When You Need Care, Can You Get Care?

I recently read an article that pointed out that psychiatric care is hard to find, even for those with insurance.  Researchers posed as patients who, after being seen for depression in the hospital emergency department, were instructed to get an outpatient follow-up appointment within two weeks. The patients had excellent health insurance. After calling 64 facilities, they were only able to get 8 appointments, 4 of those within the suggested two-week window.

In the same week that I read this article, I received a call from a friend who struggles with depression and has made an attempt on his life before. To his credit, he knew he was slipping and called me when he just didn’t know what else to do. He was finding doors closed at a time of great personal need. My friend does not have insurance.

When he called to get help, he was told the soonest appointment would be three months away, although he could come in for an emergency assessment. At the emergency assessment, when asked if he was suicidal, he stated no, which left the three-month wait for an appointment as his only option. That would be far too long without the medication and therapy he knew he needed. On his behalf, I called his provider organization and learned that it would be possible for him to come in as a “stand by” patient. He embraced this option and I am happy to report that he has been seen.

Both of these experiences have led me to reflect on the status of our mental health delivery systems and how a patient with a psychiatric emergency gets care when they need it. How can it still be so hard to get emergency care in 2011? Sometimes, people in crisis don’t have time for long waits.  How does one get through the door when a crisis is most pressing? 

We know we need more mental health professionals and better insurance reimbursement rates. We are experiencing budget cuts that make delivery of services harder to get, not easier. Some estimates suggest that between 2009 and 2011, states cumulatively cut more than $1.8 billion from their mental health services budgets. What will the impact of these cuts be for those who need care? As need increases, services seem to be going in the opposite direction. Where is the outrage, where is the sense of urgency, where is the compassion for those who in times of need, should not have to be figuring out how to maneuver successfully through a complex and complicated system?

I know that we’ve come a long way in our field. But, can we say there’s been progress if we can’t get an emergency appointment for a psychiatric crisis in less than two weeks?  We would not let a cardiac patient wait for CPR and emergency treatment in an ER and we should do nothing less for the patient with a critical mental health need.  If we are about helping those in need get the care they require,  we must work harder to ensure every door is the right door, any hour is the right hour and any patient with a psychiatric emergency can be seen, with or without insurance.