Rhode Islanders are over four times more likely than the national average to be forced out-of-network for mental health care than for primary health care, increasing their out-of-pocket costs. (Getty image)
I’ve been a licensed practicing psychologist in Rhode Island for over 20 years. I have never seen the need for services and access to providers as intense as it is right now. My practice never used to carry a wait list — we were generally able to see people within a week or two of initial contact. The waitlist for my group practice is now over 100 people deep.
And it just keeps growing.
Every practitioner I speak with is in the same situation. Two-thirds of psychologists have reported an increase in the severity of symptoms among patients experiencing anxiety and depression, trauma, stressor-related disorders, and substance use disorders in 2022. We need more quality, well-trained behavioral health providers to alleviate this historic bottle neck in treatment access.
The country, including Rhode Island, is experiencing a major mental health crisis The National Alliance of Mental Illness reports that 178,000 adults in Rhode Island have a diagnosed mental health condition, 41.5% of adults reported symptoms of anxiety or depression, and 27.2% were unable to get needed counseling or therapy
Access to services is a major problem with 36% of the U.S. population—over 125 million Americans— living in a place designated as a mental health professional shortage area, according to the Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services,
In Rhode Island, Newport and Washington counties are both designated as mental health professional shortage areas. That means nearly a quarter of a million people in Rhode Island live in a community that does not have enough mental health professionals. Most psychologists in the state are located between Warwick and Providence.
Clearly, Rhode Island needs more well trained mental health providers. But what would it take to draw more of them to the Ocean State?
Look no further than the fact that Rhode Islanders are over four times more likely than the national average to be forced out-of-network for mental health care than primary health care, making it more difficult to find care and less affordable due to higher out-of-pocket costs. Low reimbursement rates serve as a disincentive to clinicians who might consider providing services here.
Compared to our colleagues in medicine, doctoral level psychologists are tragically underpaid, yet it is a very expensive area of health care. Better and more sustainable models of reimbursement are needed.
Governor Dan McKee recently statutorily authorized the Office of the Health Insurance Commissioner to examine social and human services reimbursement rates, including Medicaid and commercial insurance, and make regional comparisons.
So, what else can we do to better meet the mental health needs of Rhode Islanders? While these are complex issues, there are some steps we can take to alleviate the mental health crisis on local and national levels. Clearly, as evidenced by the long wait list at my practice, we need more quality, well-trained behavioral health providers. Additionally we should work to improve the following:
- Integrated Behavioral Health (IBH): IBH is when behavioral health professionals coordinate and work closely with medical doctors, especially primary care physicians. This may come in the form of co-location or other less intensive but coordinated arrangements. A large number of behavioral health issues present in primary care offices, so this can be an effective way to intervene and treat these issues earlier, improving outcomes and reducing overall costs.
- Telehealth: If there was any benefit from the pandemic, it was the acceleration of integrating telehealth into the healthcare system. This trend needs to continue and expand based on evidence-based, best practices.
- Technology: The area of digital therapeutics, or the use of cell phone applications, for the alleviation of mental health issues is on the rise. We need evidence-based policy to guide the proliferation and use of these technologies.
With coordinated efforts among clinicians, educators, researchers, policy makers, and the insurance industry, we can more effectively address the needs of our nation and our state. This is not the time for delay or siloed thinking – we all need to work together toward the common goal of quality, affordable behavioral health care.
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