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Kids' Mental Health Care Imperiled

Survey Says 50 Percent Of Psychiatrists Reject Private Insurance For The Young

April 13, 2007
By WILLIAM HATHAWAY, Courant Staff Writer

If parents are lucky enough to find a child psychiatrist in Connecticut for their children, they are likely to find that half no longer take private insurance.

And many of those who accept private insurance say restrictions often force them to prescribe drugs rather than engage in talk therapy, according to a survey of child and adolescent psychiatrists released Wednesday.

The survey is another illustration of why more parents are having difficulty getting professional help for troubled children, said Attorney General Richard Blumenthal, who released the survey Thursday at a news conference with Child Advocate Jeanne Milstein.

Milstein cited the case of a woman with two bipolar sons who was given a list of 90 child psychiatrists by her managed care company only to find no one who was taking new patients.

Some of the names on the list were duplicates or dead, Milstein said.

"We would not accept this for someone with leukemia," said Ann Nelson, a mental health advocate for children, at the press conference.

Although the state officials conceded they had limited leverage over actions of insurers, Blumenthal and Milstein urged managed care companies to pay psychiatrists reasonable fees for talk therapy to encourage more doctors to enroll in their plans. They also said the companies need to improve accuracy of the lists of providers.

Some of the problems in delivery of child psychiatric treatment are real but should not all be laid at the door of managed care companies, said Keith Stover, a lobbyist for the Connecticut Association of Health Plans. Connecticut has some of the most aggressive laws in the nation requiring coverage of mental health conditions, he said.

"To say that the managed care industry is responsible for all the ills suffered in child psychiatry is an easy shot to take, but in some respects it is a total copout," Stover said.

The 131 child psychiatrists who answered 17 questions on the mail survey were sharply critical of managed care plans in Connecticut.

Managed care companies do not reimburse for the true cost of caring for children and arbitrarily limit the number of visits or the time children can spend with therapists, many of those who responded to the survey said.

The cost of caring for children is much higher than for adults, explained Hank Schwartz, vice president for behavioral health at Hartford Hospital and psychiatrist in chief at the affiliated Institute of Living.

Psychiatrists must not only treat children, but meet with parents and discuss problems with schools and other agencies, Schwartz said. None of that time is reimbursed, he said.

The hassles of dealing with insurance paperwork are a large reason why half the psychiatrists say they will no longer see patients with insurance and now only take cash. The dwindling number of psychiatrists who take insurance means that parents must either pay cash, delay needed treatments until they can get an appointment, or go without care, Blumenthal said.

"Connecticut now has a two-track system to deal with mental health and the track covered by managed care is going over a cliff," Blumenthal said.