Privately insured may lack adequate access to psychiatric care

Access to outpatient psychiatric care in the Boston area – even for those with private insurance who have been referred by an emergency department – is severely limited, according to a preliminary study published in the August issue of the Annals of Emergency Medicine.

"Despite having private coverage, our simulated patients faced daunting barriers when trying to access psychiatric care," said lead author J. Wesley Boyd, MD, an attending psychiatrist at the Harvard-affiliated Cambridge Health Alliance, in a press release. "How likely is it that a real patient in the grip of severe depression would persevere through so many unsuccessful attempts?"

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In the study, researchers posed as patients insured by Massachusetts' largest insurer, Blue Cross Blue Shield of Massachusetts. They called every mental health facility within a 10-mile radius of the city that was contracted under the insurer's PPO, saying they had been evaluated for depression in an emergency department and discharged with instructions to obtain outpatient psychiatric care within two weeks.

Only 8 of the 64 facilities (12.5 percent) listed by Blue Cross as preferred providers offered appointments and only 4 (6.2 percent) offered an appointment within two weeks. The study also found that 23 percent of phone calls seeking appointments were never returned, even after a second attempt. Further access difficulties resulted from the fact that 23 percent of psychiatric providers only make appointments available to patients already enrolled with a primary care doctor affiliated with their psychiatric facility.

"People with mental illness often can't advocate for themselves - especially in a crisis," said Boyd, "Health insurers, through their restrictive provider networks and their low reimbursement rates for psychiatric services, have created a situation where a patient with a potentially life-threatening disorder is essentially abandoned at a time of great need."

Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians (ACEP), a national medical society that seeks to advance emergency care through continuing education, research, and public education.

Debra Houry, MD, MPH, FACEP, an associate editor of Annals of Emergency Medicine said that Cambridge Health Alliance's preliminary findings need "to be replicated on a larger level."

In a separate ACEP study conducted in 2008, 80 percent of ACEP members responding to a survey reported that psychiatric patients who had been admitted to the hospital were routinely "boarded," or held, in the emergency department, sometimes as long as 24 hours. The shortage of in-patient psychiatric beds has been cited as one of the most serious problems facing patients with mental illness.