“When I went looking for a psychiatrist on my own, I had very little luck,” said Siracusa, who lives in Whitefish, Montana. While his therapist – a health care provider who doesn’t write prescriptions – gave him a referral, no appointments were available for six to eight weeks.
For someone struggling with mental health during a pandemic, that seemed a long way off. “If I’m honest, it didn’t go very well,” he said. “It felt like whatever I was doing, I couldn’t get the help I was looking for or it was out of reach.”
At a time when the ongoing pandemic is putting pressure on mental health, many people are left without care. Experts say the pandemic is exacerbating a shortage of mental health care providers far older than the current crisis.
Whether you find help at all may depend on where you live, who you are, and how much you have to spend.
How it is for providers
“In the beginning, I increased my hours significantly,” said Akua K. Boateng, a psychotherapist in Philadelphia. ‘I still have a waiting list of one to two months. That has never happened to me before. ‘
Eventually, Boateng realized that she could not sustain the extra hours indefinitely, she heard from other professional colleagues.
“I started to have a little burnout,” she said. “I did all that while I was still in a pandemic myself, experiencing everything everyone else was going through.”
Everyone works as hard as they can
“Everyone has worked their hardest,” agrees Todd Essig, a clinical psychologist and psychoanalyst on the American Psychoanalytic Association’s Covid-19 advisory team. When Essig rejects a prospective patient, he offers suggestions from other practitioners. Today they often return empty-handed.
“They come back a few weeks later to see if I have any openings because they haven’t had better luck anywhere,” he said. “That never happened to (me) prior to the pandemic.”
Like Boateng, Essig emphasized that mental health problems predate Covid-19. He pointed to diminishing reimbursements from insurance companies to in-network providers that have led some practitioners to decline in-network status, putting their prices out of reach for many seeking care.
“The pandemic is exposing fault lines that should have been corrected years and years ago,” Essig said.
Differences in care
While individuals in any community can face hurdles in seeking mental health care, the shortages are not evenly distributed.
“More than half of the counties – and most of them nationwide – had no mental health providers,” said Paul Gionfriddo, president of Mental Health America, a nonprofit with a mission to meet the needs of people. people with mental illness. Even in urban areas where care is theoretically available, finding a care provider can be difficult.
“We have seen consistent patterns where even when people are listed as available and take new patients, they are often not available or take new patients,” Gionfriddo said.
Land dwellers aren’t the only people who miss it.
“There are many differences based on race, gender and age,” said Gionfriddo. Young people are the group most likely to miss mental health treatment. “We often overlook the problems of children,” he said. “They are historically the neediest 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 to find help. And despite a greater willingness to seek care, Gionfriddo said black people in the United States have less access to mental health care than white counterparts.
The LGBTQ population is also at particularly high risk, Gionfriddo explained. “People who identify in that population are significantly more likely to have mental health problems,” he said. “They have some of the greatest needs, but the least understood, recognized, and served.”
Is technology the solution to the crisis?
Mental health care was scarce before the pandemic. Now, increased demand has exacerbated the deficit. But in the battle to adapt mental health care to Covid-19, telecare can be a silver lining.
“It helps because it provides better access in areas that normally had no or limited access at all,” said Gionfriddo. “We have progressed about 10 years in telecare in a year.”
The pandemic has also resulted in some changes in insurance. “Until the pandemic, the Medicare program did not involve a phone call,” he explained. “Phone calls are now being refunded.”
New technologies, such as text or chat therapy, are also very promising, Gionfriddo said. Different groups need different types of care, and new technologies make it easier to spread services over a relatively diffuse population.
“This gives us the opportunity to microtarget information and resources and actually build sufficient demand within smaller communities,” he said. “It doesn’t just have to be done at the local level.”
Telehealth does not solve every problem
But while telehealth can bring care to areas with few caregivers, it won’t solve America’s mental health shortage.
“The number of providers is not increasing,” said Gionfriddo. “It just divides them a little bit differently.” He underlined the importance of sustainable long-term solutions and noted that the emotional distress associated with the pandemic can go well beyond a vaccine.
“The mental health effects of this being felt today will persist for many years to come,” said Gionfriddo. And, he explained, it can take a long time for some of the most serious consequences of untreated suffering – including suicide – to appear.
“No one will know if the suicide rate has risen for at least a few years as a result of the pandemic,” he said. But focusing on suicide rates for 2020 would be totally the wrong question, he added, because suicide is often a late-stage event that can happen after years of suffering.
“You actually have to look at the suicide rates over the next 15 years to get an idea of how deeply the pandemic has affected the mental health of the country,” said Gionfriddo.
Finding – and asking – the help you need
If you’re looking for mental health care, experts say it’s important to start immediately. Despite shortages, there is help. If you have health insurance, the best way to start is by calling the insurer’s information line to get contact information for in-network providers.
After weeks of phone calls and delays, Siracusa found a psychiatrist who could write a new prescription for antidepressants. It made a difference. “Since I switched medications, I have felt 100 times better,” he said. “Everything isn’t as much of a struggle as it used to be, which is super enlightening.”
One problem, Siracusa said, is that the symptoms of depression and other mental illnesses can make it difficult to stay motivated while seeking care. It’s easy to give up when things feel so difficult.
If that’s what you’re struggling with, Siracusa recommended asking a loved one to provide some logistical support. When he told his wife about the lack of care, she offered to call on his behalf.
“That was really helpful,” he said. “It kind of took the burden off me.”