Massachusetts residents who need health care are colliding with a hard reality: Having medical insurance doesn’t guarantee you can get treatment, particularly for psychiatric problems.
More than half of adults who sought mental health or addiction treatment in recent months had difficulty getting that care, according to a survey of 2,201 residents by the Blue Cross Blue Shield of Massachusetts Foundation in Boston. About 39 percent of those surveyed went without needed treatment. And about 13 percent went to an emergency room — even as about half of those patients acknowledged their condition was not an emergency, according to the survey.
The obstacle wasn’t a lack of insurance; the vast majority of patients were insured. Rather, the problem was that providers either did not accept their insurance or their practices were closed to new patients.
Lower-income patients were especially hard hit by the lack of access to care, as they were more likely to seek mental health and substance abuse treatment in the first place.
Karen Gromis, deputy director of the National Alliance on Mental Illness in Massachusetts, said the results are not surprising. “It’s what we hear constantly,’’ she said.
The Globe reported in October that Massachusetts has more mental health care providers per capita than any other state, more psychiatrists than anywhere else but Washington, D.C., and more child psychiatrists than all but D.C. and Rhode Island. Yet, only about half accept payment from the state and federal Medicaid program. Even when it comes to private insurance, only about half of psychiatrists in the Northeast take it.
Audrey Shelto, president of the foundation, said the nonprofit organization has received anecdotal reports that people can’t get appointments with mental health providers. But this is the first time the foundation has asked residents about access to mental health and substance abuse treatment since it began the surveys a decade ago.
“If change is going to happen at the magnitude that’s needed, it’s going to be necessary that we start building a more solid evidence base,’’ Shelto said.
The survey was conducted by phone between February and May and asked residents about their experiences in the prior year.
Shelto and several other leaders who work in the field said solutions must include higher fees for psychiatrists, psychologists, and social workers. Medicaid and many private insurers don’t pay enough to practitioners, they said, who are already in constant demand.
On top of that, they spend hours on applications to join insurance networks, and on paperwork needed to get paid for treating patients.
Vic DiGravio, president of the Association for Behavioral Healthcare in Natick, said the Legislature and the Baker administration have invested heavily in mental health care and substance abuse treatment. Health and Human Services officials have said that Medicaid is increasing fees to mental health providers by $100 million between 2016 and 2020.
But when it comes down to the rates paid to an individual provider, the increases have not been enough to persuade more of them to participate in the program, said DiGravio, whose organization represents community-based mental health and addiction treatment organizations.
“The biggest crisis in access is to prescribers,’’ such as psychiatrists who can write prescriptions for medications, he said.
“For a clinic to have a doctor on staff to see patients on a regular basis, the rates don't cover their time.’’
Elissa Snook, spokeswoman for the state’s Medicaid program, said in an e-mail that rate increases for providers will hit this year, and that as the foundation report pointed out, “the problem of providers refusing to accept insurance extends to’’ private insurers, too.
The foundation survey also found that Massachusetts residents have difficulty accessing regular medical care — though apparently for different reasons than they do with mental health care. About 46 percent of respondents said they had difficulty getting health care treatment in general.
Shelto said this problem is more difficult to untangle. The cause may be a lack of primary care providers, and middle-income patients being unable to afford high deductibles and other cost-sharing required by their insurance policies. The results are similar to previous surveys, she said.
“Unfortunately, we aren’t making much progress in this area,’’ Shelto said.
Liz Kowalczyk can be reached at firstname.lastname@example.org.