unbelievable. Could they treat someone like this as an inpatient in the hospital until services in the community are available?
I’m not in the US and my initial referral (not in crisis) was about 4 weeks (including the Christmas break) which I felt pretty lucky for, but I was given resources for the interim (to see the referring GP and also info about a community service organisation). We also have a system (that’s not that easy to find unfortunately) where people can see a psychiatrist weekly in a group, with urgent referrals done immediately afterwards.
Regardless of who the payer is (state vs insurance co. vs individual), the supply:demand problem underlying this will not be resolved.
haha and those of us with universal health insurance are the supposedly the sad saps having to wait so long for any treatment? that is the myth thrown around over there in the US.
I wanted to see a counselor, got an appointment with my gp in one day. got the referral from the gp and that evening received a call from the counselor and I was in her office by the end of the week. My total out of pocket for the entire thing, $22.
Interesting follow-up study to an earlier study which also appeared in the the Annals of Emergency Medicine (August 2009), “Referral Without Access: For Psychiatric Services, Wait for the Beep.”
Sadly, after struggling to obtain any treatment for depression one has to struggle further to obtain that treatment which makes a difference. In its July 5, 2010 press release, “National Council Launches Project to Improve Depression Treatment,” the National Council for Community Behavioral HealthCare noted that , ” …. less than one-third of people who seek help receive minimally adequate care.”
One wonders what depression treatment outcomes are being fostered in a mental health system where any depression treatment is hard to get and less then minimally adequate care dominates.
I find that trying to see a doctor or counselor is impossible. Right now I am having stress, anxiety, depression with some thoughts of just ending it all. Life seems so worthless. After a week of trying to get anyone to see me I was referred to the ER where they wanted to admit me to the mental Heath unit. I agreed because I would to able to see a doctor the next day. I would strongly advise against this. That is not a place for someone with depression and anxiety. I didn’t make it a hour there and was allowed to go AMA. So I’m back to square one. I need help but no one in that profession seems to care.
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