Hi. I'm receiving conflicting guidance and interested if and how psychiatrists are navigating care for clients with serious mental illness (psychotic disorders).

My insurance provider (Cigna) offers limited local in-network psychiatry while pushing patients toward behavioral telehealth (MDLIVE, Rula, Alma, Headspace, etc.).

I've had various providers through Rula for years but walked away due to sketchy business practices (shuffling me from one psych NP to another, being dropped when I asked my provider of over a year for help with FMLA paperwork, being MIA during actual psychiatric emergencies, etc.).

I tried MDLIVE where the psychiatrist filled the script but informed me that MDLIVE doesn't offer med mgmt for SMI, which "requires in-person support."

There are at best 5 people listed on my insurance portal who are local. When I contact them or visit their websites, they're only available for virtual appointments.

I understand that telehealth can be convenient care accessed from the privacy and comfort of one's home...but there's this immensely privileged assumption that people's homes offer both privacy and comfort.

I'm at a loss for how to navigate this new landscape for psychiatric (and medical) care.

So far it looks like, despite paying insurance, I would need to pay out-of-pocket to receive the level of care my condition requires. Mind you, this is not even therapy--this is just someone who can write a prescription and hopefully support me in the event of a future psychiatric hospitalization.

I ordered a year's worth of my prescription because I don't think I'm going to find an in-network psychiatrist who also meets in-person, and I need to budget for a therapist with experience in complex conditions (and who, to no one's surprise, is also out-of-network).

What is happening and how is this sustainable?