Scheduling psychiatrist appointments is even difficult for people with private Insurance or willing to pay out of pocket

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Scheduling an appointment with a psychiatrist is next to impossible.

National data has shown that around two-thirds of primary care physicians struggle with finding outpatient mental health care services for their patients. A recent study conducted by a Harvard research team has revealed that scheduling an appointment with an outpatient psychiatrist is a difficult endeavor no matter if the patient has private insurance or if they are willing to pay out of pocket.

"This study poignantly illustrates how difficult it can be for patients to obtain needed mental health care," Dr. Monica Malowney, formerly at the Harvard-affiliated Cambridge Health Alliance and now with the Department of Population Health at the Maimonides Medical Center in Brooklyn, N.Y., said in a statement. "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. How likely is it that a severely depressed person would persevere through so many obstacles?"

Malowney and her colleagues called 360 psychiatrists in the Boston, Chicago, and Houston metropolitan areas posing as patients hoping to set up an appointment. Psychiatrists were listed in the Blue Cross and Blue Shield (BCBS) online database of in-network provides and were located within a 10-mile radius of suburban ZIP codes in each metropolitan area. The BCBS system is the largest health insurance provider in Massachusetts, Illinois, and Texas. Researchers, or "simulated patients," either posed as a patient with BCBS PPO insurance or Medicare, or a patient willing to pay out of pocket.

These "simulated patients" were only able to schedule an appointment with 93 psychiatrists out of 360 (26 percent). Psychiatrists in Boston were the least likely to set up an appointment compared to those in Houston who were most likely to do so. Out of the 267 psychiatrists that failed to schedule an appointment, 23 percent did not even bother to call the patient back. Fifteen percent said that their practices were full and could not take any more patients. Ten percent said they did not offer adult outpatient services.

"Insurers provide lists of providers, but they are filled with names of individuals whose practices are full or who don't bother to return phone calls or with phone numbers that are simply wrong. Calling for a psychiatric appointment and reaching a McDonald's? That is totally unacceptable." said Dr. J. Wesley Boyd, an attending psychiatrist at Cambridge Health Alliance and Harvard Medical School faculty member.

The results from this study show that health insurance does not guarantee an appointment with an outpatient psychiatrist. Even though patients with BCBS insurance or those willing to pay out of pocket had an easier time scheduling an appointment compared to patients with Medicare, this finding was minimal. Researchers concluded that the only way to increase psychiatric care availability was to increase the number of psychiatrists. To do so, they suggest making the psychiatry field more appealing to medical students by combining psychiatric care with primary care and better reimbursements from insurers.

"Insurance companies care more about turning a profit than actually providing care," Boyd added. "Everyone, even individuals with supposedly excellent insurance, has a hard time accessing psychiatric care, so what is needed is a comprehensive overhaul of psychiatric care in the context of a thoughtful single-payer system that allocates resources according to our nation's medical needs."

Source: Keltz S, Fischer D, Boyd W, Malowney M. "Availability of Outpatient Care from Psychiatrists: A Simulated-Patient Study in Three Cities." . 2014.