Residents of major U.S. metropolitan areas who need a psychiatrist are often likely to come up empty-handed, regardless of ability to pay, new research suggests.
Why? Wrong numbers, unreturned phone calls, and full practices, according to a study conducted around Boston, Houston and Chicago.
"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 study senior author Dr. J. Wesley Boyd, an assistant clinical professor in the department of psychiatry at Harvard Medical School.
"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 added.
Mental illness is the number one cause of disability in the United States, touching the lives of roughly 20 percent of Americans, the authors noted in the study, published Oct. 15 in Psychiatric Services.
But according to 2011 estimates, fewer than 40 percent of those people are getting the mental health care they need, according to background information in the study. That means about 11 million Americans have inadequate care.
To determine how easy or difficult it might be to find appropriate care, the study team posed as patients searching for a psychiatrist in private practice.
Investigators tried to get an appointment with 360 outpatient psychiatrists based in either Boston, Houston or Chicago. All were listed in the database of a major private insurer, and a maximum of two attempts were made.
In the first go-around, four in 10 calls were answered. However, not all answers resulted in a connection with a psychiatrist's office, given that 16 percent of the numbers listed in the database were incorrect. Instead of reaching a doctor, callers were variously put in touch with a jewelry store, a boutique and a McDonald's.
Unanswered calls, meanwhile, were returned a little more than one-third of the time, with return calls more common in Boston than in Houston.
Yet even after two calls -- and despite having insurance (Blue Cross Blue Shield or Medicare) or declaring a willingness to pay out of pocket -- appointments were secured with only about one-quarter of the doctors. And average waiting time: 25 days for a first visit.
Boston psychiatrists were least likely to offer an appointment and Houston doctors were most likely to do so.
About one in five psychiatrists weren't accepting any new patients. In 5 percent of cases, the patient's intended form of payment/reimbursement wasn't accepted, and another 5 percent of offices wanted more information before booking an appointment.
But more than half the time (55 percent), failure was due to a basic inability to reach the physician, often because the phone number given was incorrect.
The findings support other national research indicating that two-thirds of primary care physicians can't secure outpatient mental health services for their patients who need them, the researchers said.
Boyd believes there simply aren't enough psychiatrists to handle the pool of patients who need them. He attributes this to "roadblocks" faced by mental health care providers.
"First of all, just like with general practice medicine, psychiatrists tend to be reimbursed less than other doctors," he noted. "But what we see here speaks to a larger problem with the health care system.
"When managed care come on the scene, about 20 years back, we started to see psychiatry singled out for special scrutiny," he said. "Lots of roadblocks were set up, requiring providers to get permission and pre-authorization before providing the care they need to provide," Boyd said.
"Medical students see this reality, and probably choose other fields in order to not have to deal with these endless obstacles," he added.
Dr. Leslie Gise, a clinical professor of psychiatry with the University of Hawaii in Honolulu, agreed.
"Insurance companies have a stigma against mental health," she concurred. "They put pressure on psychiatrists to write prescriptions rather than spend time with patients, so that the whole field becomes about medication management rather than patient contact."
"Doctors who are paid, in part, to talk to patients, as opposed to providing testing services or surgery, are paid less, which does discourage medical students from becoming psychiatrists," Gise added.