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The Austin chapter of Physicians for Social Responsibility (PSR) recently surveyed local primary care physicians about access to mental health services for their patients. The results overwhelming painted a grim picture. Seventy-five percent of those who responded indicated that accessing mental health services is generally "extremely difficult compared to other specialties." "This is a growing and dire problem," one physician wrote, expressing the sentiment of many.
Frustrated and concerned by our own experiences referring patients to psychiatric care, physician board members of the Austin chapter of PSR, a national nonprofit advocacy organization, recently moved beyond the group's historic focus on the environment and national security policies to concentrate on mental health care access in Travis County. Through a series of meetings with community leaders and mental health experts, Austin PSR board members sought to better define the problems and begin to develop solutions.
With the generous help of TCMS, a survey was sent to all TCMS members who practice family medicine, pediatrics, internal medicine, or obstetrics and gynecology. While recognizing the incredible challenges faced by mental health professionals in caring for patients with mental illness and getting reimbursed for their services, Austin PSR's intent with the survey was to determine the pervasiveness and repercussions of the problem with accessing mental health care from the point of view of primary care physicians.
The vast majority of respondents felt that referring to mental health providers was more difficult than referring patients to other specialties, significant time was spent by patients and staff trying to arrange appointments, and negative outcomes occurred as a result. The concerns were shared by physicians of all specialties surveyed and by those in private practice as well as those who work in the community clinics.
Fifty-two percent of respondents wrote that they and their staff spend 30 minutes or more per patient when referring for mental health services, with nearly 12 percent saying they typically spend more than an hour. Among those who spend less time, several wrote that they had been forced to turn the responsibility of accessing care over to the patient. "I am forced to put the burden of accessing mental health services on the patient," one doctor wrote. "Unless the patient is a danger to self or others, she is the one spending hours trying to find mental health access. I had one patient last week say she made 40 phone calls without finding a psychiatrist to see her."
More than half of the survey respondents reported that the average wait time to see a psychiatrist for patients needing an urgent mental health assessment was four weeks or more. A large majority of physicians also reported that they are occasionally (43 percent) or frequently (35 percent) "managing psychiatric issues beyond my comfort level." Over 95 percent reported at least occasionally seeing negative outcomes in patients unable to access care.
Several doctors expressed their concern that many private practice psychiatrists have stopped accepting insurance plans and are fee-for-service only, which limits access for low income patients. "This issue is getting worse all the time!" one physician wrote. "We have plenty of cash-only/no insurance psychiatrists but few or none who will see patients on insurance who cannot afford $500-$1000 payments."
Yet psychiatrists and other mental health care providers are faced with inconsistent reimbursement from insurances and overly burdensome requirements to get visits approved. Many find it best to avoid the insurance companies altogether. Austin PSR Board member and psychiatrist, Dr. Laurie Seremetis, explains, "The shortage of psychiatrists and the unfair burden placed on psychiatric practitioners as insurance benefits have been 'carved out' have made many psychiatrists opt out of the insurance business. It often requires extensive time and the sharing of very private patient information in order to eke out approval for just a few sessions at a time, and even then there are unrealistic and arbitrary limitations placed on psychiatric benefits and diagnoses covered."
The difficulties experienced by local primary care doctors, as well as psychiatrists, are concerning and warrant action. Austin Physicians for Social Responsibility realizes that the problem is complex and multifaceted. As such, it will require a coordinated, united solution. Austin PSR plans to present the results of the survey to the leadership of TCMS, the Austin Psychiatric Society, the Mayor's Mental Health Task Force, and members of the Hospital District Board to discuss ways to improve the current situation.
Austin PSR seeks further input from primary care physicians and psychiatrists about improving access to mental health care for Austin-area residents. To learn more about Austin PSR or to see a copy of the survey and complete results, please go to the website www.austinpsr.org. Many thanks to those of you who completed the survey.
Lisa Doggett, MD, MPH is a local family physician and the director and board president of Austin Physicians for Social Responsibility.