Mental health care access is a joke

We’ve been trying to find my husband a psychiatrist.  It hasn’t been going very well.

The first place we tried was a local community health center with several psychiatric nurse practitioners.  A referral and some phone calls later, he was told to come in at 8 a.m. on a specific day for a walk-in appointment.  It turns out “walk-in appointment” is an oxymoron, because, when he arrived, he was told that the earliest available time slot that day was 10 a.m., and that wasn’t with any of the people he’d been told he would see.  For one of them, he’d have to wait until at least 3 p.m.

Well, my husband is a man with a job and a tight schedule, so he left.  Further calls revealed that the center has no non-walk-in options for the initial evaluation appointment.  That wasn’t going to work.

So we tried a different place.  The friendly assistant on the phone informed us that yes, Dr. M. was taking new patients, but the earliest available appointment was in January 2016.  What?!

Health care in the U.S. always tends to be a maze of referrals and insurance verifications, but mental health care seems to be the worst of all.  You see, to see a psychiatrist (or a psychologist, or a therapist or counselor), you have to do go through the following steps:

1.  Find a practitioner who sounds like a good fit for you.

You would think that you could just get a recommendation from your regular doctor.  You would think.  That’s how other specialties seem to work.  When I was referred to a physical therapist for some long-term hip problems, the referring doctor sent me to a specific person.  Someone they thought might be appropriate.

Mental health?  Nope.  When I talked to my OB-GYN about postpartum depression, I got some vague hand-waving about how they couldn’t recommend anyone in particular because they didn’t know who took my insurance.  When I walked into my university’s student counseling center – the people who handle all student insurance referrals for mental health – and asked to be referred to a therapist for postpartum depression, they had no idea to whom they should send me.  After a long while of awkward searching, I asked if they could just give me a blank referral and let me find someone.  They did.

2.  Check that the practitioner in question accepts your health insurance and is taking new patients.

The health insurance question seems to be particularly problematic with therapists, who often practice alone and may only contract with a handful of insurance companies.  And the only way to get a solid answer is to call the practitioner’s office and ask.  I’ve yet to encounter a health-insurance-created online “provider search” that is user-friendly in any way.

3.  Get the official, insurance-approved referral from your primary care physician.  [May be optional depending on how your health insurance works.]

That’s right, you have to make a completely separate appointment with your primary care physician, just to get the piece of paper / electronic signature saying that your mental health care is medically necessary.  Or in my case, you have to go through triage at the student health center again and re-answer a bunch of irrelevant questions about your drinking habits.

4.  Call to make an appointment.

Theoretically straightforward.  Often frustratingly not.  Sometimes, like The Mort Mommy, you face a bureaucracy so unorganized that you never get through.

5.  Wait for the appointment.

Maybe the soonest they could get you in was a few weeks from now.  Maybe it was eight months away.  It’s not like mental health issues are ever urgent, right?

6.  Attend appointment.  Decide if you feel comfortable enough to make another.  If not, rinse and repeat the entire cycle.

Comfort level is important with any medical professional, but especially when it comes to mental health.  If you don’t mesh with your therapist, it’s not going to work very well.  My latest attempt at therapy ended after just five sessions because it became clear that he didn’t have a frame of reference for my issues and so we were going over and over and over the same things with no forward progress.

This whole process is hard enough when you’re sane and have your life together.  It gets exponentially harder when you’re depressed.  When it feels like every little task takes an overwhelming amount of energy and it all seems hopeless anyway.  Or when you’re so anxious that every phone call to a stranger leaves you panicking that you’ve said something wrong.

It’s ridiculous.  My husband and I have decent health insurance.  We can afford the $25-a-visit co-pays.  We live in a moderately-sized city, and we have the job flexibility to make appointments during the work day.  Even at our worst, we have each other for support and the presence of mind to say to a doctor, “I am depressed and need help.”  And we still struggle to access mental health care.  Imagine how much harder it must be for those who don’t have the same level of support and privilege.