Why Is It So Hard to Get an Appointment with a Child Psychiatrist?

by Victoria Chen and J. Wesley Boyd

The COVID-19 pandemic has significantly negatively impacted the mental health of children and adolescents, exacerbating what was already a crisis of anxiety, depression, and suicidality among youth. Getting treatment for adolescents with mental health issues was notoriously difficult prior to the pandemic; now, we have published a study in Psychiatric Services that sheds light on just how difficult it has become for families to access outpatient child psychiatric care since the start of the pandemic.

In our study, we utilized a simulated-patient methodology in which researchers posed as the parents of a 10-year-old child and called child psychiatrists listed in the Blue Cross Blue Shield (BCBS) database of in-network providers in Los Angeles, Chicago, and Houston in hopes of obtaining an appointment. Our results were just short of shocking: We were able to obtain appointments only 11 percent of the time. Not surprisingly, it was significantly more difficult to obtain an appointment when we wanted to use Medicaid as our payment type, compared with BCBS or self-pay.

Much of our difficulty stemmed from the fact that one-fifth of the numbers in the BCBS database were wrong and one-quarter contained practices that were full and not accepting patients. Of those few appointments that we were able to secure, the average time until that appointment was over a month.

When a child needs inpatient psychiatric care, the situation is equally dire, because insurance companies generally require clinicians to obtain prior authorizations before patients can be admitted to inpatient facilities. In a study that one of us (JWB) conducted several years ago in a children’s hospital, the average amount of time that clinicians spent on the phone with insurers to obtain these authorizations was one hour.

Given that every single one of these prior authorizations was approved, it's possible that insurance companies hope that the amount of time it requires to obtain that authorization will dissuade clinicians from seeking to admit patients to psychiatric facilities. If that is indeed the case, the requirement to obtain prior authorizations would essentially amount to rationing psychiatric care by “hassle factor.”

The difficulties of obtaining needed child psychiatric care have serious implications for the mental health and well-being of children and adolescents. Mental disorders already rank as the leading cause of disability in the United States, and the pandemic has only intensified a pre-existing crisis.

Children experiencing mental health issues face numerous challenges in their personal, social, and academic lives. Without timely access to appropriate care, their conditions can worsen, leading to prolonged suffering, diminished productivity, and even suicide.

Our study's findings highlight the urgent need for systemic changes to improve access to child psychiatric care. We believe the following should take priority: First, insurance companies need to ensure the accuracy of their provider databases, as incorrect information can hinder families' efforts to find care.

Additionally, efforts should be made to increase the number of child psychiatrists and integrate psychiatric care into primary care settings to enhance accessibility. And finally, reimbursement rates that insurers pay for psychiatric care ought to be increased, so that more psychiatrists would be willing to accept insurance. By taking proactive measures, insurance companies could help alleviate the burden on families seeking mental health care for their children.

In conclusion, our study reveals the dire state of access to outpatient child psychiatric care during the COVID-19 pandemic. Our findings underscore the urgent need for systemic improvements in the availability and accessibility of mental health services for children.

Addressing the crisis requires collaborative efforts from insurance companies, healthcare providers, policymakers, and society as a whole. By prioritizing mental health care for children and implementing effective strategies, we can ensure that children receive the support and treatment they need to lead healthy and fulfilling lives.

Victoria Chen is a medical student at Baylor College of Medicine.