Mental care can be hard to find

Just four facilities could accommodate an appointment that soon, the researchers said. At four others, appointments were available - but more than two weeks later.

Fifteen facilities, about 23 percent, never returned the call, even after a second attempt. Another 23 percent told callers that patients had to have a primary care doctor within that facility’s system to be seen by a psychiatrist.

With those odds, “it’s quite unlikely that a severely depressed person could persevere’’ to get care, said Dr. Steffie Woolhandler, an author and former Cambridge Health Alliance primary care physician now at City University of New York.

The study was submitted to the Annals of Emergency Medicine but declined for publication on the grounds that it needs to be replicated on a larger level. Instead, the journal asked the authors to submit their results as a letter to the editor, scheduled to be published today.

The study grew out of concern from physician trainees in psychiatry that patients seen in the emergency department were unable to get follow-up care, Woolhandler said.

Dr. J. Wesley Boyd, a Cambridge Health Alliance psychiatrist, said he has seen mental health services squeezed in recent years by internal policies and shrinking reimbursements to physicians and clinics.

Cambridge Health Alliance is one of the largest in-patient mental health providers in the state but has scaled back services in recent years. Because of a reduction in state aid, Cambridge Health Alliance cut adult psychiatry beds about 39 percent, to 89. It also limited outpatient services to patients living within the hospital’s direct service area or those with a primary care doctor in the system.

The latter requirement, Boyd said, amounts to “a secretive way of rationing of care.’’ Hospital systems don’t put up such roadblocks for patients seeking high-paying imaging services or surgery, he said.