Residents of major U.S. metropolitan areas often find difficulty in obtaining psychiatric services, a recent study found, further confirming what mental health advocates have long described as a mental health care system in need of a serious revamp.
Investigators acting as patients in search of psychiatric services reached out to 360 offices in Boston, Houston, and Chicago. Cold calls revealed that 16 percent of the offices had incorrect listings in the major private insurer database. Nearly one-third of the offices also failed to return calls.
After two attempts to call each psychiatrist, investigators — who said they had insurance or expressed a willingness to pay out of pocket — only secured appointments with nearly 25 percent of the doctors. According to the study, the first visit with those psychiatrists will take place within an average of 25 days.
As the recent study shows, the gap in psychiatric services affects many people, regardless of the type of insurance they hold. While the Affordable Care Act expanded mental health benefits to 32 million people, fewer than 40 percent of Americans receive the mental health services they seek, according to a survey conducted by the Substance Abuse and Mental Health Services Administration.
That’s why Dr. J. Wesley Boyd, the study’s senior author, told WebMD that the findings could allow public health professionals to further explore the hurdles that those suffering from mental health problems often find in addressing their long-term needs.
“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,” said Boyd, also an assistant clinical professor in the department of psychiatry at Harvard Medical School.
Boyd added: “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.”
According to the National Alliance on Mental Health, mental illness counts as one of the leading causes of disability in the United States. Today, common mental ailments include depression, anxiety, and conduct disorder. If not diagnosed early, long-term effects include impaired thinking and alterations in mood, thinking, and behavior. The risk of suicide also increases by 300 percent for people struggling with a mental disorder, according to the University of Washington’s School of Social Work.
Last year, the CDC reported that up to 50 percent of Americans will experience a mental disorder at one point in their life, many of whom may be dealing with chronic diseases like diabetes, asthma, obesity, cardiovascular disease, epilepsy, and cancer. Experts say that effective treatment can help people living with mental illness reduce the impact of their disorder and gain a sense of independence. Developing a plan to manage the illness serves as a key component of the healing process, an activity where a psychiatrist could prove helpful.
But more than 91 million Americans will most likely be unable to schedule an appointment with one of nearly 93,000 licensed psychiatrists in the United States. A 2013 study cited psychiatrists’ reluctance to accept private and public insurance as a key reason. Leaders of psychiatrist associations point to the shortage of professionals and low reimbursement rates as contributing factors in those decisions. That’s why the few psychiatrists who are available often take on cases for more well-to-do patients, especially as they approach retirement age.
The poor and geographically isolated fare much worse in receiving much needed mental health treatment, a reality that experts say discourages them from seeking professional help. Rural areas of the United States account for more than 85 percent of the locations that the federal government designated as “mental health professional shortage areas.” A 2009 Center for Rural Affairs Report found that some of the counties in those areas didn’t have practicing psychiatrists, psychologists, or social workers.
In response to what has become a dire public health issue, the Obama Administration finalized rules that would require private insurers to reimburse mental health services in the same manner they would cover physical health care. Officials called the provision the last piece of the puzzle that’s known as the 2008 Wellstone-Domenici Mental Health Parity and Addiction Equity Act, a measure that initially expanded mental health benefits.
Some organizations have also pressed for a greater involvement from primary care physicians. Last year, the Robert Wood Johnson Foundation (RWJF) joined forces with General Electric to launch a program company representatives said would allow mental health specialists to teach social workers, nurses, and primary care physicians the basics of mental health care during weekly web conferences.
RWJF’s project takes after the collaborative care model, a practice that 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.
In his Everyday Health column, former American Psychiatric Association president Dr. Jeffrey A. Lieberman said that the collaborative care model could ensure parity for mental ailments that have been stigmatized for decades.
“Collaborative care can help solve the shortage problem,” Lieberman said. “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.”