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Why therapists say wait lists are getting longer

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

“Our triage staff is unable to make any progress on this waiting list with the current number of incoming referrals,” the Aug. 18 letter to physicians said.

Earlier this week, a new letter was sent saying that the issue had not yet been resolved. “Help is on the way, but it will take longer than we expected,” she said.

Jeffery Huffman, clinical director of MGH’s department of psychiatry, said the demand for mental health care has been “so unprecedented” that the hospital is understaffed to keep up. He said he expects things to improve “in the next couple of months” with new hires.

The hospital is not unique in its order book. Over the course of the pandemic, as cases of anxiety, depression, and other mood disorders have increased, mental health providers across the country have reported an overwhelming increase in demand for counseling and care.

“Our doors are being kicked in,” said Kayla Johnson, a licensed psychologist in Tomball, Texas. “I know the need is so great, I wish I could help them, but I am in my capacity.”

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

The Washington Post reached out to more than 300 mental health providers, as well as patients and policy experts, to better understand this “tidal wave of need,” as one therapist put it. Although not a scientific sample, more than half of the therapists who responded described a tense picture in which long waits for care, sometimes three to six months or more, are the norm.

“I see people suffer, and it just gets worse and worse,” said Shawn Dobson, a licensed professional counselor in Smyrna, Georgia.

To offset the demand, Dobson created a 12-step support group, TraumAnon, which streams weekly on TikTok and Facebook while hosting on Zoom, attracting between 50 and 300 people. She also hosts regular “therapy retreats” at a log cabin where some 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 the therapists who got into this because they want to make a difference are also desperate.”

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

“If the kid really likes soccer, we would make that call and say to the coach, ‘I’d love for someone to sit down with this kid once a week. If you get scared or worried, be sure to let us know,'” Schlozman said. “It is a lot of weight on the shoulders of a coach, it is not what they signed up for. Ideally, we’d love for the child to meet a trained therapist, but there just aren’t enough 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 a month or so if they’re willing to meet virtually; in-person sessions, she says, may be closer to a six-month wait.

Several therapists said they have added evening and weekend hours to meet demand. Others said they have hired interns or trainee therapists to help. Some have stopped accepting insurance, which means less paperwork, better pay and more time to see patients. But it also means their services are less accessible to people who can’t pay out of pocket.

Maya Polon, a public affairs specialist in Sacramento who suffers from generalized anxiety disorder and panic attacks, said her primary care doctor at Kaiser Permanente told her it would be unlikely to get an appointment with an in-house mental health provider because of the accumulation. (A Kaiser Permanente spokesperson said Polon’s PCP “will not answer for any particular patient’s care.”) Even with an out-of-network referral, Polon he said it took him three months to find a therapist and another eight months to find a psychiatrist to administer his medications.

The process, she said, was humiliating and exhausting: She felt like she had to prove how sick she was, take time off work to make dozens of calls to fix referral problems, and call and assess dozens of providers, some of whom they never came back. your calls

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

10 Ways to Get Mental Health Help During The Therapist Shortage

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

Krista Curl, a licensed professional counselor in Broomfield, Colo., said she has noticed new referrals experiencing more intense symptoms, such as suicidal ideation, dissociative disorders and other complex issues.

“This means that people who would normally be hospitalized or in intensive outpatient treatment programs are turning to private practice care,” Curl said. “I think this is indicative of a larger mental health crisis.”

This crisis is even worse for children and adolescents, experts say. Martha, a single mother of four, who asked that her last name not be revealed for the children’s privacy, has experienced the crisis up close.

In the spring of 2020, her 10-year-old daughter, suffering from depression, swallowed an entire bottle of ibuprofen. After a two-week hospital stay, the boy was released with a month’s supply of antidepressants and instructed that she find a psychiatrist because the hospital did not have a provider available.

Martha, a nurse educator in Thornton, Colo., said she couldn’t find a psychiatrist and her daughter’s primary care doctor wasn’t comfortable overseeing medications for such a vulnerable child.

When the girl’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 accepting her because of her age, no one was prescribing, no one was accepting referrals,” Martha said.

Expansion of the mental health workforce

Last year, more than 129 million people lived in a federally designated mental health facility.professional shortage area,” 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 a variety of ways, said Terri Tanielian, special assistant to the president on the national policy council.

the American rescue plan, for example, includes about $5 billion to help states expand the mental health workforce, including school counselors, psychologists, and social workers, and crisis services such as the national 988 suicide hotline and mobile suicide units. mental health. It also includes funding to promote mental health and reduce burnout among health professionals.

The President’s mental health strategy also proposes to enforce and expand parity laws that require mental health and substance use care to be covered at the same levels as other health services and calls for expanding access to telehealth, Taniel 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 crisis services for people with mental health or substance use problems, regardless of their payment capacity.

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

“It’s basically impossible to find a competent queer therapist in Missouri,” said Erin Smith, a licensed clinical psychologist in St. Charles, Mo. Smith accepts insurance, including Medicaid, and keeps a few free places open.

She sees around 30 patients each week and her caseload is up to 42 clients. “It’s a lot to handle,” she said, “but there are a lot of queer and disabled Missourians who can’t access quality mental health care because providers aren’t trained or capable or transphobic.”

Eldridge Greer, a licensed psychologist in Denver, said there has been a “sea change” in how many of his clients, predominantly in the BIPOC community, view counseling. Historically, he said, “there was some uneasiness about doing counseling, the idea that therapy is 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’s helped people embrace the idea that they don’t have to suffer in silence,” Greer said.

If you’re trying to find a therapist, providers’ main takeaway is don’t give up. Securing mental health care often comes down to sheer persistence.

Linda Siegel, a pediatric critical and palliative care physician in New York City, was spending about $2,500 a month on out-of-network mental health care for herself and her son. After several years, Siegel could no longer cover the costs and stopped her own therapy.

Then the pandemic happened, his father died, and his depression returned. Siegel said he called or emailed at least 20 providers; they weren’t accepting new patients or were no longer accepting his insurance. He tried two providers, he said, but neither was a good fit.

“It’s hard being a doctor and being in therapy,” he said. Ultimately, Siegel found a young therapist online who could help her navigate her high-stress work life and find balance. But after just a few months, her employer changed insurance companies and that therapist was no longer in-network. Siegal was devastated, but eventually the therapist was able to arrange a status change that allowed her to come back online.

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