Access to psychiatric care severely limited in major cities

Despite a recent movement to increase primary care physicians' ability to identify mental health problems in their patients, many may struggle to get their patients access to psychiatric care, according to a study published online today by Psychiatric Services.

For the study, researchers posed as patients carrying Blue Cross Blue Shield (BCBS) PPO [preferred provider organization] insurance, Medicare or as willing to pay out of pocket, and made telephone calls to 120 psychiatrists in each of the Boston, Chicago and Houston metropolitan areas.

Of 360 psychiatrists called, the "simulated patients" were able to obtain appointments with only 93 of them or 26 percent. Other findings included the following:

  • Callers insured by BCBS or paying out of pocket were only slightly more likely to obtain appointments than those on Medicare
  • Psychiatrists in Boston were the least likely to offer an appointment, while Houston offered the most access
  • Twenty-three percent of psychiatrist offices did not return calls, while 16 percent of the numbers (from the BCBS database) were incorrect
  • Fifteen percent of practices were closed to new patients
  • Ten percent of the psychiatrists in the directory did not see general adult patients

Noting that mental health disorders are the leading cause of disability in the United States, study authors concluded that more must be done to increase access to psychiatric care, coordinate primary and mental healthcare and improve insurance reimbursements for psychiatry.

"This study poignantly illustrates how difficult it can be for patients to obtain needed mental healthcare," said lead author Monica Malowney, M.P.H., formerly at the Harvard-affiliated Cambridge Health Alliance and now with the department of population health at the Maimonides Medical Center in Brooklyn, New York, in an announcement.

"Insurance companies need to ensure that the lists of providers they offer patients contain accurate phone numbers as well as practices that are actually accepting new patients," she said. "How likely is it that a severely depressed person would persevere through so many obstacles?"

To learn more:
- read the announcement 
- here's the study abstract