WASHINGTON, October 20, 2014 – Nearly 93,000 licensed psychiatrists are listed in the United States, yet a new study conducted in several metropolitan U.S. cities found that it is very difficult to secure an appointment with one of them, regardless of insurance or ability to pay for services.
The study was conducted in Boston, Chicago and Houston and included 360 office that investigators, posing as patients in search of psychiatric services, reached out to. Investigators claimed to have health insurance or expressed a willingness to pay for the cost of care out of pocket in their phone calls, yet only secured appointments with around 25% of the doctors. Of appointments scheduled in the study, the average wait time for the first visit was a 25 day period.
Investigators made two attempts to contact each psychiatrist. Cold calls in the study found that 16% of the offices in the sample had incorrect listings with the major private insurer database. Nearly one third of the offices contacted failed to return the investigators’ phone calls.
The findings of the study confirm what many professionals and activists in the mental health community have known for quite some time, and that is that the mental healthcare system in America is inadequate.
According to the CDC, 25% of all Americans live with a mental illness, while nearly 50% of Americans will experience a mental disorder at some point in their lives. Yet, less than 40% of Americans receive the mental health services they seek according to a survey conducted by the Substance Abuse and Mental Health Services Administration.
The Affordable Care Act of 2008 expanded mental health benefits to 32 million people by enforcing rules that forced private insurers to reimburse mental health services in the same manner as physical health care. However, this expansion of health insurance does not seem to have had any substantial impact on the availability of mental health care in the U.S.
Dr. J. Wesley Boyd, the senior author of the study and an assistant clinical professor in the department of psychiatry at Harvard Medical School spoke with WebMd concerning the study’s implications and stated, “One message from this is that having insurance, even good insurance, is not enough to guarantee that you can get the mental health care you need.”
Several contributing factors contribute to the lack of accessible mental health care in America. A 2013 study found that psychiatrists were less likely to accept private insurance than doctors in other fields. The study also found that psychiatrists accepted other insurance plans, such as Medicaid and Medicare at significantly lower rates than other doctors.
Access to psychiatrists is also very limited in many parts of the United States. A report in 2009 by the Center For Rural Affairs found that over 85% of the 1,669 federally designated “mental health professional shortage areas” were rural locations. The report stated, “Only in rural America did the National Advisory Committee on Rural Health find entire counties with no practicing psychiatrists, psychologists, or social workers.”
The ability to meet with a doctor and develop a comprehensive plan to manage mental disorders is imperative for those who suffer from mental illness. The consequences of an individual not receiving treatment for mental illness in a timely manner can be staggering and include substance abuse, loss of job, homelessness and suicide. The risk of suicide increases 300% for those struggling with a mental illness according to the University of Washington’s School of Social Work.
“It’s all the more poignant for those who are profoundly depressed or anxious, because for them it may really be just too much to be able to make enough phone calls and endure all the hurdles in their way before actually being able to secure an appointment.” Boyd stated.
The collaborative care model is a practice that is gaining traction among professionals in the mental health community, the model “expands across the entire health care process, including diagnosis, treatment, surveillance, health communications, management, and support services, and allows families to make their own health care decisions.”
Many in the mental health care field believe this approach offers solutions for some of the problems plaguing the field. Former American Psychiatric Association president Dr. Jeffrey A. Lieberman stated in his Everyday Health column that the “collaborative care model could ensure parity for mental ailments that have been stigmatized for decades.”
Lieberman also stated, “Collaborative care can help solve the shortage problem. This approach brings together mental and physical health services for patients, so that psychiatric and primary care doctors are working in close coordination with each other and with care managers. The combination of better mental health coverage through the Affordable Care Act, an increase in accountable care organizations and patient-centered medical homes, and long overdue national attention to mental illness mean this is a life-changing time for so many Americans who have been stigmatized and denied equality in health coverage and benefits.”