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6 Ways to Get Better Mental Health Care from your HMO

Let's face it: HMOs put hurdles in place that make it harder for you to get the mental health care that you need. By design, these systems have fewer mental health professionals on staff, which creates delays and backlogs. At the same time, they are accountable to provide medically necessary care and are rated by third-party companies that check to see if they are doing so.

What can you do to improve your probability of success?

  1. Make it clear that you are either in acute distress or have impairment in your functioning and that you need help now. You HMO is obliged to treat distress/functional impairment when it is medically necessary, meaning that it is viewed as being clinically significant. HMOs often have you complete self-report assessments for depression (PHQ-9) and anxiety (GAD-7). These scales ask you to rate yourself in terms of the number of days you have a symptom over the past 2-weeks. Did you know that a formal diagnosis of depression means that you should be feeling depressed or a lack of interest or pleasure most of the day for the past two weeks? If you are feeling depressed, be clear about your symptoms and their duration. Similarly, if you are feeling anxious, for it to be clinically significant, it should be happening almost every day. In other words, don't hold back. Make sure that your misery and distress are visible and that these are a significant cause of concern.

  2. Be ready to explain how your functioning has been impaired. Maybe you are underperforming at work or school. Be ready to give examples. Impairment can also be seen in a person's social life. Maybe you've stopped eating out or going to movies. Maybe you aren't responding to texts from your friends. Maybe you've become disengaged with your family members, and they are complaining about it. Impairment can also occur in your free time. Maybe you have stopped going to the gym or stopped mountain biking. Maybe you are unable to game like you usually do.

  3. Ask for what you need. If you want therapy, ask for it. If you think that your mental health medications require the care of a psychiatrist, and not your primary care person, ask for it. If you want to switch therapists, or want more therapy sessions, ask for it.

  4. Be ready to complain. Your HMO might have you speak to a low-level clinician first. That clinician may not offer you what you need. If you don't get the help you want, speak up. Tell that person what you want. If they are unable to help you, then use the secure message platform of your HMO and send a message to your primary care person and complain to them. Find the page of the complaints person at your HMO and send them a message. All HMOs have this feature. You can also complain to the state:

  5. It's okay to do a reset and try again. If you find that the first person you spoke to was unable to provide you the care you need, then start the process off again. Sometimes, the second or third clinician you talk to will be more helpful. There is a wide range of experience in an HMO so you might be unlucky the first time you reach out and get assigned to a novice.

  6. Be ready to decline services that are not what you need. You might be offered the opportunity to join a group class or be pointed toward apps that are available for free. Decline these services if you don't want them. Ask the person why they are not offering you the service you wanted, like therapy or a psychiatrist. They are obliged to explain their decision-making process. Let's be clear: they are denying you 1:1 care because they think that your not functionally impaired or are not in acute distress. You will need to be clear that you reached out due to one of those two problems.

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