Wrong numbers and unreturned calls, mislabeled providers and unavailable providers— researchers from Harvard University encountered all of these problems and more during a recent study about the availability of psychiatric care in the United States. Posing as patients seeking appointments for mental health care, the researchers telephoned 360 listed providers in the Boston, Houston and Chicago metropolitan areas. Blue Cross Blue Shield (BCBS) is the largest health insurance provider in Massachusetts, Texas and Illinois, so the Harvard team used the BCBS database in order to find psychiatrists in that network.
Providers Don’t Return Calls
The simulated patients posed as members of the BCBS preferred provider organization (PPO), as Medicare recipients or as non-members seeking to pay their expenses out of pocket. They discovered that even patients with high-quality private insurance policies face difficulties when it comes to securing mental health appointments. Although the simulated PPO patients had slightly more success at making appointments, the differences among the groups of patients were “not significant.” The most common difficulty the researchers faced when it came to making appointments was never receiving a call back. Even when the researchers called twice and left two messages with requests for appointments, 23 percent of the providers never returned the calls. There were also a large number of wrong numbers in the BCBS database, indicating that the information was either entered incorrectly or was not updated. Sixteen percent of calls to providers listed in the database yielded incorrect or disconnected numbers. Some of the providers who were contacted revealed that they did not see general adult outpatients despite the fact that they were listed under these services. In total, 20 percent of the listed providers did not offer the services that the simulated patients were seeking. Finally, the researchers found that many providers were simply fully booked and unable to take new patients. Fifteen percent of the contacted psychiatrists were not able to offer appointments because they did not have any openings.
Accessibility of Mental Health Treatment a Growing Problem
These findings are consistent with a growing body of information showing that mental health care in the United States is hard to get, regardless of your insurance status and income. Previous research has found that approximately two-thirds of primary care doctors are unable to successfully refer patients for mental health services. Individuals with mental health problems face additional barriers to treatment as well. The nature of some mental illnesses makes it difficult for those who are ill to recognize that they have a condition that might benefit from treatment. Social stigma is another major hurdle for people to overcome; many people worry about negative repercussions in their work, home or social lives if they seek treatment for a mental health condition because of the discomfort and misconceptions that still surround many mental health disorders. The difficulties that the Harvard researchers encountered would likely be frustrating or discouraging for anyone. Faced with the additional challenges of recognition and social stigma, it becomes even less likely that people seeking treatment will persevere through unreturned phone calls, wrong numbers and unavailable providers. This may be particularly true for people with conditions like depression or social anxiety, for whom the process of reaching out for help may be exhausting and uncomfortable.