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California joins other states with laws limiting wait times for mental health issues


Many Americans with mental illnesses report long delays in getting care, even when they're struggling with severe depression, substance abuse or suicidal thoughts. In some states, the average wait is five to six weeks. But California just passed a law telling health insurers they have to reduce those wait times to no more than two weeks. Here's April Dembosky from member station KQED in San Francisco.

APRIL DEMBOSKY, BYLINE: When Greta Christina fell into a deep depression five years ago, it got so bad she couldn't work. She called up her therapist in San Francisco, someone she'd had a great connection with in the past, and she found out he was now on staff at Kaiser Permanente, California's largest insurer. This meant she wouldn't have to pay out of pocket anymore to see him.

GRETA CHRISTINA: And so I was like, great. I have Kaiser. I'm just going to see my therapist through Kaiser. That's perfect.

DEMBOSKY: At first, her therapist was able to see her every couple weeks - not ideal, but it was enough.

CHRISTINA: And then it just started being every three weeks, every four weeks. Now I'm lucky if I see him every five or six weeks.

DEMBOSKY: She says it's been like this for a couple years now. Medication helps, but without regular talk therapy, she says the depression is catching up with her. She's starting to have memory loss. She can't stay focused. She can barely get out of bed in the morning.

CHRISTINA: 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. It's not enough. It's not even close to enough.

DEMBOSKY: Then, over the summer, she was diagnosed with breast cancer.

CHRISTINA: And I need to be in therapy. I have cancer, and still nothing has changed.

DEMBOSKY: Everything related to her cancer care has happened promptly. Her mammogram..

CHRISTINA: Mammogram...

DEMBOSKY: ...Then biopsy...

CHRISTINA: ...Biopsy.

DEMBOSKY: ...She got scheduled for surgery.

CHRISTINA: Which is in October.

DEMBOSKY: Then had her pre-op appointments...

CHRISTINA: Breast surgeon, plastic surgeon, oncologist.

DEMBOSKY: ...All like clockwork.

CHRISTINA: It is a well-oiled machine.

DEMBOSKY: But she still has to wait six weeks to see her therapist.

CHRISTINA: It is a hot mess.

BRANDI PLUMLEY: It just feels so unethical, honestly. It feels so unethical.

DEMBOSKY: Brandi Plumley is a triage therapist at a Kaiser mental health clinic east of San Francisco. Every day, she takes multiple crisis calls from patients who have a therapist but can't get in to see them. She says the typical wait right now is two months.

PLUMLEY: Their caseloads are enormous at this point. It's heartbreaking. It really is heartbreaking, and it eats on me day after day after day.

DEMBOSKY: The new state law aims to change this. Starting next summer, health insurers across the state will have to make sure mental health appointments are available every two weeks. If they don't, they could be fined.

PLUMLEY: What Kaiser simply needs to do is hire more clinicians.

DEMBOSKY: But Kaiser says there just aren't enough out there. Health insurance companies initially opposed the bill, saying a shortage of therapists would make it too difficult to meet the two-week mandate. Lobbyist Jedd Hampton testified in the Senate last spring.


JEDD HAMPTON: The COVID-19 pandemic has only exacerbated this workforce shortage. Simply put, mandating increased frequency of appointments without addressing the underlying workforce shortage will not lead to increased quality of care.

DEMBOSKY: But lawmakers pushed back. They accused insurers of overstating the shortage. They said the therapists are out there, and it's up to the insurers to recruit them by paying better and cutting back on paperwork. This approach may work in California, but it's unlikely to spread nationwide anytime soon. Only seven states have laws limiting wait times for mental health.

HEMI TEWARSON: In some states, there really isn't the workforce.

DEMBOSKY: Hemi Tewarson runs the nonpartisan National Academy for State Health Policy. She says in places like New Mexico or Montana or Wyoming, there really aren't enough therapists out there at any price.

TEWARSON: They don't have the provider. So you could find the insurers as much as you want, you're not going to be able to, in the short term, make up those wait times if they already exist.

DEMBOSKY: In California, Greta Christina says she's desperate for the new wait time rules to take effect that will happen in July.

CHRISTINA: Knowing that this bill is on the horizon has been helping me hang on.

DEMBOSKY: She thought about paying out of pocket to find a therapist she could see more often. But she says in the middle of a cancer crisis, it was too hard to think of starting over with someone new. For NPR News, I'm April Dembosky in San Francisco. Transcript provided by NPR, Copyright NPR.

April Dembosky is the health reporter for The California Report and KQED News. She covers health policy and public health, and has reported extensively on the economics of health care, the roll-out of the Affordable Care Act in California, mental health and end-of-life issues. Her work is regularly rebroadcast on NPR and has been recognized with awards from the Society for Professional Journalists (for sports reporting), and the Association of Health Care Journalists (for a story about pediatric hospice). Her hour-long radio documentary about home funeralswon the Best New Artist award from the Third Coast International Audio Festival in 2009. April occasionally moonlights on the arts beat, covering music and dance. Her story about the first symphony orchestra at Burning Man won the award for Best Use of Sound from the Public Radio News Directors Inc. Before joining KQED in 2013, April covered technology and Silicon Valley for The Financial Times, and freelanced for Marketplace and The New York Times. She is a graduate of the University of California at Berkeley Graduate School of Journalism and Smith College.

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