Even if you can manage to get an appointment, for most people it is becoming increasingly difficult to afford mental healthcare. Not all insurance plans cover it and it can cost hundreds of...
Even if you can manage to get an appointment, for most people it is becoming increasingly difficult to afford mental healthcare. Not all insurance plans cover it and it can cost hundreds of dollars per session. Not to mention that the health insurance industry is a nightmare, so even if you have coverage, they might challenge you and send you jumping through hoops made of red tape to get the assistance you need. Oh and you're doing all of this document gymnastics while mentally unfit to do so.
As an anecdotal aside, I had insurance try to deny me from mental health treatment because I admitted to using marijuana. I was living in California after it had been legalized, so yeah I tried it (and found it to be helpful in relieving the worst of my depressive symptoms when they became too much to bear). The insurance company found some doctor in Kentucky that claimed cannabis use caused my depression and therefore insurance wouldn't cover anything. Despite the fact that my medical records showed I had been diagnosed and treated for depressive episodes since I was 14 years old. My therapist and psychiatrist were livid and worked to get it fixed, but it's horrible how the system fights you every step of the way while you're just trying to save yourself and don't have the energy to fight back without a good support system.
Yeah. I pay $200 to see my Psychiatrist and that is with having insurance. Then the cost of medication on top of that. For example, in addition to my previous diagnosis, my therapist suggested...
Yeah. I pay $200 to see my Psychiatrist and that is with having insurance. Then the cost of medication on top of that. For example, in addition to my previous diagnosis, my therapist suggested that I may have ADHD. Never dawned on me, but it made sense and we went back and forth on some questions to see if I checked the boxes for an ADHD diagnosis, and I did. She tried prescribing me Vyvanse, which was $300 for a 30 day prescription.
NOPE. I'm now on Ritalin (and boy, what a difference this makes in my life) which is 1/5 the price. Hoping the generic version of Vyvanse is affordable when it comes out in August, but I'm not counting on it.
Also, do you know what can happen to you if you are on anti-depressants and suddenly you don't have them? I couldn't afford an appointment and the meds, so I stopped cold turkey. The emotional roller-coaster I was on was one of the worst mental experiences in my life, and that includes a time where I checked myself into a hospital for self-harm. Literally had no control. I would break out crying. I was in my car once and just screamed and pounded on the car wheel. Fully. Unhinged.
Anyways, funny enough, I am a lucky one. My prescriber worked with me behind the practice's back, at no charge to help me get right. I will forever be grateful to her, she honestly really cares and does her best to take care of her patients.
Not that I can guarantee your insurance would cover this, but there is a genetic testing service that can try and see which SSRIs will have the least side effects for you. My wife's psychiatrist...
Not that I can guarantee your insurance would cover this, but there is a genetic testing service that can try and see which SSRIs will have the least side effects for you.
My wife's psychiatrist introduced us to this, as her previous two meds made her extremely sick for a week at a time each time she got on or off. The test was really easy and it returns a chart with symptom predictions. They tried a med with a good prediction and it went and has been going extremely well
I'm so sorry you went through that, that sounds horrible. I don't think I ever stopped cold turkey, but for a while I was constantly tapering on and off of medications trying to find one that...
I'm so sorry you went through that, that sounds horrible. I don't think I ever stopped cold turkey, but for a while I was constantly tapering on and off of medications trying to find one that worked. All the changes just seemed to contribute to the unsteady, uneasy feeling I had from being depressed in the first place, on top of the growing despair that "nope, this one didn't work either..."
Yeah. In a sense I am lucky that the medications I have been prescribed have generally worked for me right away, with side effects that I consider tolerable. My wife has needed to cycle through a...
Yeah. In a sense I am lucky that the medications I have been prescribed have generally worked for me right away, with side effects that I consider tolerable. My wife has needed to cycle through a lot of medications before finding something that worked without debilitating side effects. That process is really rough.
I'm with you, lucky that I found medications that work, but unlucky that I need generally the higher allowable doses if not the maximum doses because of how my body processes things. It's...
I'm with you, lucky that I found medications that work, but unlucky that I need generally the higher allowable doses if not the maximum doses because of how my body processes things. It's exhausting to have the highest dose of everything right away or be treated like a crazy person when I explain that starting low has barely any effect on me. I'm lucky I found a psychiatrist who listened when I did because she understood what I needed right away.
I'm glad you're doing better and I hope to never ever stop my medications cold turkey.
My current insurance company (that I will be leaving at the enrollment period) put me in a crisis level before I got to seeing my therapist. It was to the point that I complained to the company,...
My current insurance company (that I will be leaving at the enrollment period) put me in a crisis level before I got to seeing my therapist. It was to the point that I complained to the company, my HR director, the state regulatory agency, several of my local legislators and even the governor of CA's office before they made any moves to actually help me after initiating seeing a new therapist last June (after being an active patient for many years but my therapist left and they never got around to assigning me a new one for 8 months).
First they denied I needed therapy, then I used my secondary insurance to see a therapist outside of the primary insurance, then the insurance refused to deny the claims so my secondary insurance could pay for it because "I was eligible for in-house care through Kaiser." Then I went to try to get care and they refused to see me for months and sent me to their contracted company to see a therapist through their third-party service. They sent me a list of therapists practicing in my area for what I need and I called all 30 on their list, in addition to almost everyone else on the site that weren't specifically on the list they gave me. it ended up being around 70 therapists in the area (many of which weren't actually in my area and I wanted to be seen in person, which I'm still not being seen in person, but that's another story). of all of those calls I made, all of them more than once, only one got back to me that he wasn't accepting new patients nor insurance and wasn't sure why he was on the list.
Then I had to fight with Kaiser to get be back into the internal system for over a month, after being laughed at and hung up on by a supervisor and going through the reporting process all over again with Kaiser, the regulatory agency, and several other parties, just to have a therapist who can only see me via video chat once a month because she doesn't want to work past 5 pm, even though they told me that I could be seen after 5 in person.
this is all after my chronic pain doctor requested I get back into therapy for my chronic pain (after seeing how poorly I did in the chronic pain management group therapy program they run). I'm still reeling from all of that because it only got resolved in April. I've seen this therapist 3 times in total because they won't see me more frequently even though I'm in crisis levels and my doctor and psychiatrist requested I be seen every other week.
But at least I'm able to be seen, I see how hard it is for others, and if you don't fight the system, you will be dropped and forgotten by it, regardless of whether your a patient or a provider.
Jesus that is horrifying that you had to go through all of that. When we moved to CA and were choosing insurance plans, the advice we got was "Kaiser is pretty great unless you need mental health...
Jesus that is horrifying that you had to go through all of that. When we moved to CA and were choosing insurance plans, the advice we got was "Kaiser is pretty great unless you need mental health care" so we ended up going with a different plan. I don't understand the Kaiser system really well but it sounds like going outside of their network is extremely difficult, as you described.
It's more like Kaiser is pretty great unless you need more than base-level care. I had to fight for an exploratory laparoscopy to determine if I had endometreosis, fibroids, or PCOS for years when...
It's more like Kaiser is pretty great unless you need more than base-level care. I had to fight for an exploratory laparoscopy to determine if I had endometreosis, fibroids, or PCOS for years when my OBGYN basically thought that all I needed was an IUD unanesthetized to solve all of my problems (I did end up getting the IUD during my surgery because there was no way I would get one without being under general anesthesia, and surprise surprise, it didn't solve my issues). Or if you're a chronic pain patient. They have groups, but they don't really do much aside from treat you like you're just there for drugs and you should just wish the pain away. Or if you have certain medical issues that require you to receive specialized care regularly for the rest of your life (like needing actual hands-on physical therapy for the rest of your life for the chronic pain that they refuse to properly diagnose because they don't want to have to provide you with this rest of your life care because it's expensive).
What I'm saying is they're basically good to provide you with your annual physical and maybe a few things here or there as long as they're not life-long issues. Then they try to get out of treating you with anything but medication all the while calling you a drug seeker.
The article didn’t really get into what’s causing the shortage, or at least half of it. Clearly, if the story is true, there is a discrepancy between demand and supply, and COVID may have caused a...
The article didn’t really get into what’s causing the shortage, or at least half of it. Clearly, if the story is true, there is a discrepancy between demand and supply, and COVID may have caused a spike in demand (although I’m not sure if that would still be the case?), but what is keeping the numbers of psychiatrist low?
I'm sure burnout is a huge factor. It was reaching crisis levels before the pandemic. Now it's so far beyond that it's difficult to even think of an effective way to approach addressing it. This...
I'm sure burnout is a huge factor. It was reaching crisis levels before the pandemic. Now it's so far beyond that it's difficult to even think of an effective way to approach addressing it.
This is anecdotal, but I also vividly remember being interested in this career path in high school and college, and being discouraged by all of the adults in my life, including those in an official academic advisory capacity, because they believed the field was already over saturated and I would struggle to find work. My husband and many of my friends had the same experience. There were very few scholarships available for that avenue of study, and introductory classes were treated as a fun little treat to round out the education of students wisely pursuing other majors, rather than an opportunity for someone who may be interested in further pursuing the topic to get a good foundational understanding. The idea that anyone in those classes would actually take more advanced classes on the subject was barely acknowledged.
It's possible that experience was specific to my high school and college, but I'd be surprised.
That still leaves a lot of questions. In the article (and often anecdotally), people say that therapists are overbooked, with long waiting lists, and are also very expensive. That would seem to...
That still leaves a lot of questions. In the article (and often anecdotally), people say that therapists are overbooked, with long waiting lists, and are also very expensive.
That would seem to indicate that if you opened a new practice, you'd have a bunch of customers who'd also pay a lot of money?
Undergrad psychology is infamously one of the most common bachelors (as you noted when people discouraged you). So something must be keeping that supply, from turning into a supply of psychiatrists that can run therapy practices (which would seem to be lucrative? Or otherwise they should raise prices if they're not, if demand is that high). Is it just the rigors and/or expenses of med school?
I think the unsaid portion is that the therapists that are affordable, that are willing to accept insurance, that are conveniently located - those are all overbooked. If you plunk enough money...
I think the unsaid portion is that the therapists that are affordable, that are willing to accept insurance, that are conveniently located - those are all overbooked. If you plunk enough money down you can find a therapist, but a lot of them massively prefer private-pay clients because insurance reimburses at rates far below competitive hourly private-pay rates. The ones that take insurance are either doing it out of a sense of fairness or they're trying to fill gaps in their schedule, it's universally more profitable and less hassle to take insurance. That goes double for private practice therapists.
The article says she offered private pay in at least one of their examples, though, so obviously there are more hurdles. The next is discoverability. If she simply googled "therapists" and got to psychologytoday.com or the APA locator list, that's going to show a lot of the same names to people who go looking. There are likely many therapists on the bottom of the lists with availability, but they may be undesirable for some reason - cost, reviews, location, hours, etc. Some may be specialists that aren't targeting what you need, since therapists often specialize in fields like family therapy, childrens' therapy, addiction therapy, etc.
Following that, there is the noted problem of time. Licensing takes time. Degrees take time. It's challenging to come up in a high cost of living area while you're still working on your less-senior qualifications. Associates don't get paid for shit, nor do most agency workers. That's going to severely thin the herd of people willing to endure that work in areas like LA, NYC, the Bay Area, and other big metros.
The list of problems goes on. It's a field like any other, with post-COVID problems like any other. I'm sure it will equalize eventually but this is still a pretty new problem relative to the speed of matriculating and placing new therapists and psychiatrists.
I think the expectation when I was in school was that this wouldn't be the case. The process of becoming a therapist/psychiatrist isn't quick. The educational sector would need to have already...
That would seem to indicate that if you opened a new practice, you'd have a bunch of customers who'd also pay a lot of money?
I think the expectation when I was in school was that this wouldn't be the case. The process of becoming a therapist/psychiatrist isn't quick. The educational sector would need to have already begun encouraging an increase in supply 5-10 years ago, (depending on level of expertise) in order to avoid the issue we're having today.
I do also think the rigors and expenses of med school are a major factor. The expenses especially. That's a massive amount of debt to take on. Before the demand for mental health professionals became this obvious, that would have seemed like quite a gamble. Young people now deciding what career path to take are watching their older siblings drown under the debt from much less expensive degrees.
Another side of it is people want to be seen by PhD's not MFTs or LCSW's and MFTs are the hot new thing to get people through the education system and providing therapy faster for their patients....
Another side of it is people want to be seen by PhD's not MFTs or LCSW's and MFTs are the hot new thing to get people through the education system and providing therapy faster for their patients. It's great to help with demand, but when someone actually needs to see a doctor doctor for their therapy for complex cases, there are very few available.
This is an interesting point. There may be overconsumption of specialized mental healthcare services. Consumers who can afford it may demand the highest quality care regardless of whether their...
This is an interesting point. There may be overconsumption of specialized mental healthcare services. Consumers who can afford it may demand the highest quality care regardless of whether their needs merit it — a misallocation of resources.
I have some (handsomely-compensated) friends who will talk with their therapists every week or more frequently. Often about work, dating, and so on. And I imagine that they will accept nothing but the best. I don't have insight into their personal mental health, but I have a vague feeling that there's some unnecessary overconsumption.
Absolutely! I think many people are also not trusting of the MFTs or LCSWs because they're therapists, but not psychologists. I've gone to both over the years and I know that my case is very...
Absolutely! I think many people are also not trusting of the MFTs or LCSWs because they're therapists, but not psychologists. I've gone to both over the years and I know that my case is very complex with a lot of issues balled into one with chronic pain, ADHD, and childhood trauma. I need someone really experienced in the type of therapy that I need and that is almost always a psychologist. If I didn't need to push for someone more leveled up, I would have gone with anyone who could see me frequently just to talk weekly about what was bothering me.
I don't blame your friends for wanting the best their insurance can provide, that's a benefit they're entitled to. I think overall, we need to start compensating mental health professionals on par with their physical health counterparts at the very least, and figure out how to get more therapists in the system at the higher levels, whether that be through on-the-job education or grants to get these people in with less debt (I personally am in favor of no student loan debt, but we all know how well that's going in the US...)
The education requirements for psychiatry is very demanding. My wife considered it and it requires med school, then you have to get matched into a psychiatry residency program, which are very...
The education requirements for psychiatry is very demanding. My wife considered it and it requires med school, then you have to get matched into a psychiatry residency program, which are very competitive and hard to get into, then you have to do a 4-7 year residency program, and then 1-2 years of a fellowship.
I would say a large part of the situation is the amount of schooling that it takes and the actual pay upon graduation. At least when you go to medical school to become a doctor, you have a massive...
I would say a large part of the situation is the amount of schooling that it takes and the actual pay upon graduation. At least when you go to medical school to become a doctor, you have a massive salary potential upon graduation.
Even if you want to just be a therapist, not even a psychologist; you are looking at a bachelor's degree and then a master's degree in social work, or some sort of mental health counseling. Then add on another two years of practical training before you even get your license. So it's a minimum 8 years before you can practice on your own, and then you have to be good at marketing yourself to actually be successful in private practice to make money. If not you're working for someone and making a good salary, but nothing tremendous.
And then as a therapist, you aren't allowed to perform assessments or diagnose so for patients that really need medication you'll have to refer to a psychiatrist or a psychologist.
And then for a PhD/PsyD you are looking at 4 years bachelor + 5 years graduate (minimum), so that's 9 years before you are working. And it's very rare for psychology PhD/PsyD programs to be fully funded, I believe there are only a handful of programs like that. Acceptance rates are in single digits and then when you graduate you do make six figures, but not $200k like a physician would. It's a lot of schooling and highly competitive for a somewhat low return.
You have to REALLY want to do something like this and I'm sure the job has extremely high burnout rates.
Increased demand due to: pandemic political othering, greatly increased by Trump, causing significantly worse fear and anger in the population Supply low due to: Poor compensation in the field...
Increased demand due to:
pandemic
political othering, greatly increased by Trump, causing significantly worse fear and anger in the population
Supply low due to:
Poor compensation in the field
Long hours: there is a lot of overhead required in treating each patient
Burnout is high: patients don't tend to respond well. Feeling ineffective and helpless in your career is not rewarding.
Most practitioners aren't medical doctors but are instead psychologists and social workers—some who may have a doctorate. The educational requirements are steep but only the psychiatrists are paid particularly well by the system.
Much like paramedics, firefighters, and teachers, the compensation isn't there despite the critical need.
I imagine it's due to many of the same reasons there's a doctor shortage in the US. In brief: Congress capped funding for hospitals' residential programs in 1997. Americans are living longer. More...
There are many nurses and other professionals who are trying to earn degrees and the hurdles to get there are enormous. Not just applying and trying to find a good program, but financially. Most...
There are many nurses and other professionals who are trying to earn degrees and the hurdles to get there are enormous. Not just applying and trying to find a good program, but financially. Most schools do not provide help for getting a preceptor and if they do have “lists”, the preceptors are charging students even if you can find one. The hurdles are real.
Older article and kind of obvious - but gives some details to the scale of the problem. Aside from the sheer shortage, what other hurdles do people face when they are trying to access mental...
When the American Psychological Association surveyed its members last fall, it found a surge in demand and new referrals, particularly for anxiety, depressive and trauma-related disorders. Yet 65 percent of the more than 1,100 psychologists who responded said they had no capacity for new patients and 68 percent said their wait lists were longer than they were in 2020.
more than one third of Americans live in designated mental health professional shortage areas.
Older article and kind of obvious - but gives some details to the scale of the problem.
Aside from the sheer shortage, what other hurdles do people face when they are trying to access mental health professional services?
I work at a company that handles insurance. I recently got promoted, but the role I had before this was involved with finding people providers that were in-network. Mental health was tough. The...
I work at a company that handles insurance. I recently got promoted, but the role I had before this was involved with finding people providers that were in-network. Mental health was tough. The following things would come up:
If they were in-network, they had shit availability. Weeks to months out and sometimes there would be a waitlist. One time, I was told there was a waitlist into early 2024. And if you did manage to get an appointment, it was always at odd times. If you work a standard 9-5, best hope you are okay crying on your lunch break to your therapist or can get off work early. Or if you can get your job to approve the reoccuring appointments.
If they weren't in-network, it would be self-pay. Standard pricing is generally around $80+. If you wanted to go every week, that's $4,160 a year. Personally, my therapy costs $175 per session and I see her every two weeks on a Saturday at 10am. That's $4,550 and not everyone can be so fortunate to do that.
All in all, we were already having issues with finding mental health providers. COVID has just made it so much worse and there is a shortage.
My psych (chiatrist/cologist, does both) explicitly dropped my insurance because of how poorly they paid him and how badly they treated his patients. My insurance is now paying him more as an out...
My psych (chiatrist/cologist, does both) explicitly dropped my insurance because of how poorly they paid him and how badly they treated his patients.
My insurance is now paying him more as an out of network provider than they ever did as in-network. All I have to do is a boatload more paperwork.
I'm only willing to deal with hassle because I've been working with him for over a decade, and he's kept me from going inpatient multiple times. A reasonable insurance person would have taken one quick glance at that statement and let me keep seeing him at $0 copays. One inpatient visit is way more expensive than a lifetime of monthly's.
I'm so glad you found something that worked for you. Like some others have said in this thread, we're asking folks who are dealing with a hurt brain/souls to navigate all these hurdles while their...
I'm so glad you found something that worked for you. Like some others have said in this thread, we're asking folks who are dealing with a hurt brain/souls to navigate all these hurdles while their brains/souls are much less capable of doing so.
If you're looking for a therapist and are in NYC, check out the National Institute of the Psychotherapies (NIP). They accept pretty much all insurance. They have therapists in training. After an...
If you're looking for a therapist and are in NYC, check out the National Institute of the Psychotherapies (NIP). They accept pretty much all insurance. They have therapists in training. After an intake interview you are matched with a therapist and, after seeing them at NIP for a couple of years, you have the option of following your therapist to their new practice (which might not accept insurance).
The USA pretty much has a failed health care system. People need to try and find their own, better solutions when possible. Maybe more people who have a good aptitude for becoming therapists can...
The USA pretty much has a failed health care system. People need to try and find their own, better solutions when possible.
Maybe more people who have a good aptitude for becoming therapists can volunteer part time as they transition to retirement from other careers. Maybe more people can find alternatives to expensive, hard to obtain therapy via a more self-help approach.
Anecdote: When I was in my mid twenties I fell into depression for a couple of months after my grandmother died. My depression was cured instantly, accidentally, when I took some psychedelic mushrooms while hanging out at a beautiful park with some friends on a camping trip. I thought thru and discarded my grief over a roughly 10 minute period of introspection, and began a super-healthy (physically, mentally, and spiritually) period of my life that lasted for a couple of years. The shrooms cost me around 20$. I'm quite aware that mushrooms are on the verge of becoming legal in some places e.g. Colorado, and I think this sort of approach (not just mushrooms, but a wide variety of valid self-help approaches) could be used by huge numbers of people who suffer from health problems that would benefit from therapy.
As a society, we need to think outside the box, and not look to the government or corporations to help us actual people. As Tildes and the fediverse etc show, it's quite possible for large numbers of people to break away from mainstream approaches that aren't working out well, and find new approaches that are more grass-roots oriented.
I tried dozens of oral medications, transcranial magnetic stimulation (TMS), ketamine therapy, and combinations of those at the same time. After doing all that and getting "stable" but not...
I tried dozens of oral medications, transcranial magnetic stimulation (TMS), ketamine therapy, and combinations of those at the same time. After doing all that and getting "stable" but not thriving, I decided to go and get some mushrooms while I still lived near a place where it was decriminalized. I had followed psilocybin research for years and was getting desperate to find something that would help me feel normal. One trip sitting on my porch sipping tea did more for me than over 15 years of therapy and all of those doctors and medications combined. It was a game changer.
I don't know that it would work the same for everyone, but I'm outraged that it's illegal for people to try.
It's a drug I've used before. It's beautiful, powerful, and abundant. The first time I had some I went from anxious, self-conscious and depressed to confident, comfortable and happy over the...
It's a drug I've used before. It's beautiful, powerful, and abundant. The first time I had some I went from anxious, self-conscious and depressed to confident, comfortable and happy over the course of a few hours. That one dose didn't last forever, but the effects lasted a few months and I ended up back on an upwards trend once I cut back on THC a bit after that.
Imagine that! At least 25% of the American population subscribes to some flavor of "fuck your feelings" and they're surprised when they can't get mental health care?
Imagine that! At least 25% of the American population subscribes to some flavor of "fuck your feelings" and they're surprised when they can't get mental health care?
Even if you can manage to get an appointment, for most people it is becoming increasingly difficult to afford mental healthcare. Not all insurance plans cover it and it can cost hundreds of dollars per session. Not to mention that the health insurance industry is a nightmare, so even if you have coverage, they might challenge you and send you jumping through hoops made of red tape to get the assistance you need. Oh and you're doing all of this document gymnastics while mentally unfit to do so.
As an anecdotal aside, I had insurance try to deny me from mental health treatment because I admitted to using marijuana. I was living in California after it had been legalized, so yeah I tried it (and found it to be helpful in relieving the worst of my depressive symptoms when they became too much to bear). The insurance company found some doctor in Kentucky that claimed cannabis use caused my depression and therefore insurance wouldn't cover anything. Despite the fact that my medical records showed I had been diagnosed and treated for depressive episodes since I was 14 years old. My therapist and psychiatrist were livid and worked to get it fixed, but it's horrible how the system fights you every step of the way while you're just trying to save yourself and don't have the energy to fight back without a good support system.
Yeah. I pay $200 to see my Psychiatrist and that is with having insurance. Then the cost of medication on top of that. For example, in addition to my previous diagnosis, my therapist suggested that I may have ADHD. Never dawned on me, but it made sense and we went back and forth on some questions to see if I checked the boxes for an ADHD diagnosis, and I did. She tried prescribing me Vyvanse, which was $300 for a 30 day prescription.
NOPE. I'm now on Ritalin (and boy, what a difference this makes in my life) which is 1/5 the price. Hoping the generic version of Vyvanse is affordable when it comes out in August, but I'm not counting on it.
Also, do you know what can happen to you if you are on anti-depressants and suddenly you don't have them? I couldn't afford an appointment and the meds, so I stopped cold turkey. The emotional roller-coaster I was on was one of the worst mental experiences in my life, and that includes a time where I checked myself into a hospital for self-harm. Literally had no control. I would break out crying. I was in my car once and just screamed and pounded on the car wheel. Fully. Unhinged.
Anyways, funny enough, I am a lucky one. My prescriber worked with me behind the practice's back, at no charge to help me get right. I will forever be grateful to her, she honestly really cares and does her best to take care of her patients.
Not that I can guarantee your insurance would cover this, but there is a genetic testing service that can try and see which SSRIs will have the least side effects for you.
My wife's psychiatrist introduced us to this, as her previous two meds made her extremely sick for a week at a time each time she got on or off. The test was really easy and it returns a chart with symptom predictions. They tried a med with a good prediction and it went and has been going extremely well
I will check that out, I appreciate the advice.
I'm so sorry you went through that, that sounds horrible. I don't think I ever stopped cold turkey, but for a while I was constantly tapering on and off of medications trying to find one that worked. All the changes just seemed to contribute to the unsteady, uneasy feeling I had from being depressed in the first place, on top of the growing despair that "nope, this one didn't work either..."
Yeah. In a sense I am lucky that the medications I have been prescribed have generally worked for me right away, with side effects that I consider tolerable. My wife has needed to cycle through a lot of medications before finding something that worked without debilitating side effects. That process is really rough.
I'm with you, lucky that I found medications that work, but unlucky that I need generally the higher allowable doses if not the maximum doses because of how my body processes things. It's exhausting to have the highest dose of everything right away or be treated like a crazy person when I explain that starting low has barely any effect on me. I'm lucky I found a psychiatrist who listened when I did because she understood what I needed right away.
I'm glad you're doing better and I hope to never ever stop my medications cold turkey.
My current insurance company (that I will be leaving at the enrollment period) put me in a crisis level before I got to seeing my therapist. It was to the point that I complained to the company, my HR director, the state regulatory agency, several of my local legislators and even the governor of CA's office before they made any moves to actually help me after initiating seeing a new therapist last June (after being an active patient for many years but my therapist left and they never got around to assigning me a new one for 8 months).
First they denied I needed therapy, then I used my secondary insurance to see a therapist outside of the primary insurance, then the insurance refused to deny the claims so my secondary insurance could pay for it because "I was eligible for in-house care through Kaiser." Then I went to try to get care and they refused to see me for months and sent me to their contracted company to see a therapist through their third-party service. They sent me a list of therapists practicing in my area for what I need and I called all 30 on their list, in addition to almost everyone else on the site that weren't specifically on the list they gave me. it ended up being around 70 therapists in the area (many of which weren't actually in my area and I wanted to be seen in person, which I'm still not being seen in person, but that's another story). of all of those calls I made, all of them more than once, only one got back to me that he wasn't accepting new patients nor insurance and wasn't sure why he was on the list.
Then I had to fight with Kaiser to get be back into the internal system for over a month, after being laughed at and hung up on by a supervisor and going through the reporting process all over again with Kaiser, the regulatory agency, and several other parties, just to have a therapist who can only see me via video chat once a month because she doesn't want to work past 5 pm, even though they told me that I could be seen after 5 in person.
this is all after my chronic pain doctor requested I get back into therapy for my chronic pain (after seeing how poorly I did in the chronic pain management group therapy program they run). I'm still reeling from all of that because it only got resolved in April. I've seen this therapist 3 times in total because they won't see me more frequently even though I'm in crisis levels and my doctor and psychiatrist requested I be seen every other week.
But at least I'm able to be seen, I see how hard it is for others, and if you don't fight the system, you will be dropped and forgotten by it, regardless of whether your a patient or a provider.
Jesus that is horrifying that you had to go through all of that. When we moved to CA and were choosing insurance plans, the advice we got was "Kaiser is pretty great unless you need mental health care" so we ended up going with a different plan. I don't understand the Kaiser system really well but it sounds like going outside of their network is extremely difficult, as you described.
It's more like Kaiser is pretty great unless you need more than base-level care. I had to fight for an exploratory laparoscopy to determine if I had endometreosis, fibroids, or PCOS for years when my OBGYN basically thought that all I needed was an IUD unanesthetized to solve all of my problems (I did end up getting the IUD during my surgery because there was no way I would get one without being under general anesthesia, and surprise surprise, it didn't solve my issues). Or if you're a chronic pain patient. They have groups, but they don't really do much aside from treat you like you're just there for drugs and you should just wish the pain away. Or if you have certain medical issues that require you to receive specialized care regularly for the rest of your life (like needing actual hands-on physical therapy for the rest of your life for the chronic pain that they refuse to properly diagnose because they don't want to have to provide you with this rest of your life care because it's expensive).
What I'm saying is they're basically good to provide you with your annual physical and maybe a few things here or there as long as they're not life-long issues. Then they try to get out of treating you with anything but medication all the while calling you a drug seeker.
The article didn’t really get into what’s causing the shortage, or at least half of it. Clearly, if the story is true, there is a discrepancy between demand and supply, and COVID may have caused a spike in demand (although I’m not sure if that would still be the case?), but what is keeping the numbers of psychiatrist low?
I'm sure burnout is a huge factor. It was reaching crisis levels before the pandemic. Now it's so far beyond that it's difficult to even think of an effective way to approach addressing it.
This is anecdotal, but I also vividly remember being interested in this career path in high school and college, and being discouraged by all of the adults in my life, including those in an official academic advisory capacity, because they believed the field was already over saturated and I would struggle to find work. My husband and many of my friends had the same experience. There were very few scholarships available for that avenue of study, and introductory classes were treated as a fun little treat to round out the education of students wisely pursuing other majors, rather than an opportunity for someone who may be interested in further pursuing the topic to get a good foundational understanding. The idea that anyone in those classes would actually take more advanced classes on the subject was barely acknowledged.
It's possible that experience was specific to my high school and college, but I'd be surprised.
That still leaves a lot of questions. In the article (and often anecdotally), people say that therapists are overbooked, with long waiting lists, and are also very expensive.
That would seem to indicate that if you opened a new practice, you'd have a bunch of customers who'd also pay a lot of money?
Undergrad psychology is infamously one of the most common bachelors (as you noted when people discouraged you). So something must be keeping that supply, from turning into a supply of psychiatrists that can run therapy practices (which would seem to be lucrative? Or otherwise they should raise prices if they're not, if demand is that high). Is it just the rigors and/or expenses of med school?
I think the unsaid portion is that the therapists that are affordable, that are willing to accept insurance, that are conveniently located - those are all overbooked. If you plunk enough money down you can find a therapist, but a lot of them massively prefer private-pay clients because insurance reimburses at rates far below competitive hourly private-pay rates. The ones that take insurance are either doing it out of a sense of fairness or they're trying to fill gaps in their schedule, it's universally more profitable and less hassle to take insurance. That goes double for private practice therapists.
The article says she offered private pay in at least one of their examples, though, so obviously there are more hurdles. The next is discoverability. If she simply googled "therapists" and got to psychologytoday.com or the APA locator list, that's going to show a lot of the same names to people who go looking. There are likely many therapists on the bottom of the lists with availability, but they may be undesirable for some reason - cost, reviews, location, hours, etc. Some may be specialists that aren't targeting what you need, since therapists often specialize in fields like family therapy, childrens' therapy, addiction therapy, etc.
Following that, there is the noted problem of time. Licensing takes time. Degrees take time. It's challenging to come up in a high cost of living area while you're still working on your less-senior qualifications. Associates don't get paid for shit, nor do most agency workers. That's going to severely thin the herd of people willing to endure that work in areas like LA, NYC, the Bay Area, and other big metros.
The list of problems goes on. It's a field like any other, with post-COVID problems like any other. I'm sure it will equalize eventually but this is still a pretty new problem relative to the speed of matriculating and placing new therapists and psychiatrists.
I think the expectation when I was in school was that this wouldn't be the case. The process of becoming a therapist/psychiatrist isn't quick. The educational sector would need to have already begun encouraging an increase in supply 5-10 years ago, (depending on level of expertise) in order to avoid the issue we're having today.
I do also think the rigors and expenses of med school are a major factor. The expenses especially. That's a massive amount of debt to take on. Before the demand for mental health professionals became this obvious, that would have seemed like quite a gamble. Young people now deciding what career path to take are watching their older siblings drown under the debt from much less expensive degrees.
Another side of it is people want to be seen by PhD's not MFTs or LCSW's and MFTs are the hot new thing to get people through the education system and providing therapy faster for their patients. It's great to help with demand, but when someone actually needs to see a doctor doctor for their therapy for complex cases, there are very few available.
This is an interesting point. There may be overconsumption of specialized mental healthcare services. Consumers who can afford it may demand the highest quality care regardless of whether their needs merit it — a misallocation of resources.
I have some (handsomely-compensated) friends who will talk with their therapists every week or more frequently. Often about work, dating, and so on. And I imagine that they will accept nothing but the best. I don't have insight into their personal mental health, but I have a vague feeling that there's some unnecessary overconsumption.
Absolutely! I think many people are also not trusting of the MFTs or LCSWs because they're therapists, but not psychologists. I've gone to both over the years and I know that my case is very complex with a lot of issues balled into one with chronic pain, ADHD, and childhood trauma. I need someone really experienced in the type of therapy that I need and that is almost always a psychologist. If I didn't need to push for someone more leveled up, I would have gone with anyone who could see me frequently just to talk weekly about what was bothering me.
I don't blame your friends for wanting the best their insurance can provide, that's a benefit they're entitled to. I think overall, we need to start compensating mental health professionals on par with their physical health counterparts at the very least, and figure out how to get more therapists in the system at the higher levels, whether that be through on-the-job education or grants to get these people in with less debt (I personally am in favor of no student loan debt, but we all know how well that's going in the US...)
The education requirements for psychiatry is very demanding. My wife considered it and it requires med school, then you have to get matched into a psychiatry residency program, which are very competitive and hard to get into, then you have to do a 4-7 year residency program, and then 1-2 years of a fellowship.
I would say a large part of the situation is the amount of schooling that it takes and the actual pay upon graduation. At least when you go to medical school to become a doctor, you have a massive salary potential upon graduation.
Even if you want to just be a therapist, not even a psychologist; you are looking at a bachelor's degree and then a master's degree in social work, or some sort of mental health counseling. Then add on another two years of practical training before you even get your license. So it's a minimum 8 years before you can practice on your own, and then you have to be good at marketing yourself to actually be successful in private practice to make money. If not you're working for someone and making a good salary, but nothing tremendous.
And then as a therapist, you aren't allowed to perform assessments or diagnose so for patients that really need medication you'll have to refer to a psychiatrist or a psychologist.
And then for a PhD/PsyD you are looking at 4 years bachelor + 5 years graduate (minimum), so that's 9 years before you are working. And it's very rare for psychology PhD/PsyD programs to be fully funded, I believe there are only a handful of programs like that. Acceptance rates are in single digits and then when you graduate you do make six figures, but not $200k like a physician would. It's a lot of schooling and highly competitive for a somewhat low return.
You have to REALLY want to do something like this and I'm sure the job has extremely high burnout rates.
Clinical psychology can actually be a harder program to get into than med school, just in terms of admissions standards.
Increased demand due to:
Supply low due to:
Most practitioners aren't medical doctors but are instead psychologists and social workers—some who may have a doctorate. The educational requirements are steep but only the psychiatrists are paid particularly well by the system.
Much like paramedics, firefighters, and teachers, the compensation isn't there despite the critical need.
I imagine it's due to many of the same reasons there's a doctor shortage in the US.
In brief:
There are many nurses and other professionals who are trying to earn degrees and the hurdles to get there are enormous. Not just applying and trying to find a good program, but financially. Most schools do not provide help for getting a preceptor and if they do have “lists”, the preceptors are charging students even if you can find one. The hurdles are real.
Older article and kind of obvious - but gives some details to the scale of the problem.
Aside from the sheer shortage, what other hurdles do people face when they are trying to access mental health professional services?
related: The Difficulty of Finding a Therapist for Complex Post-Traumatic Stress Disorder.
A "us" tag would be good. This is highly local.
Ah! thank you! but I see that I was preempted by @mycketforvirrad :D [Cantonese accent] SO FAST! [/Cantonese Accent]
No one beats @mycketforvirrad!
I work at a company that handles insurance. I recently got promoted, but the role I had before this was involved with finding people providers that were in-network. Mental health was tough. The following things would come up:
If they were in-network, they had shit availability. Weeks to months out and sometimes there would be a waitlist. One time, I was told there was a waitlist into early 2024. And if you did manage to get an appointment, it was always at odd times. If you work a standard 9-5, best hope you are okay crying on your lunch break to your therapist or can get off work early. Or if you can get your job to approve the reoccuring appointments.
If they weren't in-network, it would be self-pay. Standard pricing is generally around $80+. If you wanted to go every week, that's $4,160 a year. Personally, my therapy costs $175 per session and I see her every two weeks on a Saturday at 10am. That's $4,550 and not everyone can be so fortunate to do that.
All in all, we were already having issues with finding mental health providers. COVID has just made it so much worse and there is a shortage.
My psych (chiatrist/cologist, does both) explicitly dropped my insurance because of how poorly they paid him and how badly they treated his patients.
My insurance is now paying him more as an out of network provider than they ever did as in-network. All I have to do is a boatload more paperwork.
I'm only willing to deal with hassle because I've been working with him for over a decade, and he's kept me from going inpatient multiple times. A reasonable insurance person would have taken one quick glance at that statement and let me keep seeing him at $0 copays. One inpatient visit is way more expensive than a lifetime of monthly's.
I'm so glad you found something that worked for you. Like some others have said in this thread, we're asking folks who are dealing with a hurt brain/souls to navigate all these hurdles while their brains/souls are much less capable of doing so.
it's a broken system that isn't even profitable.
If you're looking for a therapist and are in NYC, check out the National Institute of the Psychotherapies (NIP). They accept pretty much all insurance. They have therapists in training. After an intake interview you are matched with a therapist and, after seeing them at NIP for a couple of years, you have the option of following your therapist to their new practice (which might not accept insurance).
https://nipinst.org/
The USA pretty much has a failed health care system. People need to try and find their own, better solutions when possible.
Maybe more people who have a good aptitude for becoming therapists can volunteer part time as they transition to retirement from other careers. Maybe more people can find alternatives to expensive, hard to obtain therapy via a more self-help approach.
Anecdote: When I was in my mid twenties I fell into depression for a couple of months after my grandmother died. My depression was cured instantly, accidentally, when I took some psychedelic mushrooms while hanging out at a beautiful park with some friends on a camping trip. I thought thru and discarded my grief over a roughly 10 minute period of introspection, and began a super-healthy (physically, mentally, and spiritually) period of my life that lasted for a couple of years. The shrooms cost me around 20$. I'm quite aware that mushrooms are on the verge of becoming legal in some places e.g. Colorado, and I think this sort of approach (not just mushrooms, but a wide variety of valid self-help approaches) could be used by huge numbers of people who suffer from health problems that would benefit from therapy.
As a society, we need to think outside the box, and not look to the government or corporations to help us actual people. As Tildes and the fediverse etc show, it's quite possible for large numbers of people to break away from mainstream approaches that aren't working out well, and find new approaches that are more grass-roots oriented.
I tried dozens of oral medications, transcranial magnetic stimulation (TMS), ketamine therapy, and combinations of those at the same time. After doing all that and getting "stable" but not thriving, I decided to go and get some mushrooms while I still lived near a place where it was decriminalized. I had followed psilocybin research for years and was getting desperate to find something that would help me feel normal. One trip sitting on my porch sipping tea did more for me than over 15 years of therapy and all of those doctors and medications combined. It was a game changer.
I don't know that it would work the same for everyone, but I'm outraged that it's illegal for people to try.
It's a drug I've used before. It's beautiful, powerful, and abundant. The first time I had some I went from anxious, self-conscious and depressed to confident, comfortable and happy over the course of a few hours. That one dose didn't last forever, but the effects lasted a few months and I ended up back on an upwards trend once I cut back on THC a bit after that.
Imagine that! At least 25% of the American population subscribes to some flavor of "fuck your feelings" and they're surprised when they can't get mental health care?