Finding a psychiatrist in 2023 is already a tall order given the stresses on the mental health care system, thanks to the pandemic. This is especially true for the 28 million older adults on Medicare Advantage plans, according to a new study in Health Affairs. Nearly two-thirds of Medicare Advantage psychiatrist networks contain fewer than 25% of all psychiatrists in a given service area.

The new study is the latest in a series of findings highlighting a lack of coverage and access to mental health care nationwide, particularly for older adults. 

“It’s likely a rosier picture than reality,” said lead study author Jane Zhu, M.D., in a statement. “We know the actual number of psychiatrists available to see patients is much lower.” 

Tip sheet: 10 things journalists should know when reporting
on mental health and older adults

That’s because even if a psychiatrist is technically in-network, an overall national shortage of psychiatrists means that many are fully booked already and can’t accommodate new patients, Zhu said. This may translate to higher out-of-pocket costs, delays in care, or foregoing treatment entirely. In some areas, researchers found the picture was even more grim: not a single psychiatrist who accepted Medicare Advantage taking new patients. 

Compared to Medicaid, the federal-state program for low-income people or those receiving coverage through Affordable Care Act insurance plans, Medicare Advantage plans have much narrower networks of psychiatrists available to patients. 

“The reality is that access to mental health coverage does not equate to access to mental health services,” the researchers found.

Mental health crisis

In 2022, Joel Miller, chair of the National Coalition on Mental Health and Aging, called the shortage of geriatric-trained mental health professionals a crisis exacerbated by the COVID-19 pandemic. He also cited the  “snowballing effects of social isolation leading to trauma, anxiety, and depression.”

Mental health issues like depression in older adults are often brushed aside as “normal” aging, as I write in this new tip sheet. Depression and other mental health issues are treatable, but older adults are frequently reluctant to talk about their struggles, according to the Wales-based National Centre for Mental Health. There is often generational-related stigma about openly discussing their feelings.

Older adults also have unique physical and psychosocial considerations when it comes to mental health care. Grief and bereavement due to loss of a long-time partner or lifelong friends, cognitive issues, struggles with multiple chronic conditions, multiple medication regimens, differences in how their bodies metabolize medication, and more all affect diagnosis and treatment. Many older people have difficulty accessing care, which can also impact their ability to follow through with treatment.  

Insurers need to incentivize more psychiatrists and mental health professionals to accept health insurance, or to expand coverage of services delivered by other health care professionals such as psychologists, counselors or primary care physicians who provide mental health care, the study concluded.

How the study was done

Researchers built a nationwide dataset of health plan networks, their service areas and their participating providers in 2019 to assess psychiatrist network breadth compared with primary care and other specialty care physician networks across Medicare Advantage, Medicaid managed care, and the Affordable Care Act individual marketplaces. Narrow networks were defined as networks having fewer than 25% of the providers in the counties the network operated in, weighted by plan enrollment. 

They identified 682 Medicare Advantage networks, 167 Medicaid managed care networks, and 220 Affordable Care Act plan networks across 37 states, covering approximately 11.5 million Medicare Advantage enrollees (51.4% of all Medicare Advantage enrollees), 42 million enrollees in Medicaid managed care plans (77.8% of all Medicaid managed care enrollees), and 9 million enrollees in Affordable Care Act plans (77% of all Affordable Care Act plan enrollees). 

Their data analysis found that nearly two-thirds (64.6%) of psychiatrist networks were considered narrow, compared to about 40% in either Medicaid managed care or Affordable Care Act plan markets. About half of Medicare Advantage plans had network breadth less than 12.5%. They also found that psychiatrist networks were much narrower than those for primary care and other specialist physicians across all three markets.

Resources

• Tip sheet: 10 things journalists should know when reporting on mental health and older adults (AHCJ, 2023)
• Comparing older adults’ mental health needs and access to treatment in the U.S. and other high-income countries (Commonwealth Fund, 2022)
• How to improve access to mental health care for medicare recipients (NCOA, 2022)
• Addressing gaps in mental health services for older adults (PAN Foundation, 2021)
• The behavioral health care affordability problem (Center for American Progress, 2022)
• How does use of mental health care vary by demographics and health insurance coverage ? (KFF, 2022)
• A growing psychiatrist shortage and an enormous demand for mental health services (AAMC, 2022)