Did you hear about the seriously depressed man who tried to call a psychiatrist on his health plan, but the number he was given reached a McDonald's instead? Unfortunately, this is not a joke; it actually happened.

If you've ever had trouble getting a psychiatrist appointment, you're not alone. Researchers posed as prospective mental health patients in the Boston, Chicago and Houston metro areas; only a quarter of them were able to actually get an appointment, even after two tries.

Reasons ranged from psychiatrists not returning calls to phone numbers that led to McDonald's.

Two-thirds of primary care doctors cannot get mental health services for their patients who need them.

This difficulty in scheduling a psychiatrist visit is one more example of how the healthcare system can be tough for patients to navigate. It's also in line with national findings that two-thirds of primary care doctors cannot arrange mental health services for their patients who need them.

Researchers used Blue Cross and Blue Shield (BCBS) databases of psychiatrists in the three metro areas as their pool of potential psychiatrists. BCBS is the largest insurer in Massachusetts, Illinois and Texas.

Posing as patients with BCBS insurance, Medicare patients or patients willing to pay out of pocket, the researchers called 360 psychiatrists, 120 for each metro area. Only 93 (26%) ended up with a psychiatrist appointment.

There were many reasons the callers were unable to obtain an appointment. The most common was psychiatrists not returning their calls (23%). This was followed by incorrect phone numbers, including a McDonald's (16%), psychiatrists who were not accepting new patients (15%) and 10% who did not see general outpatients.

The study's senior author, Dr. J. Wesley Boyd, an attending psychiatrist at Cambridge Health Alliance and Harvard Medical School faculty member, sums up: “Insurers provide lists of providers, but they are filled with names of individuals whose practices are full or who don't bother to return phone calls or with phone numbers that are simply wrong. Calling for a psychiatric appointment and reaching a McDonald's? That is totally unacceptable.”

How likely is it that a depressed person would be willing or able to run the gauntlet of all these obstacles, wonders lead author Monica Malowney.

Among the study's other findings: It was easiest to get an appointment in Houston and hardest in Boston. And Medicare patients were less likely to obtain an appointment than people with BCBS insurance or those paying out of pocket, though this difference was not significant.

Having insurance is not a guarantee of access to psychiatric care. A study published earlier this year found that psychiatrists are considerably less likely to accept insurance than many other medical specialists are.

The current study is published online by Psychiatric Services.