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“When I first started looking for a psychiatrist on my own, I had very little luck,” said Siracusa, who lives in Whitefish, MT. While her therapist – a provider who doesn’t write prescriptions – gave her a referral, there was no appointment available for six to eight weeks.
To someone struggling with mental health in the midst of a pandemic, it seemed like a long way off. “If I’m being honest I wasn’t doing very well,” he said. “I felt like no matter what I did, I couldn’t get the help I was looking for or it was out of reach.”
At a time when the current pandemic is straining mental health, many people find themselves completely without care. Experts say the pandemic is exacerbating a shortage of mental health care providers long before the current crisis.
Whether you find help will depend on where you live, who you are, and how much you have to spend.
What it looks like for suppliers
“At first I drastically increased my hours,” said Akua K. Boateng, a psychotherapist in Philadelphia. “I still have a one to two month waiting list. This has never happened to me before.”
Eventually, Boateng realized that she couldn’t endure the increased hours indefinitely, which she had heard from other professional colleagues.
“I started to have a little burnout,” she says. “I was doing all of this while still being in a pandemic situation myself, and experiencing all the things everyone was going through.”
Everyone works as hard as they can
“Everyone worked as hard as they could,” acknowledged Todd Essig, clinical psychologist and psychoanalyst who is part of the American Psychoanalytic Association’s Covid-19 advisory team. When Essig turns down a potential patient, he offers suggestions from other practitioners. These days they often come back empty-handed.
“They come back several weeks later and check if I have any openings because they haven’t had better luck elsewhere,” he said. “This never happened to me before the pandemic.”
Like Boateng, Essig pointed out that the mental health issues predate Covid-19. He pointed to the decrease in reimbursements by insurance companies to network providers which has led some practitioners to decline network status, pushing their prices beyond the reach of many healthcare seekers.
“The pandemic exposes loopholes that should have been fixed years and years ago,” Essig said.
Disparities in care
While individuals in any community may encounter barriers when seeking mental health care, the shortages are not evenly distributed.
“In more than half of the counties – and most of them were rural – there were no mental health care providers,” said Paul Gionfriddo, president of Mental Health America, a nonprofit organization. lucrative mission to meet the needs of people with mental illness. Even in urban areas where care is theoretically available, finding a provider can be difficult.
“We’ve seen consistent models where even though people were listed as available and taking new patients, they often weren’t available or didn’t take new patients,” Gionfriddo said.
The inhabitants of the countryside are not the only ones to do without it.
“There are a lot of differences based on race, gender and age,” Gionfriddo said. Young people are the group most likely to miss mental health treatment. “We often overlook children’s issues,” he said. “They have always been the poorest of the populations, and historically they have been the least served”.
Men are also less likely to get the care they need, Gionfriddo said, in part because they wait longer for help. And despite a greater willingness to seek care, Gionfriddo said black people in the United States have less access to mental health services than their white counterparts.
The LGBTQ population is also particularly at high risk, Gionfriddo explained. “People who identify with this population are much more affected by mental health issues,” he said. “They have some of the most important needs, but the least understood, recognized and met.”
Is technology the solution to the crisis?
Mental health care was scarce before the pandemic. Now the increased demand has compounded the shortage. But in the race to adapt the delivery of mental health care to Covid-19, telehealth may be a silver lining.
“It helps, as it provides better access in areas that generally had no access or limited access,” Gionfriddo said. “We have made about 10 years of telehealth progress in one year.”
The pandemic has also led to changes in insurance. “Until the pandemic, the Medicare program did not cover a telephone conversation,” he explained. “Phone calls are refundable now.”
New technologies, such as text message or chat therapy, are also promising, Gionfriddo said. Different groups need different types of care, and new technologies are making it easier to deliver services among a relatively diffuse population.
“This gives us the ability to micro-target information and resources, and create sufficient demand within small communities,” he said. “It should not be done only at the local level.”
Telehealth won’t solve all problems
But if telehealth can bring care to areas with few providers, it will not solve America’s mental health care shortage.
“It does not increase the number of suppliers,” Gionfriddo said. “He distributes them just a little differently.” Stressing the importance of lasting and long-term solutions, he noted that the emotional distress from the pandemic could last well beyond a vaccine.
“The mental health effects of this situation that are being felt today will play out for many years to come,” said Gionfriddo. And, he explained, some of the most serious consequences of untreated suffering – including suicide – may take time to emerge.
“No one will know if the suicide rate has increased due to the pandemic for at least a few years,” he said. But focusing on suicide rates in 2020 would be entirely the wrong question, he added, as suicide is often a late event that can occur after years of suffering.
“You actually have to look at suicide rates over the next 15 years to get a sense of how deeply the pandemic has affected the mental health of the nation,” Gionfriddo said.
Find – and ask for – the help you need
If you’re looking for mental health care, experts say it’s important to start right away. Despite the shortages, the help is there. If you have health insurance, a good place to start is to call the insurer’s information line to ask for contact details for network providers.
After weeks of phone calls and delays, Syracuse found a psychiatrist able to write a new prescription for antidepressants. It made a difference. “Since I changed medication I felt 100 times better,” he said. “It’s not all as hard as it used to be, which is super relieving.”
One problem, Siracusa said, is that symptoms of depression and other mental illnesses can make it difficult to motivate while seeking care. It’s easy to give up when the going is so tough.
If that’s what you’re struggling with, Syracuse recommended asking a loved one to provide logistical support. When he told his wife about the lack of care, she volunteered to make calls on his behalf.
“It was really helpful,” he said. “It kind of took the load off me.”
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