Callers posing as mothers of adolescents with trauma symptoms who tried scheduling outpatient appointments at safety-net mental health centers were successful during only 17% of calls, a study published yesterday in Psychiatric Services found. Further, the authors identified a bias against non-White callers.
“Despite the benefits of early intervention, fewer than half of youths with a psychiatric disorder receive such intervention,” wrote Danielle Adams, Ph.D., M.S.W., of Washington University in St. Louis and colleagues. “Furthermore, research indicates that discrimination may occur during scheduling, creating additional barriers for families of color. Given the United States’ youth mental health crisis, which has worsened during the pandemic, substantial work is needed to identify and reduce the treatment barriers families face when seeking care.”
Adams and colleagues used a “mystery shopper” method to call publicly listed community mental health centers and federally qualified health centers in Cook County, Ill. The centers were called in two waves during the COVID-19 pandemic, once in the spring (from mid-May to mid-June 2021) and again in the summer (from mid-June to mid-July 2021). Voice actresses who self-identified as White, Latina, or Black posed as mothers seeking therapy for their adolescent children (14 to 18 years old) who had recently witnessed a traumatic event and were experiencing symptoms of posttraumatic stress disorder. Each center was called twice, with the callers claiming to have either Medicaid or private insurance. Completed contacts were defined as those contacts that resulted in a scheduler returning the call to schedule an appointment or to explain why an appointment could not be scheduled.The callers reached out to 229 centers 451 times.
The callers were unable to reach anyone at 32 health centers (14%) during the two sampling waves. Regardless of the insurance type or race/ethnicity of the caller, an appointment was offered in fewer than 1 out of 5 calls. The average wait time for an appointment was 12 days, regardless of the caller’s insurance type. Further, Medicaid-insured callers had to wait an average of 13.6 days for an appointment, whereas privately insured callers had to wait 9.5 days, though the authors noted that this difference was not statistically significant. An appointment was offered to 28% of the Medicaid callers who were able to connect with a scheduler and 24% of private insurance callers.
The number of completed contacts varied by the callers’ race or ethnicity. For White callers, 89% of calls resulted in a completed contact, compared with only 58% for Black callers and 53% for Latina callers.
“These results add to the growing literature indicating that discrimination may occur at mental health care scheduling, with schedulers having a bias toward being more likely to call back and schedule individuals with a White-sounding name and voice,” the authors wrote. “It is vital that safety-net health centers have an antidiscrimination policy in place and regularly audit whether employees are offering equitable services to everyone.”
