Pretend Parents Learn How Hard It Is to Get Child Mental Health Care

Getting access to child mental health services isn’t easy, even when armed with a big list of names provided by an prominent insurance company.

A group of researchers recently published the results of an interesting study in which the authors called the offices of pediatricians and child

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psychiatrists while posing as the parent of a 12-year old with depression.  They were looking to see if they could book an appointment and, if so, how long it would take.  Calls were made to physicians in 5 different urban areas (Seattle, Boston, Chapel Hill, Houston, and Minneapolis).  Phone numbers were obtained from online lists of providers who were in-network for Blue Cross Blue Shield.   The calls varied in-terms of how the service would be paid for (private insurance, Medicaid, and self-pay).   All told, the offices of 601 pediatricians and 312 child psychiatrists were contacted.   If there was no response after a first call to an office, a second one was placed.

Overall, an initial appointment was able to be made from only 40% of  the calls to pediatricians and only 17% of the calls to child psychiatrists.  The average wait time when an appointment was made was 17 days for pediatricians and 43 days for a child psychiatrist.   Significant differences were found in the ability to obtain an appointment by geographic region and by insurance, with calls claiming Medicaid as the insurance being less successful than private insurance and self-pay.  Interestingly, the most common reason that an initial appointment was not made was that the phone number was incorrect, with the contacted provider often no longer working there.

The authors concluded that appointment availability for child mental health services is low across a diverse range of locations. They urged additional efforts in increasing the workforce of child psychiatrists and additional training in mental health for primary care clinicians.

While this study probably doesn’t tell most primary care clinicians something they don’t already know, it does add some specific numbers to the problem and points out that access to behavioral health care can be difficult in both primary care and specialist settings.   It also highlights a problem that many people (including me) find really surprising in 2017, namely how challenging it is for families or referring physicians to get even an accurate and updated list of mental health professionals who are taking new patients and who take different types of payment. Finally, it should be reminded that these calls were placed just to pediatricians and child psychiatrists and not to other types of mental health professionals.


Cama S, Malowney M et al.  Availability of Outpatient Mental Health Care by Pediatricians and Child Psychiatrists in Five U.S. Cities. International Journal of Health Services.  2017:  epub ahead of print.

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