Why even insured Americans struggle to get mental health care

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JUDY WOODRUFF: Today is the first day of enrollment for 2017 under the Affordable Care Act, otherwise known as Obamacare.

But for some people who have health insurance, getting appropriate coverage can be a challenge. More than 43 million Americans suffer from depression, anxiety or other mental health issues, but more than half never get help, even people who have health insurance.

From PBS station KQED in San Francisco, reporter April Dembosky and producer Sheraz Sadiq bring us a story of a single mother struggling to use her benefits to get treatment for herself and her son with autism.

APRIL DEMBOSKY: On a Sunday afternoon, Natalie Dunnege and her boyfriend, Russell Lifson, head to the park with Natalie’s 13-year-old son, Strazh.

MAN: Let’s go.

APRIL DEMBOSKY: He has autism, a developmental disorder that affects about one in 70 children in the U.S.

STRAZH: You have strengths on one side of your brain and weaknesses on your other side, like, you know, controlling your emotions or this and that, you know? Strengths could be like coding or, you know, focusing on one thing for hours.

APRIL DEMBOSKY: Each week, an applied behavioral analysis, or ABA, therapist comes to the house.

WOMAN: Are you ready?

APRIL DEMBOSKY: ABA therapy helps kids with autism learn life skills and how to control their temper. Strazh and his therapist, Gabby Raders, create a schedule of carefully timed activities, so he can get better at transitions.

STRAZH: This is the I.D., right, the identification with the enemy. This is the width, height, speed X and speed Y.

APRIL DEMBOSKY: Ending a favorite activity can trigger a meltdown.

STRAZH: I can’t do it. No, I can’t.

NATALIE DUNNEGE, Mother: ABA therapy has helped my relationship with Strazh tremendously. It’s taught me how to communicate with him, when to back away, when to come in and help.

APRIL DEMBOSKY: As a single mom working full-time, money is tight for Natalie. She can only afford a few hours of ABA therapy a week.

NATALIE DUNNEGE: I want my son to be as successful as possible, so every time I get a raise, I just increase ABA hours.

APRIL DEMBOSKY: She has insurance through Blue Shield. But getting mental health treatment has been really tough.

NATALIE DUNNEGE: So, I went on the site. And then you can see it says, like, doctors, facilities, dentists, nothing about where to find a therapist. I called them, and they e-mailed me a list of providers.

APRIL DEMBOSKY: Oh, so this is the list?

NATALIE DUNNEGE: Mm-hmm. Yes. They all have a three-month waiting list. And then, after the three-month waiting list, you have, like, two to eight weeks of intake. And then hopefully you get approved.

APRIL DEMBOSKY: So, she pays $50 an hour, out of her own pocket, for her son’s therapy. And now she’s facing similar hurdles finding a therapist for herself.

NATALIE DUNNEGE: Blue Shield sent me a list, like, I should be fine, just make a few phone calls, I will find somebody. I called everybody on this list. Only one place called me back. I have to be as emotionally healthy as possible, so that I can be there for Strazh, because he has good weeks and he has bad weeks.

APRIL DEMBOSKY: Turns out that Natalie’s experience is by no means unique. I called 100 psychologists in San Francisco who take Natalie’s insurance.

I’m wondering if you are indeed taking new patients with Blue Shield coverage?

Half said they’re no longer taking insurance or new patients, and a quarter never even called back.

Thanks so much. Bye-bye.

Only eight had appointments outside of normal work hours. I contacted Blue Shield for an interview, but they declined. Instead, they sent a statement saying that the provider has to notify Blue Shield if they’re no longer taking new patients. They also said California is facing a shortage of mental health providers.

CATHERINE HOPMAN, Psychologist: Insurance companies are saying that there’s a shortage of mental health providers? That’s hard for me to believe. I have many colleagues who are trying to get onto panels. And they run into the problem, again and again, where panels say, sorry, we’re closed. We have enough providers in your area.

APRIL DEMBOSKY: Dr. Hopman is a psychologist who accepts a variety of insurance plans. She can get up to 20 calls a week from people asking for her help.

CATHERINE HOPMAN: It makes me really angry. It really is upsetting, and it makes me wonder, what are the insurance panels doing and why are they limiting how many therapists they take on onto their panels?

APRIL DEMBOSKY: Why do you think they might be limiting the number of therapists?

CATHERINE HOPMAN: If you make things too difficult to access, then patients will stop trying to seek the therapy and the treatment that they need. And I guess part of me thinks that that’s probably a good thing for the insurance companies.

APRIL DEMBOSKY: Another difficulty patients face is outdated or missing information about a therapist’s specialty.

CATHERINE HOPMAN: So, for instance, if I need a cardiologist for a heart problem, and I just get a list of all M.D.s that are on my health insurance panel, I’m not going to know who to call about my particular issue that I’m needing help with.

APRIL DEMBOSKY: Many therapists complain that reimbursement rates are too low.

CATHERINE HOPMAN: Over the past 18 years of being on their panels, they have not increased their reimbursement rates. And yet the co-pays and premiums are increasing for most of my patients.

APRIL DEMBOSKY: Under state and federal laws, insurance plans must cover mental health services equally compared to other forms of care.

But millions of patients across the country like Natalie Dunnege and her son Strazh still struggle to get the help they need.

MAN: We’re almost done with this. I like that.

NATALIE DUNNEGE: Getting services through my plan, the hardest one by far is getting mental health services. There’s nothing more difficult. I needed to find a doctor. I found one instantly. But mental health, behavioral health, psychiatrists, to have that be even harder, it’s almost unbearable sometimes.

MAN: Good night.

APRIL DEMBOSKY: For the “PBS NewsHour,” I’m April Dembosky in San Francisco.

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