In the national media, it typically takes a mass shooting to get people to talk about mental health and access to services.
Generally, that talk doesn’t do much and dies down after a week or two.
Even with the Affordable Care Act (ACA), which mandated that certain mental health services be covered, many people don’t receive the care they need because there aren’t enough therapists to go around.
In fact, more than half of all U.S. counties have no mental health professionals, the Washington Post reports.
That’s despite the fact that 20 percent of children and 18.5 percent of adults have, or have had at some point, a seriously debilitating mental disorder, according to the National Institute of Mental Health (NIMH).
One result is that millions of Americans with mental health issues — ranging from mild depression to schizophrenia — are receiving whatever care they do get from general practitioners.
Last month, a study appearing in the journal Pediatrics showed that primary care providers were the only contact for mental health issues for 35 percent of children.
It’s a simple case of supply and demand.
What’s Causing the Shortage?
The ACA dramatically increased the number of insured Americans, and the types of things health insurance policies must cover.
The ACA also classified mental health professions as primary care professionals. This means patients can see a therapist without prior approval from their regular doctor.
So, does this mean mental health services are easier to come by in the United States? Not really.
Michele Paiva, a licensed psychotherapist practicing in Pennsylvania, said the ACA has opened some doors to care, but that doesn’t mean the treatments are affordable.
“It is true more people are insured, but depending on the coverage that they have, they may or may not be able to afford therapy still, and the insurance is still dictating the therapy, as opposed to the therapist telling the insurance what the patient or client needs,” she told Healthline. “I find that my therapy clients are looking toward the self-pay option more and more. More now than ever before, therapists are not participating in insurance for this very reason.”
Still, for those who need help, Paiva and other therapists offer sliding scales, discounts, or even volunteer their services to nonprofit groups.
“I find that for most of us who are using discounts or sliding scales, it can be less of a fee than a co-pay for some clients,” she said.
Besides dictating care, interactions with insurance agencies are often riddled with paperwork and other issues. Most therapists are self-employed, so taking time to get paid from insurance companies pulls them away from their clients.
Toni Coleman, a psychotherapist and relationship coach in Virginia, says the therapist shortage in her area is because many providers don’t accept insurance. She does but with certain caveats.
“I don’t take all insurance because some don’t pay or reimburse according to the agreement, and/or look for loopholes to not pay, et cetera. There are some who have such low fees I would be losing money by participating with them, so I don’t,” she told Healthline. “I would love to see more established providers accept clients with insurance, even if just for a few hours a week. If everyone just lit one candle, it would make a difference.”
In fact, half of psychiatrists — who, unlike most psychologists, have a medical degree and can prescribe medication — don’t accept health insurance, according to a study in the journal JAMA Psychiatry.
More Barriers Between Professionals and Patients
Besides insurance, there are a lot of other things standing in the way of getting people the help they need.
Dr. Ajita M. Robinson, founder and clinical director of Friends in Transition Counseling Services in Maryland, said that while everyone is affected by the shortage of mental health professionals, ethnic minorities, those with mobility challenges, and those at the end of life suffer most.
Part of the problem is that some insurance companies have stopped adding clinicians to their networks.
“For example, Aetna and many of the big companies’ panels have been closed for over three years,” she told Healthline. “Clinicians are interested in joining their network but are not being given the opportunity, which contributes to access issues that ultimately impact clients seeking these services.”
There’s also the fact that college tuition has skyrocketed in recent years. There’s no incentive to spend large amounts of money preparing for a career that may not pay enough.
“The rising cost of education is a barrier for many who are attracted to this profession. Money continues to be a factor throughout one's career,” said Robinson, a licensed clinical professional counselor herself. “Mental health professionals often engage in years of unpaid clinical internships and residencies in pursuit of independent licensure.”
Before getting into the profession, Coleman recommends having a realistic and workable plan laid out beforehand. This includes knowing how long the process takes, including becoming established, marketing, and handling the business side.
“Too many people think of it as a great gig that will earn them a lot of money, and allow them to work from a home office,” she said. “This isn’t for everyone. It’s a lot of responsibility and the work is demanding and challenging. No-shows, clients acting out, people who don’t pay their bills, potential lawsuits are all out there and need to be managed or avoided.”