It’s becoming impossible to find a therapist

If you’re looking for a therapist – as an individual or for a couple – you know this is true.

The shortage has changed the way I do my job as a consulting columnist. I used to tell people that my love letter column was for entertainment and light support. If the letter writer issue or bad feelings seem persistent, I recommend finding a therapist. But in 2021, I can’t just say, “Hey, look for professional help.” It’s not that simple.

And when friends, colleagues and acquaintances ask if I can nominate a good consultant, I have no answers. As of the spring of last year, none of the specialists I work with have received new patients, and many have stopped adding to their waiting lists.

Although the scarcity of treatment is not unique to Massachusetts, the scarcity of treatment is an important issue here, and not just in hospitals, which are overwhelmed by patients who need psychiatric care. There are some obvious reasons for this supply and demand problem.

Of course, COVID-19 means that many of us are suffering at the same time, and many of them are struggling with the fact that, despite vaccinations, we will not be. With a pandemic anytime soon. We are still dealing with shocks, big choices, and change in the midst of a global crisis.

COVID-19 has also removed some of the stigma associated with treatment, I think, inflating patient demand. There have been people in my life who have either resisted treatment, or given up counseling long ago, who have suddenly decided, “Okay, it’s time to get help, and I don’t feel weird asking for it.”

For others, getting help has become more manageable in a logistical sense. Most therapists switched to online appointments after a COVID infection, and treatment is easier when you don’t have to limit travel time.

However, it didn’t take long before mental health professionals with job opportunities reached the maximum number of cases. And even if they had slots, they wouldn’t necessarily take a lock, making them inaccessible For a large segment of the needy people. (Why don’t these therapists take insurance? More on that later.)

President of the Massachusetts Psychiatric Association Martin R. Pierre said there are about 6,000 psychologists in the state, 1,700 of whom are members of the MPA. Although he does not have solid data, “It can be said anecdotally that the vast majority of [psychologists] Full,” he says. “It has been stretched to an extreme. Queues range from approximately 5 to 15 customers. This changed at the height of the epidemic.”

This summer, I called Dana Mauch, president and CEO of the Massachusetts Mental Health Association, and told her I wasn’t sure what to advise people seeking therapy anymore. People in the industry are asking the same question, Mauch said.

“Rates of people reporting a disorder in their mental health and well-being almost doubled than in the pre-epidemic period among adults. And for some children, it’s actually higher – young adults aged 18-24.” Even in the pre-pandemic era, she said, “we didn’t have enough specialists to treat,” and the system for finding them was opaque.

This problem is so big that her organization has started a campaign called #JustAsk, which provides links to resources, including community health centers, support groups, hotlines, and private clinics, and also reminds people that they can connect with their friends and family. for support. I think this is better than nothing.

Restrictions on insurance coverage continue to play a large role A role in patients’ ability to access behavioral health care. Even before the pandemic, Mauch said, a big problem for mental health professionals was that insurance companies often did not reimburse them for what they were actually charging. A therapist might pay $200 an hour, for example, but only get paid $75 by the client’s insurance company. This disconnect can lead practicing therapists to refuse insurance altogether and, according to Mauch, can dissuade potential therapists from pursuing the field.

Pierre said results of the MPA’s Spring 2020 survey, “Massachusetts Psychologists’ Experiences with Insurance Plans,” showed that 83 percent of respondents were in-network or out-of-network health insurance providers. But they may not take MassHealth, for example, or for you Insurance whatever.

A study funded by Massachusetts’ Blue Cross Blue Shield, “Access to Outpatient Mental Health Services in Massachusetts,” found that 45 percent of outpatient mental health providers did not accept MassHealth, 38 percent did not accept Medicare, and 16 percent agreed not to accept commercial insurance.

In response to a 2018 BCBSM study, nearly 36 percent of adults in Massachusetts seeking treatment for mental health and/or substance use disorders said they had been told that their provider did not accept their type of insurance; Nearly 11 percent were told that the provider does not accept insurance at all.

It’s hard to blame mental health professionals for bailing them out of the insurance system. Earlier in her career, when local therapist Monica O’Neill billed insurance companies, she remembers asking her landlord to wait for rent because she hadn’t yet been paid for the work she did.

“For trying to get paid by an insurance company, it would be easy to be in an hour and it’s just a wild chase,” she said.

Several therapists have told me that mental health care providers — including licensed social workers, psychologists, and psychiatrists — are in an ongoing battle with insurance companies over how and how much they pay and when the money comes. This means less time for customers.

And for someone already struggling with anxiety or depression, finding an affordable therapist and accepting new patients can be stressful. Many ask friends, family, colleagues – and people like me talk a lot about therapy. They are Google. Psychology Today has a very good list of therapists in all zip codes. But not every therapist is out there, and the guide doesn’t always tell you who’s taking new patients.

In 2019, when he was a resident psychiatrist at Massachusetts General Hospital, Jack Turpan wrote a revealing story for STAT about trying to find a therapist for himself. Turpan, now a fellow in child and adolescent psychiatry at Stanford University School of Medicine, has discovered that insurance companies’ listings of available therapists often go nowhere—inaccurate listings have been dubbed “ghost networks” or “phantom.”

When I called some insurance companies to talk about the problems, their spokesmen said they were doing their best to connect people with available therapists.

The shortage of therapists has prompted her group to adopt new technologies, said Emily Bailey, former vice president of behavioral health at Point32Health, the now-integrated Tufts Health plan and Harvard Pilgrim Health Care. Including Apps like Sanvello, Talkspace, and Happify, which, she says, studies show can be clinically effective. Some offer things like life coaching and happiness exercises, access to support from other users, text therapy, or online occupational therapy.

But Mauch said the techniques and studies are new, and that patients should be careful about how the systems are organized and whether the treatment they provide is from certified professionals.

(Disclaimer: The therapy platform announces on the podcast “Love Letters.”)

For my part, I’ve been reaching out to more mental health experts to consult love letters when it seemed like they might be helpful. I know they can’t diagnose anyone based on a 200-word letter in an advice column, and that love letters are not a substitute for licensed help (like many how-to columnists, I’ve only trained as a journalist). But these days, columns like mine might be the only help anyone can find.

Most therapists want to help as many people as possible, but they have to set limits for themselves too, said Sienna Hunter Cojet, clinical director at And Still We Rise. The therapists in her group see patients who are coping not only with the pandemic, but also with racism and discrimination based on their gender or sexual orientation. Therapists balance treatment needs with administrative work and their own experiences during this crisis period.

She said mental health professionals with And Still We Rise are receiving new patients, and the group plans to hire more new therapists.

“All of us go into this field because we care about Person,” Hunter Quigit said. “Putting someone off is just… I don’t even know if I have the word to really describe it.”

Meredith Goldstein writes the love letter advice column. Send your relationship questions to loveletters@globe.com. Watch Meredith Goldstein’s ‘Love Letters’ podcast on loveletters.show Or wherever you listen to podcasts. If you are a licensed therapist willing to share your professional opinion on Love Letters, send an email to meredith.goldstein@globe.com.

Help getting help

Can’t find a therapist? The therapists and experts I spoke to had some suggestions.

1. Consider teamwork. Sometimes finding group therapy is easier than finding individual therapy. Contact your primary care physician, your insurance company, and even local hospitals to find out what group therapy services are available.

2. Say yes to any waiting list. Some used to say, “Well, ah, I can’t wait six months.” But even waiting lists can be hard to come by now. Get all the listings you can.

3. Ask for a referral. Mauch advises asking your primary care physician if he or she belongs to any behavioral health practitioner.

4. Pierre recommends that you ask someone you trust to help make the initial phone calls, so the process is less difficult.

5. Don’t underestimate your immediate needs. If you need help now, treat it like any other emergency and get help, even if it means an emergency room.

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