New CA law targets long waiting times for psychiatric care: shots

New CA law targets long waiting times for psychiatric care: shots


When Greta Christina heard that Kaiser Permanente’s psychiatrists were protesting long waits for therapy on October 13, 2019, she made her own sign and showed up to support her. She had to wait up to six weeks between therapy appointments because of her depression.

Ingrid Nelson


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Ingrid Nelson


When Greta Christina heard that Kaiser Permanente’s psychiatrists were protesting long waits for therapy on October 13, 2019, she made her own sign and showed up to support her. She had to wait up to six weeks between therapy appointments because of her depression.

Ingrid Nelson

When Greta Christina fell into deep depression five years ago, she called her therapist in San Francisco – someone she had a good connection with in the past when she needed therapy. And she was pleased to learn that he was now “on the network” with her insurance company, which meant she no longer had to pay out of pocket to see him.

But their excitement was short-lived. Over time, Christina’s appointments with the therapist went from every two weeks to every four weeks to every five or six.

“Telling someone with severe, chronic, disabling depression that they can only see their therapist every five or six weeks is like telling someone with a broken leg that they can only see their physical therapist every five or six weeks,” she says. “It’s not enough. It’s not even close to enough.”

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Then, this summer, Christina was diagnosed with breast cancer. Everything to do with her cancer treatment – her mammograms, biopsy, surgery appointments – happened promptly, like a “well-oiled machine,” she says as her depression treatment stumbled on.

“It’s a hot mess,” she says. “I have to go to therapy – I have cancer! And yet nothing has changed. “

A new law signed by Governor Gavin Newsom in October aims to fix this problem for the Californians. Senate Bill 221, passed by near-unanimous vote by state lawmakers, requires health insurers across the state to reduce waiting times for psychiatric care to no more than 10 working days. Six other states have similar waiting-limit laws, including Colorado, Maryland, and Texas.

Unequal access to behavioral care is ubiquitous

Long waiting times for mental health care is a nationwide problem, with reports of patients waiting an average of five or six weeks for treatment in community clinics, the VA, and private offices from Maryland to Los Angeles County. Across California, half of residents surveyed said they had to wait too long to see a psychotherapist when they needed one.

At Kaiser Permanente, the state’s largest insurance company, 87% of therapists said patients who needed them were not available weekly appointments, according to a survey by the National Union of Healthcare Workers, which represents Kaiser’s therapists – and the main sponsor of the Bill.

“It just feels so unethical,” says triage therapist Brandi Plumley, referring to the typical two-month wait she experiences in Kaiser’s mental hospital in Vallejo, east of San Francisco.

Every day she takes several crisis calls from patients who have already been assigned a therapist, but who cannot come to them, she says, and describes the provider’s case numbers as “enormous”.

“It’s heartbreaking. And it eats me up every day, ”says Plumley. “What Kaiser just has to do is hire more clinicians.”

But Kaiser says there just aren’t enough therapists to hire them. Kaiser is an integrated system – it’s a healthcare provider and insurance company under one roof – and it has struggled to fill 300 open positions in behavioral clinical health, according to a statement from Yener Balan, Kaiser’s vice president of behavioral health in Northern California. Even hiring more clinicians will not solve the problem, says Balan, suggesting that there will never be enough clinicians in the future to maintain individual therapy for all who want it: “We all need to rethink our approach to what is already there national care model. “

Both Republicans and Democrats have endorsed California law

Kaiser raised concerns about the bill when it was first introduced, and the commercial group that represents insurers across the state, the California Association of Health Plans (CAHP), rejected the bill, saying the shortage of therapists would make it too difficult to the two week mandate.

“The COVID-19 pandemic has only exacerbated this labor shortage, and the demand for these services has increased significantly,” CAHP lobbyist Jedd Hampton said last spring during a Senate hearing on the bill.

Hampton referred to a UCLA study that predicted California would have nearly 30% fewer therapists than would be needed to meet needs by 2028. “

Legislators pushed back and accused the insurers of exaggerating the shortage. State Sen. Connie Leyva, D-Chino responded that the therapeutic providers exist, but it is the responsibility of insurers to attract them and recruit them into their networks by paying better rates and reducing the administrative burden.

If insurers want more young people to enter the psychiatric profession in the future, they must improve local salaries and working conditions now, said Senator Richard Pan, D-Sacramento. (A 2016 KQED research uncovered several ways insurers can save money by keeping their provider networks artificially small.)

As bipartisan support for the law increased in Sacramento, insurers withdrew their formal opposition. The draft law passed the legislature with 111 MPs and only one voted against.

“COVID and the fact that each and every one of us is severely affected in terms of our isolation has made the focus of lawmakers and their understanding of the importance of treatment almost universal in my opinion,” said Julie Snyder, Government Affairs Director of the Steinberg Institute , a proponent of the bill.

The reasons for the long waiting times can be found nationwide

But it’s not clear whether other states have the political will or the resources to enact a similar solution, says Hemi Tewarson, executive director of the bipartisan National Academy for State Health Policy in Washington, DC. While California may be able to force insurers to hire more therapists, she said, places like New Mexico, Montana, Wyoming, and parts of the south really don’t really have enough therapists at any cost.

“You don’t have the providers, so you can fine the insurers as much as you want. You won’t be able to catch up on those waiting times in the short term if they already exist,” she said.

The new California law is a solid step towards improving access to mental health care, with communities of color benefiting the most, says Lonnie Snowden, professor of health policy and management at UC Berkeley.

African Americans, Asian Americans, and Latinos face the most barriers when getting care, Snowden said, and when people of color come for treatment there is a high dropout rate.

“Anything you can do to expedite future appointments will therefore likely disproportionately benefit people who are already staying away from barriers,” said Snowden. “If you can remove any of the barriers, you are the ones who benefit.”

But there has to be some form of oversight and enforcement for the new rules to work, said Keith Humphreys, a psychiatry professor at Stanford University. Kaiser has data systems that can keep track of the time between appointments, but other insurers contract with resident therapists who manage their own case numbers and schedules.

“Who would keep track of whether people who were seen once were seen again in 10 days when it is hard enough just to keep track of how many vendors we have and who they are seeing?” he said. “And if someone hasn’t been seen in 10 days, then how do we distinguish the cases where they have been denied the care they want and the cases where they have decided that an appointment is all they wanted?”

These are questions that will come before government regulators, primarily the California Department of Managed Health Care. The department monitors compliance with other legal access standards, mainly through self-reports from insurers and, more recently, through on-site audits. It has fined insurers $ 6.9 million since 2013 for violating those standards, including a $ 4 million fine on Kaiser for excessive mental health delays.

Earlier state law required insurers to Initial Psychiatric appointments within 10 days – the new law makes it clear that they must do the same follow up Events.

Greta Christina, who is being cared for at a Kaiser facility, says she desperately wants the new law to come into effect. It comes into force on July 1, 2022. She considered paying out of pocket in the meantime to find a therapist she could see more often. But in the middle of a cancer crisis, she says, it was too difficult to think about starting over.

So she’s waiting.

“Knowing that this law was on the horizon helped me persevere,” she said.

This story was made as part of the MediaFrolic’s health reporting partnership with KQED and Kaiser health news (KHN). KHN is not affiliated with Kaiser Permanente.



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Rachel Meadows

Rachel Meadows

Trending topics news writer who enjoys cooking, walking her dog and travel.

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