Because therapists say waiting lists are getting longer


This summer, Massachusetts General Hospital had a whopping 880 people on a waiting list for psychiatric services. The list had grown so large that the hospital made an unusual appeal to its doctors: Stop referring psychiatric patients for non-urgent care.

“Our triage staff are unable to make any progress on this waiting list with the current number of referrals coming in,” the August 18 letter to doctors stated.

A new letter came out earlier this week stating that the problem has not yet been resolved. “Help is on the way, but it will be slower than we hoped for,” she said.

Jeffery Huffman, clinical director of MGH’s psychiatry department, said the demand for mental health care was “so unprecedented” that the hospital doesn’t have enough staff to keep up. He said he expects things to improve “in the next couple of months” with the new hires.

The hospital is not unique in its backlog. Over the course of the pandemic, with the increase in cases of anxiety, depression and other mood disorders, mental health service providers across the country are reporting an overwhelming increase in demand for counseling and assistance.

“Our doors are being broken down,” said Kayla Johnson, a licensed psychologist in Tomball, Tex. “I know the need is so great, I wish I could help them, but I’m at my best.”

The American Psychological Association reported last year that 7 out of 10 psychologists with a waiting list said it had grown longer since the pandemic began. “This trend is not going away,” said clinical psychologist Vaile Wright, senior director of health innovation at APA.

The Washington Post reached out to more than 300 mental health providers, as well as patients and policy experts, to better understand this “surge of need,” as one therapist called it. While this is not a scientific sampling, more than half of responding therapists described a difficult landscape in which long waits for care – sometimes three to six months or more – are the norm.

“I’m watching people suffer, and it’s getting worse and worse,” said Shawn Dobson, a licensed professional counselor in Izmir, Georgia.

To offset the demand, Dobson has created a 12-stage support group, TraumAnon, which livestreams weekly on TikTok and Facebook while hosting on Zoom, which attracts 50 to 300 people. He also holds regular “therapeutic retreats” in a wooded hut where about 35 people talk about developing coping skills and other life skills.

“It’s so unorthodox, but I don’t know what else to do,” he added. “People are desperate and so are the therapists who have gone into this because they want to make a difference.”

Steve Schlozman, a child psychiatrist at Dartmouth Health Children’s in Lebanon, NH, said he is starting to suggest alternative solutions to the shortage of therapists that would have been unheard of even five years ago. He said he contacted him clergy, school guidance counselors and even football coaches to act as de facto therapists for children and adolescents suffering from depression.

“If the guy really likes football, we’d make that phone call and say to the coach: ‘I’d like someone to sit with this guy once a week. If you get scared or worried, be sure to let us know, ‘”Schlozman said.” There’s a lot of weight on a coach’s shoulders, that’s not what they signed up for. Ideally, we’d like the child to meet a qualified therapist, but there aren’t enough of them available.

Colleen Lang, a clinical psychologist and founder of a small group practice of six therapists in Brooklyn and Manhattan, tells potential clients that they can probably see a therapist in about a month if they are willing to meet virtually; in-person sessions, she says, may be closer to a six-month wait.

Several therapists said they added evening hours and weekends to meet demand. Others said they have hired interns or trainees to help. Some have stopped taking insurance, which means less paperwork, better pay, and more time to see patients. But it also means that their services are less accessible for people who cannot afford to pay out of their own pockets.

Maya Polon, a public affairs specialist in Sacramento who suffers from generalized anxiety disorder and panic attacks, said her primary care physician at Kaiser Permanente told her getting an appointment with an internal mental health provider would be unlikely. due to the backlog. (A Kaiser Permanente spokesperson said Polon’s PCP “will not respond to a single patient’s care.”) Even with an off-network referral, Polon he said it took three months to find a therapist and another eight months to find a psychiatrist to manage his medications.

The process, she said, was humiliating and exhausting – she felt like she was required to prove how sick she was, take a break from work to make dozens of calls to correct the growls on referrals, and call and select dozens of suppliers, some who his calls never returned.

“The experience of untreated anxiety and frequent panic attacks made the process of seeking therapy and psychiatric help completely debilitating,” Polon said. “Without friends to help me navigate the system, I would never have gotten the help I so desperately needed.”

10 ways to get mental health help during a therapist shortage

As time passes before people get help, their symptoms, of course, can worsen.

Krista Curl, a licensed professional counselor in Broomfield, Colorado, said she’s noticed new referrals exhibiting more intense symptoms such as suicidal ideation, dissociative disorders, and other complex problems.

“This means that people who would typically be inpatient or in hospital intensive outpatient treatment programs are pouring into private care,” Curl said. “I feel this is indicative of a broader mental health crisis.”

This crisis is even worse for children and teenagers, experts say. Martha, a single mother of four who asked for her surname to be hidden for the privacy of the children, has experienced the crisis closely.

In the spring of 2020, her 10-year-old daughter, suffering from depression, swallowed a whole bottle of ibuprofen. After a two-week hospitalization, the child was discharged with a month’s supply of antidepressant and was asked to find a psychiatrist because the hospital did not have a supplier available.

A nurse educator in Thornton, Colorado, Martha said she couldn’t find a psychiatrist and her daughter’s primary care physician was not comfortable supervising medication for such a vulnerable child.

When the baby’s medications ran out, there was no doctor to write a new prescription for a month, and the girl attempted suicide again. “We went through this cycle where no one was going to take it because of her age, no one was going to prescribe it, no one was getting referrals,” Martha said.

Expanding the Mental Health Workforce

Last year, more than 129 million people lived in a federally designated “career gap area” for mental health, and less than a third of the US population lived in an area where there were enough psychiatrists and other mental health professionals available to meet people’s needs.

The Biden administration is working to increase access to mental health care for adults and children in various ways, said Terri Tanielian, the president’s special assistant on the domestic policy board.

The American Rescue Plan, for example, includes approximately $ 5 billion to help states expand the mental health workforce, including school counselors, psychologists and social workers, and emergency services such as the 988 National Suicide Hotline. and mobile mental health units. It also includes funding to promote mental health and reduce burnout among healthcare professionals.

The president’s mental health strategy also proposes to enforce and expand equality laws that require mental health and substance use assistance to be covered at the same levels as other health care and requires the expansion of access to telemedicine, Tanielian said. The Department of Health and Human Services announced $ 315 million for states to “develop and transform” certified community behavioral health clinics, which provide 24-hour emergency services for people with mental health or use problems. of substances regardless of their ability to pay.

Therapists have stated that, in general, the more specialized the care, the more difficult it is to find a provider.

“It is virtually impossible to find a competent queer therapist in Missouri,” said Erin Smith, a licensed clinical psychologist in St. Charles, Mo. Smith takes out insurance, including Medicaid, and keeps a few pro bono jobs open.

He sees around 30 patients every week and his workload reaches 42 clients. “It’s a lot to manage,” she said, “but there are so many queers and disabled people in Missouri who can’t access quality mental health care because the providers aren’t trained or are skilled or transphobic.”

Eldridge Greer, a licensed psychologist in Denver, said there has been a “sea change” in how many of his clients, primarily in the BIPOC community, view counseling. Historically, he said that “there was some trepidation in counseling, the idea that therapy was a white thing.”

But attitudes have changed as more athletes and media personalities have discussed their own depression and anxiety and normalized counseling, he said. “It has helped people embrace the idea that they don’t have to suffer in silence,” Greer said.

If you are trying to find a therapist, the main take-out of providers is not to give up. Securing mental health care often comes down to sheer persistence.

Linda Siegel, a pediatric physician in palliative and critical care in New York City, spent about $ 2,500 a month on offline mental health care for her son and herself. After several years, Siegel could no longer cover the costs and stopped his therapy.

Then came the pandemic, his father died and his depression returned. Siegel said he called or emailed at least 20 suppliers; either they weren’t taking new patients or they no longer accepted his insurance. He tried two suppliers, he said, but neither was suitable.

“It is difficult to be a doctor and to be in therapy,” he said. Eventually, Siegel found a young networked therapist who could help her navigate her high-stress work life and find balance. But after a few months, her employer changed insurance company and that therapist was no longer online. Siegal was devastated, but ultimately the therapist was able to arrange a change of state that allowed her to get back into the network.

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