Having insurance doesn’t mean you can get a mental health appointment in U.S.
Study uncovers widespread problems with provider directories
COLUMBUS, Ohio – Americans with commercial insurance are generally told they have access to a strong network of mental health providers. But when researchers called providers listed in those networks, securing an appointment was usually difficult or impossible, according to a new study.
Researchers, posed as “secret shoppers” looking for appointments for issues including anxiety and grief, called 5,822 psychiatrists and psychologists on commercial provider lists in five states — Delaware, Montana, New Jersey, Rhode Island and Virginia.
Their aim was to test whether the provider information in insurance directories actually connected patients with available, in-network mental health professionals.
A successful call (meaning someone picked up the phone) resulted in an appointment with the health care provider only 24% of the time. If the caller was willing to see another clinician, an appointment could be made 31% of the time.
The research, led by Simon Haeder and Wendy Xu of The Ohio State University College of Public Health, appears today in JAMA Health Forum.
“Access to mental health care in the U.S. is a well-documented struggle. This shows that even those with private insurance, who are told they have many providers to choose from, can have a hard time getting the care they need,” Haeder said.
The researchers couldn’t analyze more than 6 in 10 calls because they reached an automated system or answering machine and could not speak with a person.
When analyzing the remaining 2,252 calls, Haeder and his colleagues found:
- 56% revealed inaccurate information in the provider directory.
- 22% of calls didn’t result in an appointment because of capacity limitations, including providers not accepting new patients.
- Callers were told they’d have to wait an average of 20.5 days for care, with longer waits for psychiatry than psychology.
“Providers move, change phone numbers, leave practices or otherwise become unavailable, but those changes aren’t always reflected in insurance directories,” Haeder said.
Insurers may also list clinicians who are part of a contracted group even when those individual clinicians aren’t actually available. Researchers describe these as “ghost” providers or networks because they appear to exist on paper but aren’t necessarily accessible to patients.
“Our study speaks to a broader problem in American healthcare: the disconnect between having health insurance and actually being able to use it,” said Xu, an Ohio State professor of health services management and policy.
“Inaccurate provider directories are not simply an administrative inconvenience. They can create substantial barriers to care, leaving people effectively underinsured despite having insurance.”
Challenges with provider network directories have been documented across healthcare and are especially worrisome when it comes to people looking for help with mental health concerns, the researchers said.
“Seeking help can already be difficult for someone experiencing anxiety, grief or another mental health concern, and that’s exacerbated when they’re running into answering machines, unavailable providers and ‘in-network’ psychologists who’ve moved to another state,” Haeder said.
Provider-directory accuracy is a longstanding, systemic problem across specialties, with its roots in several challenges, including inconsistent regulation and enforcement and incentives for insurers to beef up provider lists, he said.
“I’d love to see a centralized provider directory that clinicians maintain and insurers can access, rather than every insurer separately trying to maintain its own database,” Haeder said.
The study received funding from Inseparable, a national mental health advocacy organization.
Other researchers who worked on the study are Ohio State doctoral student Yuqin Lou and Benjamin Miller of Stanford University.
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CONTACTS: Simon Haeder, Haeder.1@osu.edu; Wendy Xu, Xu.1636@osu.edu
Written by Misti Crane, Crane.11@osu.edu; 614-292-3739
Journal
JAMA Health Forum
Article Title
Mental Health Ghost Networks in Commercial Insurance Plans
Article Publication Date
16-Oct-2026
Scaling perinatal mental-health care: CDI scientists assess home visiting programs in Midwest
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Elissa Z. Faro, Ph.D., an implementation scientist and medical anthropologist at the Hackensack Meridian Center for Discovery and Innovation (CDI), alongside co-principal investigator Kelli Ryckman, Ph.D., associate dean of Research at Indiana University School of Public Health - Bloomington, led a team investigating the effe tiveness of home mental health visits in the Midwest. The results appear now in the journal BMC Health Services Research.
view moreCredit: Hackensack Meridian Health
Can reaching out to new mothers right at the outset of parenting set them on the right path from the start?
A new study published in BMC Health Services Research assesses a program of home health visitation programs, which provide perinatal mental health services for mothers and families who might not otherwise have access to such resources.
The study details a community-engaged formative evaluation designed to scale the "Mothers and Babies" cognitive-behavioral intervention within state home visiting programs across Iowa and Indiana. The investigation was led by Elissa Z. Faro, Ph.D., an implementation scientist and medical anthropologist at the Hackensack Meridian Center for Discovery and Innovation (CDI), alongside co-principal investigator Kelli Ryckman, Ph.D., associate dean of Research at Indiana University School of Public Health - Bloomington.
Perinatal depression and anxiety are common and potentially serious complications of pregnancy and childbirth, directly contributing to maternal mortality and persistent health disparities, particularly among Black, Indigenous, and People of Color (BIPOC) populations.
Home visiting programs (HVPs) are a vital community health link already reaching thousands of low-income and marginalized families annually. But delivering evidence-based mental health interventions from these HVPs—which vary in operations, staffing, and funding—poses implementation challenges.
The researchers consequently launched a multi-faceted investigation as part of the National Institute of Mental Health (NIMH)-funded IMPACT (Implementing Mental Health Programs Across Communities in Iowa & Indiana) trial. Using a modified Implementation Mapping approach, the team partnered with healthcare providers, state agency representatives, and program recipients to adapt an implementation facilitation strategy.
The researchers mapped more than 500 programs across Indiana and Iowa. A survey of 72 of these HVPs demonstrated that over 90 percent of responding programs routinely screen for perinatal depression - only further emphasizing the need for structured, evidence-based intervention tools during home visits.
Interviews with participants reached in the program identified key engagement barriers, including fear of judgment, scheduling logistics, and the importance of involving broader social networks and family connections.
In-person meetings held in Des Moines and Indianapolis brought together home visitors, supervisors, program directors, social workers, and state health department officials to understand and prioritize social determinant factors in outreach.
Virtual panel meetings conducted in English and Spanish further connected the outreach to the groups.
The formative evaluation revealed key differences in state priorities: Indiana emphasized logistical challenges such as staff workload and integration into existing workflows, while Iowa participants homed in on the importance of communication systems, training infrastructure, and mental-health consultations.
Altogether, the research group produced the IMPACT Implementation Support Package, structured around four core performance outcomes: profession development and staff growth through ongoing skill development, integration into system of implementation, better staff understanding of mental health, and the ongoing building of trust and rapport among clients and client groups.
These findings emphasize the need to reach out to mothers who need a helping hand - and ear - at a critical start of their parenting experience.
“The findings from this study carry important implications for health service delivery and policy,” the authors write.
Faro’s leadership on the IMPACT study highlights the unique interdisciplinary expertise she brings to the CDI. An archaeologist by training with a doctorate in classical art and archaeology from the University of Michigan, her early academic work focused on understanding complex human systems and recovering the perspectives of individuals omitted from dominant historical narratives.
By merging community engagement, implementation science, and health equity, Faro and her colleagues are working to ensure that evidence-based perinatal mental health support reaches the families who need it most.
Journal
BMC Health Services Research
Method of Research
Observational study
Subject of Research
People
Article Title
Adapting implementation facilitation to scale evidence-based perinatal mental health services in home visiting programs: a community and partner-engaged formative evaluation across Iowa and Indiana
Article Publication Date
1-Oct-2026
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