Is There a Gap When Doctors Make Mental Health Referrals?

The Barrier to Mental Healthcare We Didn’t See Coming

When we ask people who are looking for a therapist about the barriers to care that they face, they often bring up concerns about cost and insurance coverage, frustrations around lack of general availability and trouble coordinating schedules for an appointment, difficulties finding a therapist who they connect and bond with who also provide the specialty or specific therapeutic modality they need, and, unfortunately, the stigma around therapy and counseling. Frankly, these are exactly the kinds of barriers we anticipated encountering and had set out to solve.

The barrier to mental health care that completely shocked us, however, was raised not by patients, but by medical professionals. It seemed that everyone we spoke with, from primary care physicians to specialists, said that a huge number of their patients could see significant benefits from therapy but that their offices had little to no psychotherapy referral system in place.

It seemed that every team member was consistently hearing the same thing:

• “I just spoke with an OB/GYN who sees mental health issues present in a large number of their patients, but they don’t really refer patients to anyone because they only really know two therapists and they have both been completely booked and unable to accept new patients.”
• “I was talking with an oncologist who was saying that not only is therapy important for their patients, but for the families and caregivers of their patients as well. While they recommend talking to a therapist, the handful of therapists they know charge $250 per hour and are only cash-pay, so they typically won’t refer people to them.”
• “A family doctor told me they get asked about mental health all the time and they encourage people to call their insurance company for a list of therapists who are in-network. Most of these patients are put on a 2-3 month waiting list, and often become unmotivated to attend a first appointment since the wait is so long.”

Over and over, we heard the same story. Medical professionals thought their patients could really benefit from psychotherapy, and knew that physical outcomes would improve once mental health was addressed, but they didn’t have the network, the time, or the tools to help their patients connect with a counselor or psychologist.

Many Doctors Aren’t Confident in Their Therapy Referral Network

Troubled by what we were hearing, we wanted to see if this was as widespread as it seemed based on our interactions. So we turned to Sermo, a global data collecting platform of over 800,000 anonymous, verified physicians, to ask them about the mental health of their patients and their psychotherapy referral networks.

Survey of Psychiatrists and Therapy Referrals

70% of psychiatrists surveyed said their referral system will get fewer than half of their patients to actually see a therapist.

We first asked psychiatrists on Sermo’s platform whether they had a psychotherapy referral system that they were confident in. Their overwhelming response was that they did not, with 70% of psychiatrists surveyed reporting that fewer than half of their patients actually make it to a first therapy session.¹ This aligned with what we’d been hearing in our informal conversations with medical professionals, but these results still surprised us. If psychiatrists, MDs who are well-connected in the mental health space, didn’t have a referral network they could confidently use for psychotherapy, what were referral networks like for other physicians?

Survey of OB/GYNs and Therapy Referrals

93% of OB/GYNs surveyed reported that fewer than half of patients they recommend speak to a therapist actually will.

We then surveyed OB/GYNs on Sermo’s platform. OB/GYNs often garner a high level of trust and comfort with their patients and play an important role in identifying the early signs of mental health issues in their patients. 53% of OB/GYNs we surveyed reported that more than 4 out of 10 of their patients are asking about their mental health or presenting with symptoms of mental health issues.²

They expressed low levels of confidence, however, that the patients they recommend speak with a therapist or counselor ever make it to a single session. 93% of OB/GYNs surveyed reported that while patients were asking about or presenting with mental health issues, fewer than half of those they recommend speak to a therapist actually make it to a first therapy session.²

Broad Survey of Physicians and Therapy Referrals

81% of physicians surveyed reported that fewer than half of patients they recommend therapy to actually make it to a first therapy session.

Finally, we surveyed a broader pool of physicians on Sermo’s platform. They too recognized and reported that their referral systems were often inadequate, with nearly half (49%) of physicians surveyed reporting their referral systems ineffective.³ 70% of physicians surveyed also reported that their referral systems were more highly strained than previous years due to this past year’s pandemic.³

65% of physicians surveyed reported that more than 4 of 10 of their patients are asking about their mental health or presenting with symptoms of mental health issues, but stated low confidence that the patients they recommend speak with a therapist make it to a first session. 81% of physicians surveyed reported that fewer than half actually make it to a first therapy session.³

Final Thoughts

While these surveys are far from conclusive, they point to a potentially large gap in our healthcare system and a lack of access to adequate mental health care. Below are results from the three surveys outlined above.

Infographic with Survey Results