What to Do If You're Having Trouble Getting in to See a Psychiatrist

With psychiatrists already in limited supply and more people gaining insurance coverage under the Affordable Care Act, increasingly many psychiatrists aren't taking new patients because they're at capacity.

"There is a shortage of psychiatrists, and there is even more of a shortage of child psychiatrists and geriatric psychiatrists," says Dr. Renée Binder, immediate past president of the American Psychiatric Association. According to the American Medical Association, the number of adult and child psychiatrists increased by just 12 percent from 1995 to 2013, from 43,640 to 49,079, lagging far behind the 45 percent increase in total physician numbers and population growth in the U.S.

Despite the Mental Health Parity and Addiction Equity Act, which was enacted in 2008 in an effort to ensure mental health services are covered on par with medical and surgical health insurance benefits, experts in the field say mental health coverage still lags, leaving many patients to pay out-of-pocket or forgo coverage. Many psychiatrists don't accept private insurance or Medicare, while others have chosen to opt out of insurance plans or networks, citing what they see as unfavorable reimbursement levels.

A 2013 study published in JAMA Psychiatry found that the percentage of psychiatrists taking private insurance dropped 17 percent between 2005 and 2010 to 55 percent, and that the percentage accepting Medicare dropped 20 percent, also to 55 percent. That compares with 93 percent of non-pediatric primary care physicians, for example, who report they take private insurance and 86 percent who take Medicare (though the number taking new patients is considerably lower at 72 percent), according to 2015 Kaiser Family Foundation/Commonwealth Fund survey data. As a result of coverage limitations and the psychiatrist shortage, patients frequently have difficulty getting in to see a psychiatrist.

"I meet patients all the time who struggle with this," says Dr. Andrew Gerber, medical director and CEO of the Austen Riggs Center in Stockbridge, Massachusetts, which provides a continuum of care for adults with complex psychiatric problems. Despite the obstacles, however, including the fragmented nature of mental health care, there are steps patients can take to improve their ability to get the mental health care they need.

[See: How to Find the Best Mental Health Professional for You.]

To start, talk to your primary care provider. Primary care doctors -- including OB-GYNs who serve as ad hoc primary physicians for many women -- often help patients with mental health concerns, says Teri Brister, director of knowledge integration at the National Alliance on Mental Illness, a nonprofit advocacy, education and support organization. In addition to doing an initial assessment, taking a patient history and prescribing medication, a primary care provider can refer a patient to an appropriate mental health professional, if needed.

Who the best practitioner is really depends on the mental health issue a person faces, Binder says. A doctor might recommend seeing, for example, a family or marriage therapist for issues that have a strong relational component or a psychiatrist to treat a serious mental health condition, such as major depression, schizophrenia or substance abuse issues. In addition to helping guide a patient's decision, a doctor's referral -- and even having the doctor's office call the mental health provider -- can expedite the process to see a mental health professional.

Taking on fragmented health care, some primary care offices now feature an integrated model of care, such as where primary care physicians and mental health professionals see patients under one roof. In some instances, those who provide mental health services work in close consultation with a psychiatrist (who is generally not based in the primary care office, but works outside the office), who provides input on treatment decisions. That''s a collaborative care model the APA supports, Binder says.

Check your health plan's list -- twice. If you're planning to see a psychiatrist, you should be able to obtain a list of covered providers from your health plan. "Every insurance policy has such as list," Gerber says. However, he's quick to add, that doesn't mean every psychiatrist on the list will be taking new patients. Out-of-date directories, or so-called "phantom" networks or panels, Binder says, make it look like patients have many more options than they actually do, when health plans list providers who aren't in network or perhaps not even practicing. "I've seen panels where the psychiatrist is deceased," she says. Gerber says in addition to sharing the list with a primary care provider for recommendations, it's important to call through the list to see who is -- and isn't -- taking new patients.

[See: 11 Simple, Proven Ways to Optimize Your Mental Health.]

Go the extra mile. For those in less populated areas, Gerber recommends calling the nearest medical center of excellence, like an academic medical center, to inquire about affiliated local providers. "That's not to say academic medical centers are always the right or best place to go for care," he says. "But they often have networks and know about providers, particularly when you're in a more rural area." If you can afford the time and gas, he adds, it may also be worth driving extra miles, within reason, to see a psychiatrist or therapist who's a good fit.

Try telepsychiatry. This is offered in some primary care offices, as well as by other health providers. Through telephone or videoconferencing, patients can gain access to psychiatrists where options are limited or otherwise non-existent, such as in rural areas. This can be very helpful in providing a needed consult, Binder says. The downside: Some nuances, like a patient's nonverbal cues, may be missed. "Much of what we do in psychiatry depends upon face-to-face interactions that are really much more difficult to do even by videoconference," Gerber says. Still, experts say it's a far better option than forgoing seeing a mental health provider altogether.

Get professional help getting professional help. Brister says often it's a struggle for people just to get the mental health help they need. For that reason, NAMI provides support services, including aligning individuals and families with others who have been through similar struggles. You can call the organization's HelpLine -- 1-800-950-NAMI (6264) -- to find a chapter or services in your area.

Don't put your emergency on a waiting list. Sometimes a mental health crisis can present an immediate danger to the individual or others. In such cases, experts advise going straight to a hospital emergency room. That could range from being suicidal to acute signs of psychosis, such as delusions or paranoia, making it important to advocate for loved ones if they can't take themselves to the ER. "All emergency rooms have access to psychiatric care," Binder says -- with a mental health team that's on call and supervised by a psychiatrist.

Opt for collaborative care. Research finds the most effective treatment addresses the biological, psychological and social aspects of mental health conditions. "We call it the biopsychosocial model of collaborative treatment -- that's really what we advocate for, it's looking at the whole person," Brister says. For patients, seeing multiple mental health providers is not only an evidence-based therapeutic approach, but a practical solution to the short supply of psychiatrists.

[See: Apps to Mind Your Mental Health.]

"Most psychiatrists don't engage in therapy," Brister notes -- even though they're trained to be able to do so -- instead focusing limited time primarily doing check-ups, including to discuss medications patients are taking. So patients are often best served to see both a psychiatrist and psychologist or a psychiatrist and a counselor or social worker. "It really does take a team approach," Brister says.

Michael Schroeder is a health editor at U.S. News. You can follow him on Twitter or email him at mschroeder@usnews.com.