Mental health patients could see wait times cut under bill
State Sen. Scott Wiener, DSan Francisco, introduced legislation this week that would require health insurance providers to help accelerate the delivery of mental health care services that advocates say are desperately needed to confront a growing crisis fueled by the coronavirus pandemic.
The bill, SB221, would cut down on wait times for patients seeking care for mental health and substance use issues, requiring health plans and insurers to provide timely followup appointments. Wiener said the legislation is meant to ensure that mental health is treated with the same urgency as other medical issues.
“If you break a leg, you can expect to receive immediate followup care — no one with health insurance would be told they have to wait six months to get a cast removed because no providers were available,” Wiener said. “Yet, that’s
exactly how we currently treat mental health and substance use disorder treatment.”
State law mandates that health care providers schedule patients for an initial appointment within two weeks, but it makes no stipulation for followup visits, leading to long wait times for those attempting to access mental health care. The bill would target long wait times at Health Maintenance Organizations, or HMOs, like Kaiser Permanente, which serve as both a health care insurer and a provider. It would also prevent health insurers from enforcing limits on coverage for mental health.
After initially responding to a reporter’s inquiry about the legislation, Kaiser Permanente did not respond to direct questions or make a representative available for an interview.
Health care workers and advocates say the pandemic has exacerbated an already dire mental health care crisis, as shortstaffed facilities contend with a growing demand for services to treat depression, anxiety, substance use and other maladies aggravated by shelterinplace orders.
“Wouldn’t it be amazing if mental health care was just as easy to get as medical health care?” said Ann Rivello, a licensed clinical social worker in the psychiatry department at Kaiser Permanente in Redwood City.
Patients frequently wait up to two months for followup appointments or are funneled into group therapy, Rivello said. The pandemic had reached a “boiling point,” she said, causing many people to seek out counseling for the first time.
“People are facing joblessness, moving back at home, a difficult relationship, and we have to tell them, ‘We don’t have any appointments, don’t get your hopes up,’ ” she said.
Rivello said she hopes the bill is successful in mandating insurers to provide adequate services — and she isn’t alone. The National Union of Healthcare Workers, which represents more than 4,000 clinicians, therapists, psychologists, social workers and psychiatric nurses at Kaiser Permanente, has thrown its support behind the bill.
“We’ve worked so hard to lessen the stigma surrounding mental illness, but people who are desperate for help still aren’t getting better because their health insurer makes them wait a month or longer to see their therapist,” said Sal Rosselli, the union’s president. “This legislation would close the biggest loophole that still allows insurers to deny Californians timely and appropriate mental health and substance use disorder care.”
Chelsie Martinez knows the importance of frequent, sustained mental health care in a crisis. As a patient at Kaiser Permanente in Santa Rosa for six years, she waited between six and eight weeks for each followup appointment, a cadence she called wholly inadequate to treat her history of trauma.
“I had therapists who couldn’t remember my name because they hadn’t been able to see me for so long,” she said.
Martinez began seeing a therapist she trusted, but said that despite her best efforts, she was only able to book infrequent sessions. Her flashbacks, suicidal thoughts and posttraumatic stress disorder continued, an experience she said greatly affected her young son.
The therapist “got to know me as a person and know my story,” she said, “but I couldn’t see him enough to pick up where we left off.”
Martinez later began seeing the same therapist in private practice once or twice weekly — paying for the sessions out of pocket — and within a short span of time she began to stabilize, she said.
“I got my flashbacks and PTSD under control better in six weeks of consistent therapy than I did in the previous six years,” she said.
Martinez credits her improvement to the consistent care she received. She said she hopes that mandating timely followups can have positive effects not just for the patient seeking therapy, but for their family and their community.
“The focus is on the patient, but there is a much bigger picture,” she said.