Study finds mental health difficult to access in Washington, D.C.

A new study conducted by the American Psychiatric Association found 86 percent of psychiatrists in the three largest carriers in Washington, D.C.'s Health Insurance Exchange Network were either not reachable or not able to schedule a new outpatient mental health visit.

The APA joined with APA Foundation to conduct this study due to complaints by patients that were not able to find a psychiatrist in any of the three largest health insurance plans. The study was presented by by Joyce West, PhD, of the APA and the Johns Hopkins Bloomberg School of Public Health at the APA 2016 Annual Meeting.

The study concluded that:

• Only 14 percent of psychiatrists listed were available to schedule new outpatient appointments;
• Nearly a quarter (23 percent) of the phone numbers listed did not work;
• Nearly half (49 percent) of the psychiatrists were no longer at the number listed;
• Only 7 percent of listed psychiatrists were able to schedule a new appointment within two weeks, 3 percent were able to schedule within 15-28 day and 4 percent had wait times longer than four weeks;
• The average wait time for a new appointment was nearly three weeks (19.1 days).

“This study shows us that many people are not able to access needed care and people are paying for mental health care they cannot access,” said APA CEO and Medical Director Saul Levin, MD, MPA. “The Affordable Care Act is intended to expand access to mental health and substance use disorder care, yet networks are shrinking both because psychiatrists are dropping out of the networks citing unreasonable administrative burden and low payment rates as reasons and because plans are ‘narrowing their networks’ while providing robust directories of providers to attract purchasers to the plan.”

In a panel at the APA 2016 Annual Conference, Medscape Medical News reported that most panelists experienced the same problems in their regions as well. The main problem was the supply of psychiatrists not meeting the demand for the care.

Incoming APA President Maria A. Oquendo, MD, of the New York State Psychiatric Institute and New York–Presbyterian/Columbia University Medical Center, told Medscape that "about 20% to 25% of the population suffer mental illness, and on average, in the United States, we have 13 psychiatrists per 100,000 population, and in some places even fewer. In Idaho, there are only 6 per 100,000. So there simply aren't enough physicians in general but also psychiatrists in particular in the United States. So we really need to partner with physician extenders."