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?
This problem of psychiatrists not taking insurance is very common in the Washington, DC area, and moreover many of them only manage medication (i.e., do not do therapy). For therapy, there are non-physician providers who are cheaper than psychiatrists.
I agree that medication management can be done by others, but in New York City, I don’t think the public has a clue where to go, who these cheaper providers are. Are people educated by health plans, for example, about psychiatric nurse practitioners, in Washington? A heck of a lot of people on meds before the hurricane are having meds raised. For newbies –it’s a big problem.
Cheaper providers can be LMHCs and LCSWs, both of which there are a surplus in NYC. Googling about sliding scale therapy in NYC also comes up with results. I think it is no different than trying one’s luck finding a doctor. Also, although many therapists don’t take insurance, some do. Insurance companies have a book or website with in network provider lists, and thankfully NYS has a mental health parity law for insured individuals. I agree there are systemic issues, but I don’t think it is as difficult to find affordable care as you are presenting it to be.
This is very useful information. I agree that social workers can be excellent therapists. But what I was raising was the possibility that someone might need more than social workers are allowed to provide: perhaps medication. For that, psychiatrists are often required, particularly since, in my experience, this may entail more-than-simple depression. I have not found that many social workers know psychiatrists very well to coordinate affordable care. As I mentioned in my article, many psychiatrists listed on provider lists are not taking patients on the plans listed and some say that they haven’t accepted anyone on those plans for years.
Finding mental health care here in the Capital District (I live in Schenectady) has not been a problem, probably because the population is so much less dense, and we’ve luckily escaped most disasters. But I agree, social workers provide excellent care.
The problem in NC is that most mental health providers don’t accept any insurance. One must pay exarbordant amounts of money up front (!!). Allthough mental illness doesn’t discriminate, getting care if you are poor/middle class is very difficult. Most providers do not take medicare. It’s going to be a silly bit of help not to discriminate against people with preexisting conditions when so many sick have been living without the diagnosis/treatment they have needed for so long.
There are many outpatient mental health clinics in NYC -community based that provide affordable mental health services (psychotherapy and medication management) for those who have medical insurance and for the uninsured at a sliding scale. If your friend lives in Manhattan, there are several MHC’s available to her. Hope this helps. In a separate email, I can provide the name of one clinic.
I think it’s more variable than that- also in what people think of a particular psychiatrist’s care. What is good to one person might be substandard to another. I don’t believe that because a doctor doesn’t belong to managed care they are a better practitioner.