State to shorten wait time for mental health care

Law requires health insurers to trim to 10 business days

When Greta Christina fell into a deep depression five years ago, she called up her therapist in San Francisco. She’d had a great connection with the provider when she needed therapy in the past. She was delighted to learn that he was now “in network” with her insurance company, meaning she wouldn’t have to pay out of pocket anymore to see him.

But her excitement was shortlived. Over time, Christina’s appointments with the therapist went from every two weeks to every four weeks to every five or six.

“To tell somebody with serious, chronic, disabling depression that they can only see their therapist every five or six weeks is like telling somebody with a broken leg that they can only see their physical therapist every five or six weeks,” she said. “It’s not enough. It’s not even close to enough.”

Then, this summer, Christina learned she has breast cancer.

Everything related to her cancer care — her mammogram, biopsy, surgery appointments — happened promptly (like a “well-oiled machine,” she said), while her depression care stumbled along.

“It is a hot mess,” she said. “I need to be in therapy — I have cancer! And still nothing has changed.”

A law signed by Gov. Gavin Newsom in October aims to fix this problem for Californians. Senate Bill 221, which passed the Legislature with a nearly unanimous vote, requires health insurers across the state to reduce waiting times for mental health care to no more than 10 business days. Six other states — including Colorado, Maryland and Texas — have similar laws limiting wait times.

Long waits for mental health treatment are a nationwide problem, with reports of patients waiting an average of five or six weeks for care.

At Kaiser Permanente, the state’s largest insurance company, 87% of therapists said weekly appointments were not available to patients who needed them, according to a 2020 survey by the National Union of Healthcare Workers, which represents KP therapists — and was the main sponsor of the Cali

fornia waiting times legislation.

“It just feels so unethical,” said triage therapist Brandi Plumley, referring to the typical two-month waiting time she sees at Kaiser Permanente’s mental health clinic in Vallejo, east of San Francisco.

Every day, she takes multiple crisis calls from patients who have therapists assigned to them but can’t get in to see them, she said, describing the providers’ caseloads as “enormous.”

“It’s heartbreaking,” Plumley said. “What Kaiser simply needs to do is hire more clinicians.”

Kaiser Permanente says there just aren’t enough therapists out there to hire. It has struggled to fill 300 job vacancies in clinical behavioral health, according to a statement from Yener Balan, the insurer’s Northern California vice president of behavioral health.

Hiring more clinicians won’t solve the problem, said Balan, who suggested that sustaining one-on-one therapy for all who want it in the future wouldn’t be possible in the current system: “We all must reimagine our approach to the existing national model of care.”

Kaiser Permanente lodged concerns about the waiting times bill when it was introduced. And the trade group representing insurers in the state, the California Association of Health Plans, opposed it, saying the shortage of therapists would make meeting the two-week mandate too difficult.

“The COVID-19 pandemic has only exacerbated this workforce shortage, and demand for these services significantly increased,” said Jedd Hampton, a lobbyist for the California Association of Health Plans, in testimony during a state Senate hearing for the bill.

Hampton referred to a University of CaliforniaSan Francisco study that predicted California would have nearly 30% fewer therapists than needed to meet demand by 2028.

“Simply put, mandating increased frequency of appointments without addressing the underlying workforce shortage will not lead to increased quality of care,” Hampton said.

Lawmakers pushed back.

State Sen. Scott Wiener,

D-San Francisco, who authored the bill, accused insurers of overstating the shortage. State Sen. Connie Leyva, D-Chinom, said that the therapeutic providers are out there but that insurers are responsible for recruiting them into their networks by paying higher rates and reducing administrative burdens.

If insurers want more young people to enter the mental health care profession, they must improve salaries and working conditions now, said state Sen. Richard Pan, D-Sacramento.

As bipartisan support for the bill grew in Sacramento, insurers withdrew their formal opposition.

Greta Christina said she is desperate for the new law to take effect July 1. Christina thought about paying out of pocket in the meantime, to find a therapist she could see more often. But in a cancer crisis, she said, starting over with someone new would be too hard. So she’s waiting.

“Knowing that this bill is on the horizon has been helping me hang on,” she said.