Navigating the Intersection of Work and Mental Health
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Working Better and Stressing Less

Ideas on work and mental health

Why is it so flipping difficult to find a therapist?

In the last week, I turned away six people from my practice because I'm full. I provided them lists of my favorite local colleagues and heard that most of my colleagues are full too. So I reached out to a large list of my colleagues to find open and available counselors near me and I received zero responses to some of my inquires and perhaps one response to others. Many of my local agencies have wait lists of four to six weeks or more. I don't know where to send people. 

I do fairly short-term therapy and in any given two week period, I open and close at least once. I have space for one more and then it's full. Someone finishes therapy and I take in one more. But this doesn't solve the access problem at scale. 

If you wonder what's going on, it's many things. Here are a few:

1. There aren't enough practitioners. The Affordable Care Act was wonderful for so many reasons, helping to alleviate the burden of paying for healthcare for so many people. Now that so many more people can afford health care services, there aren't enough practitioners to treat them. This is true with physicians and it's true with mental health care providers. 

2. Your insurance company's panel isn't adequate. With the ACA, insurance companies have a lot more customers but many are slow to change their panel of practitioners or they may be deliberately restricting care by limiting the number of practitioners on their panel. "Hey so you can't find a single therapist who takes your insurance? Maybe you'll just stop looking or you'll pay out of pocket for someone not on our panel, thus saving us money." 

3. Practitioners don't want to be on your insurance company's panel because they pay terribly. Yep some insurance companies restrict panel size by simply underpaying people who contract with them. They say that they only pay for 30 or 45 minute visits, even when your community's standard of care is 60 minute visits. Or they cut reimbursement rates until a bunch of people quit their panel, thus resulting in #2 above. I know it probably sounds insane that counselors have a hard time getting by at $70 a session but that never pencils out to $70/hour ($140,000/year). Counselors in private practice have to do their own administrative work mostly and so seeing 20 clients a week is pretty much full time. Then you pay for the software with which to bill the insurance company, your own health insurance, taxes, vacation time, sick time, continuing education, licensure, office rent, other software we use to keep businesses going and $70/session quickly turns into $30/hour or even $20/hour which isn't a lot for someone with a masters degree and many years of post-degree training. 

4. Now that patients have insurance, they don't want to pay out of pocket. I get it because I feel the same way. I have health insurance that says it offers mental health care benefits so why shouldn't I be able to use my insurance to pay for it? I should, but often the best path of finding a clinician is paying out of pocket because of all the factors above. 

5. Some insurance companies have additional qualifications for counselors, over and above state licensing boards. Can you imagine your insurance company saying that they won't work with any doctor who isn't at least three years out of residency/after passing board exams? That's exactly what some insurance companies do to mental health practitioners. Counselors follow a similar but shorter path than physicians: School, school-rotations, registered internship/residency, and full licensure/board certification. Yet, some insurance companies say that this five to eight year path is not sufficient for mental health practitioners. They need three ADDITIONAL years of fully licensed experience before they'll be considered for a panel. This is done under the guise of wanting fully qualified counselors for their customers but it's actually a well-marketed tactic to restrict care. 

Am I sounding a little ranty? Yes... because I'm angry. I'm angry at a system that tells its paying customers  that it offers a service it doesn't actually deliver very well on. I'm mad that I received a bill for $1,200 for allergy testing from a company whose other customers call me all the time for services because they can't secure them internally without a six to eight week wait (even when they're in crisis). I'm mad at our society for spending so much on futile end of life interventions for people with absolutely terminal diagnoses while refusing to care adequately for social and mental health needs. And I'm also feeling a little irked at my mental health community who doesn't seem very eager to organize to help fix the problems. I get it - they're busy too. But how is anything going to change without action? 

Mostly I feel sad and so so sorry to every person I turn away when I'm full. I am so sad that you are asking for help and sometimes we can't provide it. But I'm also hopeful that if you stick with it and keep coming back to ask for more help, we will get it for you eventually. 

 

Katie PlayfairComment