Two weeks after Hurricane Sandy and a Nor’Easter that left thousands of New Yorkers without light, heat, and power for weeks, many New Yorkers were understandably shaken. Some had endured 911 and the disruption, though of an entirely different cause, elicited an anniversary stress reaction. Deaths, drownings, and unacceptable losses happened here and in many other areas.
In New York, I tried assisting a friend get psychiatric help who was traumatized after 911. She feared that she’d sink into the morass that she did following 911.
Here’s the picture that emerged:
>Many psychiatrists in New York City take no insurance. For many people, this means 100% out of pocket, or possibly a small reimbursement.
>Trauma and post-traumatic stress disorder are not something primary care physicians (PCPs) want to deal with, nor is it appropriate for them. Let’s hope health plans don’t think it is within their purview.
>Many PCPs in New York City have no psychiatric referrals to offer patients that are in network.
>Many major academic medical centers in the 5 boroughs have no participating psychiatrists at all in the largest health plans in the area. How can that be?
>Listings of participating psychiatrists in health plan networks are enormously inaccurate: psychiatrists tell you that they have not been on these plans for years.
>One friend in need got two off-network psychiatrists to consult with: the first offered a first visit for two hours at $695, followed by repeat visits of $350.
>She reached that one after ten calls to psychiatrists off list.
I know that this is not unique to New York, nor is it unique to mental health. What do you think should be done to change this? Are there more equitable ways to be sure mental health services serve people most in need?