Why behavioral health expert Ghinassi says growth in interest is exacerbating shortfall in access

The pandemic brought more patients to the offices of behavioral health care providers. And, so far, it looks like a new standard has been set.

Frank Ghinassi, who serves as senior vice president of the Behavioral Health and Addiction Service Line at RWJBarnabas Health, said people went from having maybe two contacts in their life with behavioral health disorders to more like four or five. That number hasn’t shown signs of retreating to where it once was.

Another thing that hasn’t changed in the post-pandemic environment, he added, is that it’s not always easy to find treatment when it’s needed.

“Coming off the pandemic, we’ve refocused society on the issues around the prevalence of behavioral health disorders,” he said. “But there’s still a discrepancy between need and access in a lot of places.”

Industry experts refer to the number of federally designated mental health professional shortage areas, where more than half of the country’s rural residents live, according to a report in the Journal of Clinical and Translational Science.

But access issues show up even in metropolitan areas, where private practice dominates among behavioral health service providers, Ghinassi said.

General vs. specialized

Health care professionals in rural areas tend to be more generalized, and urban areas tend to feature more specialists. There are always exceptions to the rule, but that’s how Frank Ghinassi of RWJBarnabas Health sketches it out.

“The traditional country primary doctor someone might have in mind has done a lot of suturing and done a little of everything,” he said. “In a big urban area, in general, you’re going to find more specialists.”

One thing people might not realize about the behavioral health landscape, Ghinassi adds, is that it shares some of the same characteristics when it comes to the urban and rural distinctions.

“If you’re doing psychiatry in a rural setting, you’re going to see everyone, and so you have to be a generalist,” he said. “But in the urban clusters of behavioral health professionals, it tends to be that people have anxiety specialties, or depression, or they see patients with autism.”

“There’s more psychotherapy interventions available in every city, but you’ll find that a vast majority don’t put themselves on any insurance panels,” he said. “If you’d like to use one of these services with commercial insurance or Medicaid, often, they’ll tell you they don’t take insurance. And their fee is whatever the market will value, which is probably a lot higher in (this region) than most places.”

The level at which behavioral health disorders are reimbursed falls a great deal shy of what these practices believe is required to participate in insurance plans.

“Patients are making payments in cash, and told they can go try to get it reimbursed later,” Ghinassi said. “But that might be less than half what they’re being charged.”

While the out-of-pocket fees might be lower in rural counties than urban ones, it’s always orders of magnitude more than what Medicaid or commercial plans would reimburse, he added. Private practitioners convey that they wouldn’t make an adequate income otherwise.

The predicament has led to less young health care scholars choosing to end up in behavioral health among the broad range of medical professionals available. As a result, researchers say the country could end up short of more than 30,000 psychiatrists within several years.

And, just having more students pursue behavioral health careers wouldn’t close the gap between mental health needs and accessibility, in Ghinassi’s view. That would take rethinking how these professionals are reimbursed in the first place.

“That’s why many groups across the country are trying to look into how those rates can be adjusted,” he said. “It’s a dilemma. And it’s one that states as well as the federal government will continue trying to tackle.”