Why therapists say waiting lists are getting longer


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 made an unusual appeal to its doctors: Stop referring psychiatric patients for non-urgent care.

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

A new letter came out earlier this week saying that the issue has not yet been resolved. “Help is on the way, but it will arrive more slowly than we had hoped,” the message said.

Jeffrey Huffman, MGH’s clinical director of psychiatry, said the demand for mental health care is “so unprecedented” that the hospital is understaffed to handle it. He said he expects things to improve “over the next two months” with new hires.

The hospital is not unique in its backwardness. 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 a huge spike in demand for counseling and care.

“Our doors are getting smashed,” said Kayla Johnson, a licensed psychologist in Tomball, Texas. “I know the need is so great that I wish I could help them, but I don’t have the capacity.”

The American Psychological Association reported last year that 7 in 10 psychologists with a waiting list say it has gotten longer since the pandemic began. “This trend is not going away,” said clinical psychologist Vale Wright, the APA’s senior director of health care innovation.

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 troubled landscape in which long waits for care — sometimes three to six months or more — are the norm.

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

To offset the demand, Dobson created a 12-step support group, TraumAnon, which streams live every week on TikTok and Facebook while hosted on Zoom, which attracts between 50 and 300 people. She also holds regular “therapeutic retreats” in a wooded cabin 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,” she added. “People are desperate, and the therapists who got into it because they want to make a difference are desperate too.”

Steve Schlozman, a child psychiatrist at Dartmouth Health Children’s in Lebanon, New York, said he’s starting to offer workarounds to the therapist shortage that would have been unheard of even five years ago. He said he had reached clergy, school counselors and even football coaches to act as de facto therapists for children and adolescents suffering from depression.

“If the kid really loves football, we’ll make that call and say to the coach, ‘I’d love someone to sit with that kid once a week.’ If you get scared or worried, be sure to let us know,” Schlozman said. “It’s a lot of weight on a coach’s shoulders, it’s not what they signed up for. Ideally, we would like the child to see 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 about a month if they’re willing to meet virtually; in-person sessions, she says, can be closer to a six-month wait.

Several therapists said they have added evening and weekend hours to meet demand. Others said they hired interns or therapists-in-training 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 afford to 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 physician at Kaiser Permanente told her that securing an appointment with an in-house mental health provider was unlikely because of the backlog. (A Kaiser Permanente spokesperson said Polon’s PCP “will not be responsible for individual patient care.”) Even with an out-of-network referral, Polon said it took three months to find a therapist and another eight months to find a psychiatrist to manage her medication.

The process, she said, was humiliating and exhausting: She felt as if she was required to prove how sick she was, to take time off work to make dozens of phone calls to correct growls for referrals, to call and checked dozens of providers, some of whom never returned her calls.

“Experiencing untreated anxiety and frequent panic attacks made the process of seeking therapy and psychiatric help completely exhausting,” Polon said. “Without friends helping 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 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’s seen new referrals who are experiencing more intense symptoms such as suicidal thoughts, dissociative disorders and other complex issues.

“This means that people who would normally be inpatients or in hospital intensive care outpatient programs are moving into private medical care,” Curl said. “I feel like it’s indicative of a larger mental health crisis.”

This crisis is even worse for children and adolescents, experts say. Marta, a single mother of four who asked that her last name be withheld 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 hospitalization, the child was discharged with a one-month supply of an antidepressant and was instructed to find a psychiatrist because there was no provider available at the hospital.

A nurse educator in Thornton, Colo., Martha said she was unable to find a psychiatrist, and her daughter’s primary care doctor did not feel comfortable monitoring medications for such a vulnerable child.

When the child’s medication 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 would take her because of her age, no one would prescribe, no one would take referrals,” Martha said.

Expanding the mental health workforce

Last year, more than 129 million people lived in a federally designated “professional shortage area” for mental health care, and less than a third of the U.S. population lived in an area with an adequate supply of psychiatrists and other mental health professionals. mental health 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 Terry Tanielian, special assistant to the president at the Domestic Policy Council.

The US rescue plan, for example, includes about $5 billion to help states expand the mental health workforce, including school counselors, psychologists and social workers, as well as crisis services such as the national 988 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 parity laws, which require mental health and substance use care to be covered at the same levels as other health care, and calls for expanding access to telehealth, Tanielian said. The Department of Health and Human Services announced $315 million for states to “develop and transform” certified community behavioral health clinics that provide 24-hour crisis services for people with mental health or substance use problems, regardless of ability to pay.

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

“It’s basically impossible to find a freakishly competent therapist in Missouri,” said Erin Smith, a licensed clinical psychologist in St. Charles, Missouri. Smith takes insurance, including Medicaid, and has several pro bono spots open.

She sees about 30 patients each week, and her workload is up to 42 clients. “It’s a lot to deal with,” she said, “but there are so many queer people and people with disabilities from Missouri who don’t have access to quality mental health care because providers aren’t trained or able-bodied or transphobic.”

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

If you’re trying to find a therapist, the main takeaway from providers is don’t give up. Providing 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 her son and herself. After a few years, Siegel could no longer cover the costs and stopped his own therapy.

Then the pandemic happened, her father died and her depression returned. Siegel said she called or emailed at least 20 suppliers; they were either not accepting new patients or no longer accepted her insurance. She did try two providers, she said, but neither was a good fit.

“It’s hard being a doctor and being in therapy,” she said. Finally, Siegel found a young therapist online who could help her deal with her stressful work life and find balance. But after just a few months, her employer changed insurance carriers and that therapist was no longer in network. Segal was devastated, but eventually the therapist was able to arrange a change of status that allowed her to get back online.

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