ROSLYN HEIGHTS, N.Y. (CBSNewYork) – A shortage of mental health providers is keeping some patients waiting for months.
Many families are paying out of pocket to get help because healthcare providers are refusing to take insurance – saying reimbursements are just too low.
One quarter of Long Island families surveyed said they were unable to find a mental health provider who takes their insurance. Those families told CBS2 they’re angered having to wait for help.
“Sometimes it takes them days, weeks, months, even years,” Andrew Malekoff, CEO of North Shore Child & Family Guidance Center said.
Malekoff added the shortage means many families are giving up. Some are enrolling in a “clinics” that lack in privacy or – in Jenna Kern-Rugile’s case – footing the bill for each 45-minute session.
“It was $500 a visit, I was not doing well, I was desperate, but I was willing to pay that because I was desperate… Out of pocket and I wasn’t working because of the depression,” Kern-Rugile explained.
Ninety percent of primary care physicians reportedly accept insurance, but only 55 percent of psychiatrists accept insurance because of the low reimbursement rates.
Fewer and fewer medical students are reportedly going into the field of psychiatry. (Credit: CBS2)
“We are seeing a lot of kids coming in with anxiety depression being diagnosed with ADHD,” Dr. Michele Reed said.
Yet the family practitioner added that she struggles to find psychiatrists for her young patients.
“It’s devastating. Three of the highest burden illnesses for children (are) depression, bi-polar, schizophrenia. Those are the kind of things child psychiatrists treat and there just aren’t enough of us,” psychiatrist Dr. Stephen Perret said.
Major health systems on Long Island are trying to make “behavioral health care” more accessible; placing mental health experts into family care settings where insurance is accepted.
“The last thing you need is to be turned away when you’re calling for help,” Kern-Rugile said.
Experts say medical schools need to graduate 30 percent more students in psychiatric medicine to meet the current demand.
Many providers don’t take insurance because they say reimbursements are too low, forcing families to pay out of pocket.
Dr. Kristie Golden, an associate director at Stony Brook Medicine, said lower payments from insurers have pushed many medical students to choose fields other than psychiatry, and when providers do not accept insurance not everyone can afford to pay. Photo Credit: Newsday/John Paraskevas
A shortage of mental health professionals has forced some Long Islanders to wait months for an appointment, and patients who do get care without a delay often pay out of pocket because many psychiatrists, psychologists and other therapists don’t take insurance.
Insurance reimbursements for those care providers are too low, and don’t come close to those of several other medical specialties, experts at Long Island’s largest health systems said.
And with demand for treatment high, psychiatrists often only treat patients who can afford to pay out of pocket. That can mean hundreds of dollars for a 45-minute session.
Some providers spend time at lower pay at organizations that help those who can’t pay for care. North Shore Child and Family Guidance Center in Roslyn Heights, led by Andrew Malekoff, is such a service, which operates by raising funds and seeking donors and grants. Photo Credit: Howard Simmons
Nearly 25 percent of respondents in a 2017 survey by Roslyn Heights-based North Shore Child and Family Guidance Center, a not-for-profit children’s mental health agency, said they couldn’t find a single provider who took their insurance.
“What makes the difficulty accessing care particularly difficult for people and families living with mental health and substance-use disorders is that stigma, and the shame it generates leads to delays in their asking for help in the first place,” center executive director Andrew Malekoff said. “Some may wait weeks, months and even years to ask for help.”
In addition, the lower insurance reimbursements have pushed medical students to choose fields other than psychiatry, said Dr. Kristie Golden, associate director of operations at Stony Brook Medicine. Golden said the demand won’t be met unless “psychiatrists come up with ways to make a comparable living and pay off school debt.”
There is also a broader economic cost. Depression and anxiety cost the global economy $1 trillion annually in lost productivity and absenteeism, according to the World Health Organization. But the organization said for every $1 spent on treating those disorders, there is a $4 return in better health and ability to work.
Local health systems are working to improve the situation by opening mental health care centers that accept insurance and locating mental health providers who take insurance within primary-care settings.
However, the shortage of providers is growing. The state Labor Department projected in 2012 that a 25 percent increase in psychiatrists and a nearly 30 percent increase in mental health therapists would be needed to meet demand from 2012 to 2022.
According to the National Alliance on Mental Illness, about 19 percent of adults in the United States, or 43.8 million people, experience some type of mental illness, such as depression, anxiety or bipolar disorder, in a given year. About 21 percent of teenagers experience a severe mental disorder at some point during their life, the group said.
Dr. Michele Reed, a family practitioner in Garden City, says she struggles to find psychiatrists who take the same insurance she does, so it’s difficult for her to send her patients who need help to a psychiatrist. Photo Credit: Newsday/J. Conrad Williams Jr.
Against that backdrop, just 55 percent of psychiatrists nationwide accept insurance, according to a National Council for Behavioral Health advisory board, a Washington-based organization that advocates for the mental health profession. In comparison, more than 90 percent of primary-care physicians take private insurance or Medicare, according to the Kaiser Family Foundation, a nonprofit health care policy group.
Many psychiatrists “who do take insurance come to realize that there isn’t enough time in the day to see patients and then handle all the paperwork, requests and denials that come with taking insurance,” said Dr. Ronald Brenner, chief of behavioral health services for Catholic Health Services in Rockville Centre.
Although regional numbers are hard to come by, the percentage of psychiatrists who don’t take insurance could be higher on Long Island, said Dr. Aaron Pinkhasov, chairman of the Department of Behavioral Health at NYU Winthrop Hospital in Mineola.
“There are more people who could pay out of pocket, so it’s a more feasible option for doctors in a region like this,” Pinkhasov said.
Dr. Stephen Perret, a private child psychiatrist in Westbury, says its “terribly frustrating” not accepting insurance, but the $60 insurance pays for a visit would not cover his costs, which include $200,000 in student loan debt. “The system is a mess,” he says. Photo Credit: Brad Penner
But Long Islanders still have better access than residents of rural areas of New York and the nation, where finding providers is even more difficult, experts said. In metropolitan areas, there are 17.5 mental health providers per 100,000 people, according to an American Journal of Preventive Medicine analysis completed in 2016. The number of providers falls to 5.8 per 100,000 in non-metro counties.
“It’s all perspective, and we are used to an ease of entry, where we don’t need to drive more than 10 minutes to get what we need,” said Janet Kahn-Scolaro, administrative director for behavioral health and family medicine services at South Nassau Communities Hospital in Oceanside. “But even here it could be better.”
Christine Sampson, 37, of Amagansett, said she traveled more than two hours to Hempstead, because she couldn’t find a nearby psychiatrist who took her insurance without a long wait to make an appointment.
“It took me a month just to find a psychiatrist, and he was far away,” she said. “I was desperate, so I did it.”
Patient Christine Sampson had difficulty finding a psychiatrist who would take her insurance on the East End and traveled west for hours for care. She now sees a doctor closer to her home in Amagansett and her co-pay for mental health services is $70. Photo Credit: Veronique Louis
Sampson, who has bipolar disorder, said she now sees a local psychiatrist and therapist, and her six medicines are covered by insurance. Her copay for mental health services is $70.
“One of my medicines would cost $900 without insurance,” she said. “I’m fortunate that on my current insurance, I pay a $40 copay, and that’s it.”
Karen Garcia, 39, of Roslyn said she tried to find mental health treatment.
“I really tried to get therapy, and in every case it was either too pricey or the waiting list was months long,” she said. “I gave up.”
It can be even more difficult to find child psychiatrists who take insurance because there is a shortage of them in general, said Dr. Stephen Perret, who runs a private child psychiatry practice in Westbury.
“We come in to this profession to help people, so it’s terribly frustrating that I can’t take [insurance],” Perret said. “I wouldn’t be able to cover the rent, never mind pay my employees, pay off my $200,000 in student loans or feed my family with the $60 insurance pays for a visit. The system is a mess.”
Sheree Simmons of Brentwood, who is on Medicaid, said she pays $400 to $800 out of pocket every month for her daughter to see a psychiatrist in West Islip. The cost varies, depending on how often she needs to go.
“She also needs more counseling, but I can’t afford it,” Simmons said. “Very few people are taking Medicaid.
She said she calls her daughter “three or four times per day while she is at school to make sure she is all right. It’s all very difficult.”
The lack of providers can also be maddening for family practitioners who can’t find the help needed for their patients, said Dr. Michele C. Reed, who has offices in Garden City and Rosedale, Queens.
“It’s a daily issue,” Reed said. “I routinely see patients, including children, who have anxiety issues. We try to find them a psychiatrist, psychologist, social worker or therapist who can help. But unfortunately we often tell them to call their insurer, because mental health care providers can’t accept what insurers are willing to pay. Also, usually patients who have insurance don’t feel comfortable going to a hospital-based clinic because, more times than not, they don’t feel like they’ll get the same level of privacy and intimacy” that they would in a private practice.
Experts said reimbursements are lower because insurers struggle to quantify the cost for mental health care, which can vary widely for patients with similar diagnoses, depending on the type of treatment. There is also a long-standing lack of recognition that mental illness is as serious as physical illness, and can be tied to other illnesses, they said.
In an effort to make mental health services more accessible, some providers spend time — often at lower pay — at organizations that deliver services to those who can’t pay for care.
For instance, in addition to his private practice, Perret works at the North Shore Child and Family Guidance Center.
“It’s a mission for me, and for others,” he said. “We give whatever we can to help people who need it but can’t afford the care otherwise.”
The center operates by raising between $1.5 million and $2 million a year through fundraising events, individual contributions and grants, executive director Malekoff said.
It accepts all insurance and treats between 5,000 and 6,000 children and their family members yearly, he said. The organization has eight full- and part-time psychiatrists on staff.
“Only through our fundraising are we able to … turn no one away for inability to pay and offer a rapid response with no waiting list,” he said, adding that often families are desperate by the time they seek help.
Major health systems on Long Island are trying to make behavioral health care more accessible.
One strategy includes placing / mental health professionals, sometimes social workers or counselors, inside primary-care practices.
Other systems have opened full-service behavioral health practices that include psychiatrists and psychologists — and take insurance. While psychiatrists are the only ones permitted to write prescriptions, psychologists can handle much of the care patients need, experts said.
South Nassau, which is part of the Mount Sinai Health System, has assigned a psychologist and bilingual social worker to provide behavioral health services at the Center for Primary and Behavioral Care in Hempstead and at a family medical practice in Oceanside. In less urgent cases a primary-care physician can manage the psychiatric medication in collaboration with a psychiatrist, Kahn-Scolaro, at South Nassau, said.
“For patients who require the specialist, the psychiatrist can handle the care directly,” she added.
New Hyde Park-based Northwell Health operates a mental health care office, called Northwell Health Physician Partners Behavioral Health at Manhasset.
“We plan to dot the landscape with this type of practice … They’re in great demand,” said Dr. Blaine Greenwald, Northwell’s vice chairman of psychiatry.
To make it work financially, psychiatrists at the Manhasset office see about 15 to 20 patients daily, and only treat people who need medication as part of their care, Greenwald said.
“The psychiatrist can spend 15 to 30 minutes with a patient without being hurried,” he said. “The practice can’t be financially viable if a psychiatrist spends their time doing psychotherapy too.”
“Therapists see the patients for other services,” he said.
Stony Brook Medicine has embedded behavioral health professionals in various primary-care settings, Golden said.
Stony Brook also uses tele-psychiatry to deliver behavioral health care to patients on the East End, where there are fewer providers to meet the demand.
“It’s easy and convenient for the patients,” Golden said. “A patient goes to a primary-care location and they are seen by a remote behavioral health provider at Stony Brook.”
New York State is expanding telehealth regulations to allow patients to be seen in a variety of locations, including their homes.
But there are federal restrictions that limit the reimbursement of these services to Medicare beneficiaries. A bill that would lift restrictions expired without a vote in 2018.
Catholic Health Services’ Mercy Medical Center operates a behavioral health clinic in Garden City.
“We take everyone, and it can be difficult because it’s overrun,” said Brenner, who is in charge of the health system’s behavioral health care. The facility handled 28,000 visits last year.
Brenner said CHS is also considering opening a clinic in Suffolk.“ “You’d think a clinic would be a profitable enterprise, but given the billing structure, it’s far more complicated, and many clinics struggle,” he said.
NYU Langone this year launched a corporate program in which companies contract directly with the Manhattan-based health system for mental health services.
“We negotiate directly with employers and then provide quality care for a fair level of compensation,” said Dr. Charles Marmar, chairman of the psychiatry department at NYU Langone. “More than 100 behavioral health staff becomes in-network for employees.”
Two large companies have signed on, and others have expressed interest, said Dr. David Ginsberg, the vice chairman of NYU Langone’s psychiatry department.
“It’s a very strong retention tool for companies,” he said.
More than 90 percent of primary care physicians take insurance, while only 55 percent of psychiatrists do.
Left to Right: Andrew Malekoff, Sean Grover, Nicole Nagy, Kerry Lynn Eller, Nancy Manigat, and Reverend Gideon L.K. Pollach
On Friday April 13, North Shore Child & Family Guidance Center hosted a program featuring Long Island author Nicole Nagy.
Nagy’s book, “Creative Mind: A Diary of Teenage Mental Illness,” is a moving first-person account of her mental health challenges and also of the roadblocks she faced when trying to access timely and affordable treatment.
Nagy, a graduate social work student at Stony Brook, has also become a Project Access advocate, fighting alongside the Guidance Center for timely, affordable access to mental health and addictions care.
The April 13 program featured Nagy’s discussion of her journey to healing and also addressed the battle to overcome stigma.
“In her book, Nicole writes with an authentic, courageous voice as she talks about her experiences with depression and anxiety,” said Andrew Malekoff, executive director of the Guidance Center. “With this book, Nicole has helped lift the fear of stigma by so honestly sharing her story. In addition, her advocacy for people struggling with mental health issues is very powerful. The battle for access to care is a matter of civil rights for millions of people.”
Even with excellent health insurance, Nagy said that getting access to treatment was very difficult. “It took weeks to get an appointment after I was hospitalized for a suicide attempt,” she said. When she was finally able to get the help she needed, she “learned to own and manage my illness and love myself.” Her goal is to share her story with everyone she can and give them hope.
The April 13 event included insights from an outstanding panel: Nancy Manigat, chief program officer of CN Guidance & Counseling Services; author and psychotherapist Sean Grover; Kerry Lynn Eller, a social worker at North Shore Child & Family Guidance Center who has experienced the difficulty of accessing mental health care in her own family; and the Rev. Gideon L. K. Pollach, rector at St. John’s Episcopal Church in Cold Spring Harbor.
“Nicole’s story shows that having mental illness and being successful are not mutually exclusive,” said Eller. Grover talked about the need for adults to remember what it was like being a teenager and to “tap into our humanity,” while Pollach spoke of the need for communities of faith to fight for parity for mental health and addictions treatment.
Manigat, Chief Program Officer of CN Guidance & Counseling Services, applauded Nagy for being an advocate, and also spoke about the importance of the Project Access study, which surveyed 650 Long Islanders about their experience trying to find mental health care. “We are so grateful for the opportunity to work with North Shore Child & Family Guidance Center on this very important study with the goal of improving access to lifesaving services for individuals living with a mental health and/or substance use disorder,” said Manigat. “Through our participation with Project Access, we were able to provide significant data which helped identify obstacles to care. At CN Guidance and Counseling Services, we believe in every individual’s ability to recover – and access to care is a necessary component of treatment. We are enthusiastic about the potential for change to come through the results of this survey.”
For more information about Project Access, email Guidance Center CEO Andrew Malekoff at amalekoff@northshorechildguidance.org. You can order “Creative Mind” on Amazon.com.
Times Union, March 22, 2018, Letter from Andrew Malekoff
Although our children’s safety is paramount (“School safety debate evokes Albany deja vu,” March 7), in the aftermath of yet another mass shooting, we must understand that it is incredibly rare for people living with mentally illness to be violent. In fact, they are far more likely to be the victims of violence than the perpetrators of it.
Nevertheless, we do need to have a discussion about mental illness at a time like this. That discussion, however, needs to be about how the health insurance industry and the elected officials who depend on their donations are failing miserably at having adequate networks of providers on their lists who take insurance.
Why is this? Health insurers pay substandard rates of reimbursement; consequently, fewer and fewer providers will accept insurance.
Health insurers are discriminating against people living with mental illness and addiction. This is a violation of civil rights and federal parity law, which government regulators then fail to enforce, as is their statutory responsibility.
In New York, the Department of Financial Services (DFS) is charged with enforcement. I urge Gov. Andrew Cuomo to authorize, and DFS Commissioner Mary Vullo to implement a full-scale investigation into network adequacy during this, the 10-year anniversary of the bipartisan Mental Health Parity and Addiction Equity Act of 2008.
Andrew Malekoff
Long Beach
Executive director and CEO of North Shore Child and Family Guidance Center in Roslyn Heights
In the wake of the Parkland, Fla., shootings, state senators Elaine Phillips, Republican of Floral Park, and Todd Kaminsky, Democrat of Rockville Centre, have renewed their call for an investigation into the lack of adequate insurance coverage for mental health patients. In a letter to Department of Financial Services Superintendent Maria Vullo, the senators called on DFS to investigate the availability of mental health coverage generally, while renewing an earlier call that Vullo direct her department to examine the issue of network adequacy.
Network adequacy means that health insurance carriers will make a sufficient number of doctors available in each specialty. The two senators’ January call for an investigation into network adequacy came on the heels of a report put out by North Shore Child and Family Guidance Center that was sharply critical of the lack of mental health care in most insurance plans, including those available through the New York State of Health.
Almost half of the respondents in the North Shore report indicated that it was harder for them to find appropriate treatment options for mental health or substance abuse problems than for other medical complaints. The report was compiled as part of North Shore’s Project Access, the overall aim of which is to improve access to mental health and addictions care. Its financial support comes from the Unitarian Universalist Fund of the Long Island Community Foundation. The Community Foundation supports a number of social service initiatives.
“Simply put,” Kaminsky wrote, “those with the courage to reach out for mental health treatment are given a hard time by their insurance companies, and there are too few mental health providers. In the wake of last month’s horrific mass shooting, it is imperative that we that we ensure that those who need treatment obtain the services they require.”
“Timely and affordable mental health and addiction care should be accessible to anyone in need,” Phillips wrote in agreement. “As we saw with the tragedy in Parkland, Fla., adequate mental health treatment needs to be easily attainable.”
Respondents to the questionnaire reported a range of negative experiences, from unresponsive or unsympathetic doctors, to an insufficient number of doctors, to long waiting lists to see doctors or therapists. “I work for a school district,” wrote one respondent. (All respondents were promised anonymity.) “We work with families on a daily basis, where they cannot find a provider that will accept their insurance, or they cannot afford the copay. Personally, a family member within my household needed therapy, and we had difficulty finding a provider. And when we did, scheduling was a nightmare, because so many patients were trying to see him. I believe it was because he was one of the few willing to accept multiple insurance [plans].”
Kaminsky and Phillips have requested a review of the procedures by which state agencies assess network adequacy.
“We are living in a time where both mental health and substance abuse disorders are on the rise,” the senators wrote. “In addition, more and more young people are reporting symptoms of depression and anxiety … We are wondering if the criteria currently used may need to be re-evaluated and a re-examination done, as the law provides.”
From Anton Media: Andrew Malekoff discusses the Struggle for Access to Mental Health Care
It’s a heartbreaking scenario that is far too common: someone makes the difficult decision to seek out professional help for a mental health or substance abuse problem for themselves or their loved one and is faced with a myriad of roadblocks. They start calling providers on their insurance plan and find that they are not taking new patients, or they no longer accept insurance and only want cash. And the cost of paying out of pocket is too much for many to afford.
Here is the reality: Health insurers are required by law to offer an adequate network of providers for their beneficiaries to choose from, and not just for physical illnesses. This requirement is known in the health insurance industry as network adequacy.
Along with the difficulty of finding a provider who will accept your insurance, the problem is often complicated by a family’s reluctance to seek help for a mental health or drug problem, as opposed to physical illnesses like cancer or diabetes. Despite progress in public education, stigma still looms large.
Once someone takes the leap of faith to ask for help, he or she is too often told, “I’m sorry, I don’t accept your insurance any longer.” When this happens there is a chance they will give up.
It is this reality that spurred North Shore Child & Family Guidance Center to launch a research initiative called Project Access. This entailed creating a survey that was completed by almost 650 people across Long Island. Here is some of what we found:
• Almost 50 percent of the participants said that it was more difficult finding help for mental health or drug problems than finding help for physical illnesses, especially when they were in crisis.
• Nearly 40 percent said that their insurance company did not have an adequate number of providers.
• 66 percent reported that their insurance company was not helpful in finding a suitable provider for themselves or a loved one.
One survey respondent wrote: “A family member within my household required therapy and we had difficulty finding a provider; when we did, scheduling was a nightmare because so many patients were trying to see him. I believe it was because he was one of the few willing to accept multiple insurance policies.” This was a familiar refrain.
Health insurers reimburse mental health and addictions care providers at such low rates that they flee health insurers in droves. This is a civil rights issue and a situation that puts lives at risk.
The NY State agency that Governor Cuomo has charged with monitoring and enforcing network adequacy is the Department of Financial Services. We are using the Project Access data to demand that Governor Cuomo and the Department of Financial Services launch a full scale investigation of access to care in New York State and to hold commercial health insurers’ feet to the fire.
If you agree, print this column, add a note saying “I agree” and include your name and address. You can write to the governor at: The Honorable Andrew M. Cuomo, Governor of New York State, NYS State Capitol Building, Albany, NY 12224; email him at Press.Office@exec.ny.gov; or call him at 518-474-8418.
Andrew Malekoff is the Executive Director of North Shore Child & Family Guidance Center, which provides comprehensive mental health services for children from birth through 24 and their families. To find out more, visit www.northshorechildguidance.org.
Andrew Malekoff featured on Mental Health Now television program, March 6, 2018
See this televised episode of Mental Health Now devoted to the 10th anniversary of the Mental Health Parity and Addiction Equity Act of 2008. With host Matthew Shapiro, NAMI-NYS and guests Tracie Gardner, Legal Action Center and Andrew Malekoff, North Shore Child and Family Guidance Center. Filmed on March 6, 2018 https://vimeo.com/259740918
By: Adina Genn, Long Island Business News,February 2, 2018
On Long Island, a mother with “Cadillac level” medical benefits struggled to get her child counseling when all of the professionals she called on the North Shore said they don’t take insurance. A father with equally good medical coverage resorted to driving upstate to get his child therapy for the same reason.
These scenarios are not unique, as revealed in a yearlong study produced by North Shore Child Family Guidance Center, a children’s mental health agency headquartered in Roslyn Heights. Through its initiative, “Project Access,” the organization is exploring the challenge of providing timely, affordable mental health treatment and addiction care. It aims to pinpoint obstacles to accessing care and bring about change.
“The landscape for providing community-based mental health and addictions care has changed dramatically during the last decade,” said Andrew Malekoff, executive director of North Shore Child Family Guidance Center. “At the same time that the New York State government has focused most of its attention on Medicaid recipients, middle class families with commercial health insurance have been all but brushed aside.”
Concerns about access to treatment come at a time of a growing need for care. More than 43 million Americans have faced a mental health challenge and more than 20 million grappled with substance abuse, while more than 8 million struggled with both. That’s according to “Pain in the Nation: The Drug, Alcohol and Suicide Epidemics and the Need for a National Resilience Strategy,” a joint study by Trust for America’s Health and Well Being Trust, which looked at figures from 2006 to 2015.
And while federal law established in 2008 requires insurers to provide the same level of mental health and substance abuse services as physical health services, that parity has yet to come to fruition.
Substandard rates of reimbursement
“Fewer and fewer providers accept commercial health insurance,” Malekoff noted. “Why? Because they pay substandard rates of reimbursement, well below the Medicaid rate.”
These findings are similar to those of other experts. According to a 2017 study by Milliman, a consultancy with expertise in the healthcare industry, medical and surgical providers received higher reimbursement rates than behavioral providers for comparable services. Those lower rates for behavioral providers, according to the study, led to “lower network participation by these providers,” making it difficult for people to access treatment, or to seek treatment out of network. In New York, the Milliman study found, patients were 5.8 times more likely to go out of network for care.
Out of 650 Long Islanders surveyed in the Project Access study, nearly 40 percent said their insurance providers did not have an adequate number of providers.
State Senator Elaine Phillips: ‘We need to demand change.’
Photo courtesy of the office of state Sen. Elaine Phillips
Almost half of the survey’s participants said it was more difficult to find help for mental health or substance abuse problems than finding help for physical illnesses, especially once in crisis. Two-thirds said their insurance company was not helpful when it came to finding care for themselves or a family member.
And nearly 40 percent of participants claimed that stigma and affordability were deterrents as they sought care. In addition, 23 percent said they felt that their efforts in trying to access care proved unsuccessful.
“I tried seeking mental health counseling but every time I tried getting help either my insurance wouldn’t be accepted or it was a long waiting time,” a Project Access survey respondent said. This person “was scared at first” but ultimately did get needed care.
“Unfortunately we’ve seen a lot of lack of progress, a lot of noncompliance from the insurers and, in many cases, not enough enforcement by state or federal regulators,” Henry Harbin, an advisor to the Parity Implementation Coalition and former chief executive of Magellan Health Services, told Marketplace, a program produced by American Public Media.
A push for change
Across the nation, leaders are pushing for change. For example, this week, former U.S. Rep. Patrick Kennedy was in Spokane, Washington, supporting mental health parity.
And on Long Island, leaders are asking Gov. Andrew Cuomo to launch a full-scale investigation of “network adequacy,” which requires that health insurers maintain adequate numbers of providers as a condition of their license.
“The Project Access report is a damning indictment of where we are with mental health and addictions care in our state today,” state Sen. Todd Kaminsky, D–Long Beach, said. “We’re not in the 19th or even 20th century. We have to do better.”
“We now have the data when we write to our government and state agencies,” said state Sen. Elaine Phillips, R–Flower Hill. “We need to demand change so people get the support they deserve.”
In January, Kaminsky and Phillips described Project Access’ “startling results” in a joint letter to Maria Vullo, the superintendent of New York State Department of Financial Services.
They said it is “imperative” that the state “conduct(s) a thorough investigation to determine why insurance companies are not being held accountable for network adequacy.” And, they added, “failure to properly treat mental health issues feeds into the opioid epidemic we experience in society today.”
As Malekoff explained in an email to friends and colleagues, the disparity “is a civil rights issue and a matter of life and death.”
Maria Vullo
Superintendent
New York State Department of Financial Services
One State Street
New York, NY 10004
Dear Superintendent Vullo:
We are writing to express our concerns regarding the difficulties that Long Islanders face accessing treatment for mental illness and addiction. The North Shore Child & Family Guidance Center recently released a troubling study, “Project Access,” which surveyed network adequacy and patients’ ability to access timely mental health and addiction services.
Project Access found startling results, showing insurance networks failed to grant access to an adequate number of doctors and providers in a timely manner for almost 40% of survey respondents. Further, about 50% reported it was more difficult to seek help for mental health illness than for physical maladies. In addition, 66% indicated it took between 2 to 15 doctors to access the care respondents needed when they were experiencing a crisis or a traumatic event. This may be a matter of life and death for the middle class families that we represent, and we need to act now.
It is imperative your department conduct a thorough investigation to determine why insurance companies are not being held accountable for network adequacy. When New York State neglects to monitor and regulate for network adequacy, mental health care becomes unavailable for too many. As you know, failure to properly treat mental health issues feeds into the opioid epidemic we experience in society today. This is simply unacceptable, and New York’s network adequacy must be investigated. Thank you for considering this request.
Andrew Malekoff, center, along with State Senators Elaine Phillips and Todd Kaminsky
Last week, the Roslyn-based North Shore Child & Family Guidance Center hosted a conference highlighting the difficulties Long Islanders face when seeking help for mental health or chemical dependency issues.
Project Access is a year-long study in which hundreds of Long Islanders were surveyed about their experiences in trying to obtain such medical help. The study was supported by the Long Island Unitarian Universalist Fund of the Long Island Community Foundation.
Of the 650 Long Islanders who took part in the survey, almost half said that it was more difficult finding help for mental health or substance abuse problems than finding help for physical illnesses, nearly 40 percent said that their insurance company did not have an adequate number of providers and two-thirds said that their insurance company was not helpful to them in finding a suitable provider for themselves or a loved one.
Most disturbingly, almost 40 percent reported that stigma and affordability were impediments to seeking care.
“This report verifies what we have long known: Insurance companies and the government are not living up to their responsibility to provide people with quality, affordable and timely mental health and addictions care,” said Andrew Malekoff, executive director of the center. “Even though they are legally bound to have adequate networks of care, they fall far short of that mandate.”
Several speakers shared their stories.
“When my sister’s condition began to worsen, it put our entire family into crisis,” said Kerry Eller. “We knew she needed professional help to get her through this incredibly difficult time. It was extremely challenging to access appropriate treatment for my sister. The insurance company was not helpful with connecting us to in-network providers; they would give us referrals but when we would call, we would often find out that they no longer participated with our plan. It was exhausting and heart breaking to have to endure one failed call after another.”
“At our first visit to the ER, their first question wasn’t ‘How is he doing’ but rather ‘Do you have insurance that covers mental health care?’” added Janet Susin, the president of Queens/Nassau NAMI, on the troubles she faced in getting her son care for schizophrenia. “The reality is that there are not enough psychiatrists, particularly child psychiatrists, and very few are willing to take insurance. We need to do something to rectify that situation.”
Finally, Rebecca Sanin, President/CEO of the Health and Welfare Council of Long Island, spoke of the great disparity in obtaining mental health care as opposed to care for physical illnesses. “Imagine if cancer patients faced delays and inadequate coverage; we would be up in arms as a region,” she said. “Project Access shows that two-thirds of respondents said insurance companies were not helpful and that it required multiple calls and contacts to access care. This is unconscionable. When a person is in crisis, the window to engage in treatment is small, and it may never open again if they are turned away.”
“We are calling on the New York State Department of Financial Services to launch a thorough investigation of this issue,” Malekoff added. “It’s incumbent upon all of us to advocate for change. Access delayed is access denied. People’s lives are at stake.”
Senator Elaine Phillips joined North Shore Child-Family Guidance Center officials at a news conference today to promote the importance of affordable and timely mental health care for all New York residents. . The news conference unveiled results to “Project Access,” a study conducted by the center that explores roadblocks individuals face when trying to obtain mental health and addiction care.
“Timely and affordable mental health and addiction care should be accessible to anyone in need.” Senator Elaine Phillips said. “I applaud the North Shore Child-Family Guidance Center for its unwavering support and dedicated work to raise awareness of a problem that has affected far too many middle and working class families on Long Island. ‘Project Access,’ the Center’s recent study, sheds much needed light on the obstacles individuals face when trying to obtain care for mental health illnesses and substance abuse problems.”
“Project Access” is an initiative to improve access to mental health and addictions care. Nearly 650 Long Islanders responded to the survey, with almost half of the respondents indicating that it was more difficult finding help for mental health or substance abuse problems than finding help for physical illnesses.
The North Shore Child & Family Guidance Center helps children and families address issues such as depression and anxiety, developmental delays, bullying, teen pregnancy, sexual abuse, teen drug and alcohol abuse, and family crises stemming from illness, death, trauma and divorce.
The Carter Burden Network raised more than $1 million last month at its annual gala at the Mandarin Oriental Hotel Manhattan. Proceeds from the event will go towards programming that benefits seniors across New York City. U.S. Sen. Kirsten Gillibrand made a guest appearance via video link to congratulate Board Chairman Jeffrey Weber, who is also chairman of Gillibrand’s working group on aging and received recognition for his contributions to the 46-year-old nonprofit. Also in attendance were Donna Corrado, commissioner of the New York City Department for the Aging, and Corrado’s deputy Caryn Resnick.
A new study details the obstacles that Long Island residents face when pursuing treatment for substance abuse and other mental health ailments. Nearly 40 percent of the approximately 650 people who took part in the study said that affordability was a barrier to receiving treatment, while a quarter of respondents could not locate a provider who accepted their insurance. The report calls on the New York State Department of Financial Services to further investigate whether commercial insurance providers in Long Island are complying with mandated mental health standards.
Catholic Charities Community Services of Orange and Sullivan leveraged a “Christmas explosion” of holiday decorations to raise $25,000 for needy families and individuals. A house tour through the village of Goshen took 500 people through seven different houses that were “decorated to the hilt” with holiday decor, said Kristin Jensen, chief advancement officer for the organization. She added that the event has steadily grown each year by about 100 new participants since it began three years ago.
Amida Care and Bedford Stuyvesant Restoration Corporation hosted a free community fitness class on Dec. 11 that shows what a little pre-planning can accomplish. The event – and another to be held early next year – was funded through a $5,000 grant sponsored by New York City Councilman Robert Cornegy as part of the city’s Expense Budget process. The next fiscal year will not begin for more than six months, but the submission period for fiscal year 2019 is coming up, judging by the Jan 3. opening date earlier this year. A full list of projects funded this year through the Expense Budget process can be seen here.
An item in the Dec. 12 NYN Media Buzz about a new study from the Citizens’ Committee for Children of New York City included an incorrect link. The study can be viewed here.
Janet Susin spoke at the press conference about the struggles her son had faced after being diagnosed with schizophrenia. (Photo courtesy of North Shore Child and Family Guidance Center)
Janet Susin said during her family’s first visit to the emergency room after her 16-year-old son was diagnosed with schizophrenia, the hospital staff had only one concern.
“The first question we heard wasn’t, ‘how’s he doing?’ It was, ‘do you have insurance?’” Susin said.
Susin was among a group of concerned relatives, public officials and caregivers at a press conference held Monday by the North Shore Child and Family Guidance Center to discuss the results of a year-long study titled Project Access that examined the ease or difficulty with which patients and their family have accessing mental health and substance abuse care, especially through insurance providers.
North Shore Child Guidance Executive Director Andrew Malekoff said that as part of the study, a 41-question survey was completed by 644 people who answered questions about demographics and experiences as well as an open-ended question for personal stories about the process.
Malekoff said fewer providers accept commercial health insurance plans because their rates of reimbursement are often lower than Medicare rates.
According to Project Access results, almost half the participants said it was more difficult to find help for mental health or substance abuse problems than care for physical ailments, 40 percent said their insurance providers did not have an adequate number of providers, and two-thirds said their insurance company was not helpful in finding a mental health care provider.
State senators Todd Kaminsky (D-Long Beach) and Elaine Phillips (R-Flower Hill) provided a bipartisan front from the state Legislature, both sharing stories of family members who suffered from mental health issues and struggled to receive help.
“The founder of the Nassau-Queens National Alliance on Mental Illness chapter was my cousin Arnold Gould, who passed away last year,” Kaminsky said. “He devoted his life to this issue, and for a long time, Arnold had a son who was the cousin in my family no one talked about or knew existed. We have to turn the page on that. We can do better.”
Kaminsky and Phillips both said they would write letters to Gov. Andrew Cuomo and the state Department of Financial Services with the Project Access data and their concerns about the issue.
“I am extremely proud to be supporting Project Access and to be supporting the mental health industry because it is going to take research like this when we do write the governor and the New York State Department of Financial Services,” Phillips said. “We have data behind it to say this isn’t happening in low socio-economic areas of one part of the state; this is a rampant problem that is happening throughout New York and especially here on Long Island.”
Phillips also said if needed, she would support legislation to make mental health care more accessible and affordable across New York.
North Shore Child and Family Guidance Center partnered with LIU Post for the research, and social work professor Elissa Giffords said the school received approval from their institutional review board before administering the survey to human subjects and placed surveys in waiting rooms and posted flyers with a link to the survey as well.
“People who completed the survey, it’s likely they already accessed care,” Giffords said. “This is quite important, particularly because although they could access treatment, they still reported impediments when seeking this care. This also means there’s a distinct possibility there are many people who gave up seeking care altogether.”
Susin, a past president of the Nassau-Queens chapter of National Alliance on Mental Illness, was a teacher, and her husband was a doctor at North Shore Hospital during that hospital visit 30 years ago, and she quickly learned that while her policy had $1 million worth of mental health coverage, her husband’s only offered $40,000 for the family for life.
Soon after their visit, her son, now 47, was prescribed an anti-psychotic medication and has not been in the hospital since thanks to the care of an excellent psychiatrist — a psychiatrist who charges $250 per visit and does not take insurance, Susin said.
Susin said while their psychiatrist was willing to try working with her insurance company, the agreement ended less than a year later because the psychiatrist believed the rates were too low and receiving payments from the insurers was a hassle.
Susin said she has paid out of pocket ever since.
“We’re lucky we can afford to pay for good care for our son and as a result, he’s remained stable all these years,” she said. “Every person struggling with a psychotic disorder or any mental health condition should have the same opportunity.”
Social worker Kerry Eller also spoke about the struggles of her teenage sister, who has dealt with mental health and substance abuse issues since she was 11.
Her mother was a single parent, trying to manage two younger boys while fighting to get her daughter the care she needed. Eller said her mother often blamed herself, asking if she caused these problems for her daughter and whether she was enough of a mother to care for her children.
“When anyone in my family had some kind of physical ailment, there were no issues getting care,” Eller said. “When I needed my tonsils removed, I wasn’t directed to multiple doctors just to find one that was one willing to provide me with the medically necessary treatment that my condition required. There is such a sigma related to psychiatric and substance abuse related disorders, which makes it scary to reach out in the first place.
“When you finally build up enough courage to reach out for help, and then your efforts are thwarted, it feels defeating.”
Family members share stories about difficulty accessing mental health and addictions care as results of year-long study are detailed at press conference
Roslyn Heights, NY, December 11, 2017 — If you’ve tried to get help for a family member or loved one who was struggling with mental health or chemical dependency issues and had trouble finding a provider who takes your insurance, you are not alone.
Today, North Shore Child & Family Guidance Center (also known as the Guidance Center) released the results of Project Access, a year-long study in which approximately 650 Long Islanders were surveyed about their experiences and frustrations in trying to obtain help. The results were announced at a press conference at the Guidance Center’s Roslyn Heights headquarters on Monday, December 11.
“This report verifies what we have long known: Insurance companies and the government are not living up to their responsibility to provide people with quality, affordable and timely mental health and addictions care,” said Andrew Malekoff, Executive Director of the Guidance Center. “Even though they are legally bound to have adequate networks of care, they fall far short of that mandate.”
A few key findings:
Almost half of the participants said that it was more difficult finding help for mental health or substance abuse problems than finding help for physical illnesses, especially when they were in crisis.
Nearly 40% said that their insurance company did not have an adequate number of providers.
Two thirds told us that their insurance company was not helpful to them in finding a suitable provider for themselves or a loved one.
Almost 40% of participants reported that stigma and affordability were impediments to seeking care.
And, almost 25% of participants reported that they felt their attempts at accessing care were futile.
The problem of access is often complicated by a family’s reluctance to seek help for a mental health or drug problem, as opposed to physical illnesses like cancer or diabetes. Despite progress, stigma still looms large.
Kerry Eller spoke of the difficulty in finding treatment for her family member who has mental health and chemical addictions issues. “When my sister’s condition began to worsen, it put our entire family into crisis,” said Eller. “We knew she needed professional help to get her through this incredibly difficult time. It was extremely challenging to access appropriate treatment for my sister. The insurance company was not helpful with connecting us to in-network providers; they would give us referrals but when we would call, we would often find out that they no longer participated with our plan. It was exhausting and heart breaking to have to endure one failed call after another.”
Janet Susin, the President of Queens/Nassau NAMI, spoke of the trouble she faced getting her son care for schizophrenia. “At our first visit to the ER, their first question wasn’t ‘How is he doing’ but rather ‘Do you have insurance that covers mental health care?’ The reality is that there are not enough psychiatrists, particularly child psychiatrists, and very few are willing to take insurance.We need to do something to rectify that situation.”
State Senator Todd Kaminsky, who also spoke at the press conference, said, “The Project Access report is a damning indictment of where we are with mental health and addictions care in our state today… We’re not in the 19th or even 20th century. We have to do better!”
State Senator Elaine Phillips told the audience, “With Project Access, we now have the data when we write to our government and state agencies. We need to demand change so people get the support they deserve!”
For her part, Rebecca Sanin, President/CEO of the Health and Welfare Council of Long Island, spoke of the great disparity in obtaining mental health care as opposed to care for physical illnesses. “Imagine if cancer patients faced delays and inadequate coverage; we would be up in arms as a region,” she said. “Project Access shows that two-thirds of respondents said insurance companieswere not helpful and that it required multiple calls and contacts to access care. This is unconscionable. When a person is in crisis, the window to engage in treatment is small, and it may never open again if they are turned away.”
“We are calling on the New York State Department of Financial Services to launch a thorough investigation of this issue,” said Malekoff. “It’s incumbent upon all of us to advocate for change. Access delayed is access denied. People’s lives are at stake.”
The study is supported by the Long Island Unitarian Universalist Fund of the Long Island Community Foundation.
Roslyn Heights, NY, November 27, 2017 — It’s a scenario that is far too common: Someone makes the difficult decision to seek out professional help for a mental health problem for themselves or their loved one and is faced with a myriad of roadblocks, including a lack of providers who take their insurance and demand cash only—or even if they find a therapist in their plan, the provider has an enormously long waiting list or is not accepting new clients at all.
North Shore Child & Family Guidance Center (also known as the Guidance Center) led an effort to assess these problems with Project Access, in which approximately 650 Long Islanders were surveyed about their experiences in trying to obtain help. The results will be announced at a press conference at the Guidance Center’s Roslyn Heights headquarters on Monday, December 11 at 10 a.m.
Expected to be speaking are New York State Senators Elaine Phillips and Todd Kaminsky; Janet Susin, Past President of the National Alliance on Mental Illness (NAMI) Queens/Nassau; and Rebecca Sanin, President of the Health and Welfare Council of Long Island.
“This report verifies what we have long known: Insurance companies and the government are not living up to their responsibility to provide people with quality, affordable and timely mental health and addictions care,” says Andrew Malekoff, Executive Director of the Guidance Center. “Even though they are legally bound to have adequate networks of care, they fall far short of that mandate. It’s incumbent upon all of us to advocate for change. Access delayed is access denied. People’s lives are at stake.”
A few key findings:
Almost 50% of respondents indicated that it was more difficult finding help for mental health or substance abuse/addiction problems than finding help for physical illnesses, particularly when they were in crisis.
Nearly 40% of respondents said that their insurance company did not have an adequate number of providers.
Exacerbating the problem of individuals finding appropriate providers for mental health and addictions care is stigma and the shame it generates, notes Malekoff. “If someone’s child has cancer, they won’t hesitate to call the doctor, but because of the stigma surrounding mental health, it makes it very difficult for them to reach out. Clearly, as this study reveals, despite any
progress made in eradicating stigma, we still have a long way to go with respect to public education and mental health awareness.”
The aim of Project Access is to raise public consciousness, stimulate interaction among stakeholders and motivate New York State, through the Department of Financial Services, to carry out a thorough investigation of commercial health insurers with respect to access to care.
After reviewing the research, Project Access committee member Dr. Ilene Nathanson, Chair of the Social Work Department at LIU Post, concluded, “If the definition of insurance is protection then the gross inadequacies of our insurance system are laid bare in this study. Delays, unaffordability, outright inaccessibility – all courageously endured by human beings in need of mental health care. It is time that the insurance industry stepped up to the task of protecting.”
The study is supported by the Long Island Unitarian Universalist Fund of the Long Island Community Foundation.
For previews of the research prior to the press conference, contact Andrew Malekoff at amalekoff@northshorechildguidance.org.
We’re pleased to provide you with a link to the results of a year-long research undertaking called Project Access, which has been supported by the Long Island Unitarian Universalist Fund of the Long Island Community Foundation.
We surveyed almost 650 respondents across Long Island about their experiences regarding the ease or difficulty with which they were able to access mental health and addictions care. As the results of our study show, far too many people are having trouble finding timely, affordable, quality care for themselves and their loved ones. Access delayed is access denied.
We hope that you will find this report affirms what many of us know anecdotally regarding the impediments we and our neighbors experience when seeking to access care. Please feel free to forward this and to make your legislator aware of it.
