One of the problems neither the new health care bill nor the mental health parity law that kicks into full effect in another month or so will address is a growing problem in America’s mental health system — the lack of professionals who can see you now. The problem is most seriously felt within psychiatry, where the number of medical students who choose psychiatry over a different medical specialty continues to shrink.
A friend of mine who currently sees a psychiatric nurse for her medications wanted to switch to a psychiatrist so that she can try to get off of Effexor, a commonly prescribed antidepressant than can be extremely challenging to get off. She lives north of a major metropolitan area in the U.S. and has decent health insurance.
So she started the thankless process every American faces when trying to find a new specialty provider — making endless phone calls to the list of “approved” providers from her insurance company.
(As an aside, it’s amazing to me that in the year 2010, the only way to find out if a professional has openings — and when they are — is to physically call their office. With endless talk of electronic medical records and scheduling software, there’s still no simple, central place a consumer can go to get this information quickly and easily. Talk about a business opportunity!)
Anyway, she went around and around with the phone calls, over the course of a few days. Some providers either didn’t have front office staff, or they were busy, so she needed to leave a message. Then they had to call her back to let her know their availability. If she was on the phone for her own work, she would then have to start the fun game of phone tag, which is also fairly frustrating.
Finally, it starts becoming clear when openings are available. Six months. Five months. 4 1/2 months. Finally she found a psychiatrist who could see her in about 3 months’ time. For all the talk of having long lines or “rationed” treatment in other kinds of health care systems (such as Canada’s), you don’t have to look very far to see the same thing happening here in the U.S. The long lines have long existed here; it’s just that either people aren’t familiar with them, or believe that for some reason it’s acceptable for certain types of specialties (with little reasoning or rationale).
This issue has become the focus once again as psychologists have sought to extend their prescription privileges from the current two states to a third — Oregon. Some psychiatrists, like Dr. Danny Carlat, support such an extension because he believes there is a critical shortage of psychiatric prescribers in the U.S. If properly-trained psychologists can be allowed to prescribe a small set of medications, the thinking goes, it may help alleviate some of the burden on psychiatrists. While I am against such privileges, I understand the rationale behind the push.
Nobody seems immune from this recurring problem in the U.S. health care system. It’s nearly impossible for me to get into see my dentist for a regular cleaning unless I schedule 6 months in advance. Even the world famous Mayo Clinic isn’t immune. Their Mayo Mood Clinic has a 2+ month wait list to be seen, according to a colleague.
Treatment Only Works if People Can Get It
It’s great that we keep pushing people to seek treatment for their mental health issues, but what’s the point if that treatment isn’t readily available? Trust me when I say it takes enormous courage for most people to even take the first step toward treatment by agreeing to see someone. Imagine how deflating it is when, having toiled with the idea of seeking treatment for weeks or months, you’re told you have to wait another 3 or 4 months to see someone.
I suspect a great many of those people simply say, “Thanks, but no thanks.” Making a person who is already suffering wait longer in their emotional suffering isn’t just a bad way to run a mental health care system — it’s cruel and illogical.
As a bonus, this is the way that most people get their first interaction with a mental health provider — by being told they have to wait weeks or months to see them. In a psychotherapy relationship where the therapeutic alliance is a significant component of change, you can imagine what this must do as a “first impression” in that relationship. Whether or not the fault of the provider, patients don’t care. They don’t want finger-pointing, they want it fixed.
Unfortunately, there are no simple fixes or ready solutions to this continuing problem, which seems to have only gotten worse in the past 20 years. Treatment resources will always be constrained by the availability of someone willing to pay for them. If it’s not the consumer (and the consumer in the U.S. rarely shoulders the burden of the full price of the mental health services they receive), then it’s the government or a private insurance plan. In either case, it seems pretty clear from these examples — as well as countless others I’ve heard over the years — that neither has much interest in ensuring affordable mental health care is readily accessible and available. No matter how much additional pain and suffering the waiting causes.