When Greta Christina heard that Kaiser Permanente mental health clinicians were holding a protest on October 13, 2019, in the long wait to receive treatment, she signaled her their own and appear to support them. She had to wait up to six weeks between treatment appointments because of her depression.
Ingrid Nelson
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Ingrid Nelson
When Greta Christina heard that Kaiser Permanente mental health clinicians were holding a protest on October 13, 2019, in the long wait to receive treatment, she signaled her their own and appear to support them. She had to wait up to six weeks between treatment appointments because of her depression.
Ingrid Nelson
When Greta Christina fell into a deep depression five years ago, she called her therapist in San Francisco, with whom she had a great relationship when she needed therapy in the past. And she’s happy to know that he’s now “partnered” with her insurance company, meaning she won’t have to pay out of pocket to see him again.
But her excitement was short-lived. Over time, Christina’s appointments with the therapist increased from every two weeks, every four weeks, to five or six times.
“Telling someone with severe, chronic, disabled depression that they can only see their therapist every five or six weeks is like telling someone with a broken leg that they only have You can see a physical therapist every five or 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 — mammograms, biopsies, surgical appointments — happened quickly, like a “lubricated machine,” she said, while taking care of her depression struggled.
“It was a hot mess,” she said. “I need treatment – I have cancer! And still nothing has changed.”
A new law signed by Governor Gavin Newsom in October aims to fix this problem for Californians. Senate Bill 221, which was passed by the state Legislature by a near-unanimous vote, requires health insurers statewide to reduce wait times for mental health care to zero. more than 10 working days. Six other states There are similar laws limiting wait times, including Colorado, Maryland, and Texas.
Unequal access to behavioral health care is pervasive
Long waits for mental health treatment are a problem nationally, with reports of patients waiting an average of five or six weeks for care. in community clinics, in VAand at private offices from Maryland to Los Angeles County. Across California, half of the residents surveyed say they have to wait too long to see a psychiatrist when they need it.
At Kaiser Permanente, the state’s largest insurance company, 87% of therapists said weekly appointments are not available to patients who need them, according to a survey by National Alliance for Healthcare Workers, which represents Kaiser’s therapists – and is the main sponsor of the legislative bill.
Triad therapist Brandi Plumley said: “It feels unethical to mention the typical two-month wait time she sees at Kaiser’s psychiatric clinic in Vallejo, east of San Francisco.
Every day, she receives multiple crisis calls from patients who have been assigned a therapist, but can’t get to them, she said, describing the providers’ sums as “huge.” .”
“It hurts. And it eats me day after day,” said Plumley. “What Kaiser needs to do is simply hire more doctors.”
But Kaiser says there aren’t enough therapists out there to hire. Kaiser is an integrator — it’s a health provider and insurer under one umbrella — and it has struggled to fill 300 vacancies in the clinical behavioral health sector, according to the report. a statement from Yener Balan, Kaiser Northern California’s vice president of behavioral health. Even hiring more doctors won’t solve the problem, Balan said, implying that there will never be enough doctors to maintain one-on-one therapy for everyone who wants it, in the future: We must all re-imagine our approach to the existing approach to the national model of care.”
Both Republicans and Democrats support the California bill
Kaiser complained about the bill when it was introduced, and the trade group represents insurers statewide, California Health Plan Association (CAHP), which opposes the bill, says a shortage of therapists would make it too difficult to meet the two-week mandate.
“The COVID-19 pandemic has only exacerbated this workforce shortage, and the demand for these services has increased dramatically,” CAHP lobbyist Jedd Hampton testified this season. Last spring, during a state Senate hearing on the bill.
Hampton mentioned a study by UCLA predicts California will have nearly 30 percent fewer therapists than it needs to meet demand by 2028. “Simply put, the mandate to increase the frequency of appointments, does not address the situation. lack of basic human resources, will not lead to increased quality of care.”
Lawmakers pushed back and charged insurers exaggerate the shortage. State Senator Connie Leyva, D-Chino, responded by saying that treatment providers are out there, but that insurance companies have a responsibility to attract them and recruit them to their network. them, by paying better rates and reducing the administrative burden.
Sen. Richard Pan, D-Sacramento, said: “If insurers want more young people to enter the mental health profession in the future, they must improve wages and working conditions. in this field right now. (ONE 2016 KQED Survey discovered many ways insurers save money by keeping their provider networks artificially small.)
As bipartisan support for the bill increased in Sacramento, insurance companies withdrew their official objections. The bill passed the Legislature with 111 lawmakers voting in favor and only one voting against.
Julie Snyder, head of government affairs, said: “COVID and the fact that each and every one of us is having a significant impact on our isolation, has prompted legislators’ focus and concern. Their understanding of the importance of treatment is almost universal”. director for Steinberg Institute, a supporter of the bill.
The reason behind the long wait was found nationwide
But it’s not clear if other states have the political will or resources to legislate for a similar solution, said Hemi Tewarson, executive director of the nonpartisan organization. National Academy of State Health Policy in Washington, DC. While California can force insurance companies to hire more therapists, in places like New Mexico, Montana, Wyoming, and parts of the South, there aren’t really enough therapists there, with any any price.
“They don’t have a provider, so you can penalize insurers as much as you want, you wouldn’t be able, in the short term, to cover those wait times if they already existed,” she said. .
California’s new law is a solid step forward in improving access to mental health care, with communities of color benefiting the most, Lonnie Snowden, professor of health policy and management at UC Berkeley.
Snowden said, African-Americans, Asian-Americans and Latinos face the most barriers to care, and when people of color come in for treatment, unemployment rates are high.
“So anything you can do to speed up people’s future appointments is likely to disproportionately benefit those who are staying away because of barriers,” Snowden said. “If you can remove one of the barriers, they’re the ones who benefit.”
But there must be some form of monitoring and enforcement for the new rules to work, Keith Humphreys, a professor of psychiatry at Stanford University. Kaiser has a data system that can track time between appointments, but other insurers contract with private practice therapists who manage their own groups and schedules. .
“Who’s going to keep track of whether people who’ve met once get to see each other again in 10 days, when it’s hard enough to keep track of the number of suppliers we have And who are they meeting? “, he said.” And if someone isn’t seen again in 10 days, how do we count the cases where they were denied the care they wanted versus the cases where they decided one appointment was all they wanted? “
These are questions that will fall into the hands of state regulators, primarily the California Department of Managed Health Care. The department monitors compliance with other documented timely access standards, primarily through self-reported insurance companies and more recently on-site audits. It has fined insurers $6.9 million since 2013 for violating these standards, including a penalty of 4 million dollars against Kaiser for excessive mental health wait times.
State law previously required insurance companies to provide initial mental health appointments within 10 days – the new law makes it clear that they must do so for follow up dates.
Greta Christina, who is cared for at a Kaiser facility, says she’s looking forward to the new law coming into effect. It goes into effect July 1, 2022. In the meantime, she thinks about paying out of pocket to find a therapist she can see more often. But in the midst of the cancer crisis, she says, it’s too hard to think about starting over with someone new.
So she is waiting.
“Knowing that this bill was being worked on kept me going,” she said.
This story was produced as part of NPR’s health reporting partnership with KQED and Kaiser Health News (KHN). KHN is not affiliated with Kaiser Permanente.
