Five years ago, when Greta Christina was in deep depression, she called a therapist in San Francisco. In the past, when she needed treatment, she established a good connection with the provider. She is happy to learn that he is now “linked” to her insurance company, which means she doesn’t have to pay to see him anymore.
But her excitement was short-lived. Over time, Christina’s appointment with the therapist went from once every two weeks, to once every four weeks, to once every five or six weeks.
“Tell people with severe, chronic, and disabling depression that they can only see a therapist once every five to six weeks, just like telling someone with a broken leg they can only see a physical therapist once every five to six weeks. ,”she says. “It’s not enough. It’s not even close enough.”
Then, this summer, Christina was diagnosed with breast cancer. Everything related to her cancer care — her mammograms, biopsy, surgery appointments — happened very quickly (like a “well-lubricated machine,” she said), and her depression care But faltering.
“It’s really a mess,” she said. “I need treatment-I have cancer! Still nothing has changed.”
Governor Gavin Newsom signed a new law in October aimed at solving this problem for Californians. Senate Bill 221Almost unanimously voted through the state legislature, requiring health insurance companies across the state to reduce the waiting time for mental health care to no more than 10 working days. Six other states -Including Colorado, Maryland and Texas-there are similar laws restricting waiting time.
The long wait for mental health treatment is a national problem, with reports that patients have to wait an average of five to six weeks for treatment At the community clinic, exist Department of Veterans Affairs Facilities And from the private office Maryland to Los Angeles County. Throughout California, Half of the residents surveyed The California Healthcare Foundation stated at the end of 2019 that they had to wait too long to see a mental health provider when they needed a mental health provider.
According to a 2020 survey by Kaiser Permanente, the state’s largest insurance company, 87% of therapists said that patients who require weekly appointments cannot get weekly appointments. National Federation of Medical Workers, Represents KP therapist-and is the main sponsor of California’s waiting time legislation.
“It feels too immoral,” said Brandi Plumley, a triage therapist, referring to the two typical cases she saw at the Kaiser Permanente Mental Health Clinic in Vallejo, east of San Francisco. Month waiting time.
She said that every day, she would receive multiple crisis calls from patients whose therapists had been assigned to them but could not go in to see them. She said that the provider’s volume of cases was “huge”.
“It’s heartbreaking. It eats on me day after day,” Plumley said. “All Kaiser needs to do is hire more clinicians.”
Kaiser Permanente stated that there are not enough therapists available for employment. According to a statement by Yener Balan, vice president of behavioral health for the insurance company Northern California, KP is an integrated system—a healthcare provider and insurance company under an umbrella—and has been working to fill the gap in the clinical behavioral health field. 300 positions are vacant.
Baran said that hiring more clinicians will not solve the problem. He suggested that it is impossible to provide one-on-one treatment for all people who want it in the current system: “We must all reimagine our treatment methods. Existing national care model.”
Kaiser Permanente raised concerns when introducing the waiting time bill. And trade groups representing insurance companies in the state, California Health Plan Association, Opposed it, saying that the shortage of therapists would make it too difficult to meet the two-week task.
“The COVID-19 pandemic will only exacerbate this labor shortage and the demand for these services has increased significantly,” Jed Hampton, a lobbyist for the California Health Planning Association, said during a spring state Senate hearing on the bill.
Hampton mentioned a University of California, San Francisco Learn It is estimated that by 2028, the number of therapists in California will be nearly 30% less than the number needed to meet demand.
Hampton said: “In short, forcing an increase in the frequency of appointments without addressing potential labor shortages will not improve the quality of care.”
The lawmakers fought back.State Senator Scott Wiener (D-San Francisco), who drafted the bill, accused insurance companies Exaggerate shortageState Senator Connie Leiva (D-Chino) said that treatment providers are there, but insurance companies have a responsibility to recruit them into their networks by paying higher rates and reducing administrative burdens.
State Senator Richard Pan (D-Sacramento) said that if insurance companies want more young people to enter the mental health industry, they must now improve wages and working conditions. (A sort of 2016 KQED survey Discovered a variety of ways that insurance companies can artificially shrink the provider network to save money. )
As Sacramento’s bipartisan support for the bill increased, insurance companies withdrew their formal opposition.
But it is unclear whether other states have the political will or resources to legislate similar solutions, said Hemi Tewarson, non-party executive director. National Institute of Health Policy In Washington, DC, although California may force insurance companies to hire more therapists, she said that places like New Mexico, Montana, Wyoming, and parts of the South do not have enough therapists anyway.
“They don’t have a provider, so you can fine the insurance company at will. If these waiting times already exist, you won’t be able to make up for these waiting times in the short term,” she said.
The new California law is a solid step towards improving access to mental health care, and communities of color will benefit the most, said Lonnie Snowden, Professor of Health Policy and Management, University of California, Berkeley. Snowden said that African-Americans, Asian-Americans and Latino-Americans face the greatest obstacles in receiving treatment. When people of color come to receive treatment, they are more likely to drop out of school.
The new rules need to be monitored and enforced to be effective, said Keith Humphries, Professor of Psychiatry at Stanford University. Kaiser Permanente has a data system that can track the time between appointments, but other insurance companies sign contracts with therapists in private clinics, and they manage their own case volumes and schedules.
“Who will keep track of whether a person they have met will reappear in 10 days, when it’s hard enough Keep track of how many providers we have Who are they looking at? ” he asks.
Issues like this will fall on the shoulders of state regulators, mainly California’s health care administration.Since 2013, the department has imposed fines of US$6.9 million on insurance companies for violating state standards, including $4 million fine Oppose Kaiser Permanente because the waiting time for mental health care is too long. Previous state law required insurance companies to provide initial mental health care appointments within 10 days, and the new law clarified that they must do the same for subsequent appointments.
Greta Christina, who is receiving care at a Kaiser Permanente facility, said she is eager for the new law to take effect. It will take effect on July 1, 2022. Christina considers paying out of pocket during this period to find a therapist she can see more often. But in the cancer crisis, she said, it would be too difficult to start as a new person. So she was waiting.
“Knowing that this bill is about to be introduced has helped me stick to it,” she said.
Photo credit: Aleksei Morozov, Getty Images
This story is part of a partnership that includes KQED, NPR And KHN.
KHN (Kaiser Health News) is a national newsroom that provides in-depth reports on health issues. KHN, together with Policy Analysis and Polling, is one of the three major operating projects in the United States KFC (Caesar Family Foundation). KFF is a funded non-profit organization that provides information about health issues across the country.
