In episode 270, I received a question from an individual who asked why mental healthcare is so inaccessible, despite the number of people who study Psychology at college. In this post, I dive into this topic in more depth and offer my thoughts on the problem with mental healthcare.
I’ve been a fan of your content since your ASMR days and I just recently discovered your podcast and I’m hooked. I just have a quick question. Why is behavioral healthcare so inaccessible? When I was in college it seemed like everyone was some kind of psych major. But in the real world, there seems to be a shortage of providers and waitlists are months long. As a provider do you notice this as well?
Thanks for being a longtime fan and following me through different transitions! It’s great to have you listening here. There are a few interesting things to say in regards to your question here.
First off, one thing I’ll point out about the whole many psych majors vs relatively few clinicians thing is just how much education is required to become a licensed therapist. There ARE a ton of college psych majors out there, but it’s kind of a tough situation because if you want to work in the field of psychology itself, there is almost nothing that you can do with a BA. It can be a good generalist degree for working in a variety of fields, but when it comes to actually working in mental health, you basically need a graduate degree to do that. So you finish your bachelor’s degree and want to work in the field as a therapist of some kind. Your options are either 2-3 more years of school for a master’s level degree or 5-6 years for a Ph.D. From there, you need to get licensed as a therapist, which involves complicated exams and fees. There is a TON of time and money and training that goes into being a therapist. I don’t know the statistics, but I’d assume that the majority of psychology majors do not go on to become licensed therapists, let alone psychologists. You can also get into the field in capacities other than direct clinical work. You can work in research, clinician training, teaching, etc.
So that said, what about the issue you are talking about at having a hard time finding accessible mental health care. I think it’s a totally valid concern, especially if we are talking about the USA here. A lot of this will depend on the area that you live in. If you are in a big city, predictably there will be more healthcare providers in the area. As you get more remote or rural, this vastly decreases. Beyond the actual number of clinicians in the area, I think one of the big issues when it comes to healthcare is insurance.
A glimpse from the inside
This is going to be a bit of an insider look. I make my living as a psychologist and a big portion of what I do is therapy. It is much harder to make a living as a therapist if you take insurance. As a therapist who takes insurance, you have a built in source of referrals in that you will basically be handed many of the cases in your area that have that particular type of insurance, which can be great for filling your case load. BUT they don’t reimburse very well and it’s a fight to get them to reimburse you more.
Just for reference, I charge $150 per hour for therapy. That is actually fairly reasonable. It’s a lot of money, but I could be charging up to $250 per hour and I know some people like myself that have a presence online and a specific niche that charge $300+ per hour. The reimbursement rate for Medicare in California for therapy is about $85. That might sound like a lot, but when you factor in the overhead costs, the sunken time into documentation and other issues, or being in a group practice in which you only receive part of the final payment, it takes a high volume of clients to make things work. It’s not a glamourous job in most cases. And I know a lot of people that work themselves to the bone being a private practice therapist. Now, this is different in situations like healthcare settings or there are also a lot of new healthcare companies like Foresight mental health popping up that pay their providers a salary and take insurance. The point of telling you all of this is to explain how even if there are a lot of providers in the area, they may not take insurance because it is more viable to charge cash only. For myself, I take a limited number of Medicare cases, which I get very little pay for and the rest are cash.
A long term game
I 100% agree with you that there are too many barriers to mental health treatment and it’s hard being in my position of needing to make ends meet while not working myself to death, but also wanting to give the best care to as many people as possible. I don’t know what the stats are regarding the amount of therapists available vs the amount of people seeking help. I can only speak from my own experience and observation. I see this being a problem in many areas. In my line of work, I am often referring people to neurologists and there are basically like 5 in the area that I refer to. They often have a long waitlist. For therapists, in particular, you also need to remember that appointments are typically weekly or bi-weekly and continue over a relatively long period of time. So it’s not like we have constant turnaround. I haven’t spoken to a new client in months because I have ongoing ones that fill up all my slots. I personally have a growing waitlist and each week feel guilty for not getting back to them yet.
All of this said, I think that most people should be able to find a mental health provider if they have insurance or the resources to make it happen. But it is normal for it to take a bit of legwork. As I’m outlining this response, I literally got an email from another therapist asking for me to put their transferring client on my waitlist and mentioning that they are having trouble finding someone. If I could add an additional day or two into the week, I would take a bunch more clients!
A couple things that could help: if you are open to online therapy, expand your search radius, and look for group practices or mental health startups that have a bunch of providers under their umbrella that can help match you.
You can listen to this on Episode 270 of the podcast!
Thank you for the great question!
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