An appeal for change in psychiatric care

People who have mental illnesses but can’t get the care they need suffer. But they also can cause a drain on their families, on hospital resources, and on society as a whole, said two Cambridge Health Alliance researchers who found recently that even those with good health insurance plans struggle to get outpatient care in Boston.

In a blog post today, doctors J. Wesley Boyd and Rachel Nardin said payment practices must change or those patients will remain vulnerable.

The physicians worked with other Boston researchers to call all of the outpatient mental health facilities within 10 miles of downtown Boston who were listed in the Blue Cross Blue Shield of Massachusetts network.

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The caller posed as a patient who had Blue Cross coverage and had been discharged from an emergency room with directions to get an appointment within two weeks. Just four of 64 facilities could accommodate the request. Twenty-three percent never returned the call.

The results were published as a letter to the editor in the Annals of Emergency Medicine. The two authors wrote in a blog post for KevinMD.com that such limited access has serious consequences:

The limited availability of psychiatric services has serious consequences for patients and their families. Mental health disorders are common, affecting nearly one in four adults annually. Inadequate treatment can result in individual and family suffering, lost productivity, and even death. Suicide, the third leading cause of death among youth ages 10-24, is more common among those suffering from mental illness.

Inadequate mental health care also creates problems for our health care system and society at large. A third of the homeless and more than half of all prison and jail inmates have mental illness.

The nation’s emergency departments are de facto psychiatric wards, with 79 percent of emergency doctors reporting that their hospitals board psychiatric patients for whom appropriate treatment resources could not be found, sometimes for days.

Although there are many contributors to the inadequacy of our mental health system, managed care has hit psychiatric services hard. Private insurers aggressively constrain patients’ access to services through stringent provider networks. As our study shows, this is often covert: insurers provide lists of in-network providers, but most are unavailable.

Because insurance company reimbursements for psychiatric services are far lower than for other types of care, hospitals also frequently restrict access. By contrast, hospitals compete for insured patients who need highly profitable procedures such as MRI scans or elective surgeries like knee replacements.

Insurance industry practices have also discouraged many private psychiatrists from accepting patients with health insurance.

Until such time as we have a truly universal health system providing comprehensive care, we need to ensure that insurance companies reimburse psychiatric care adequately. Until they do so, psychiatric patients will remain vulnerable, second-class citizens.

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