I’m tired of hearing about how all the world’s ills are due to lack of mental health services. The resources are there. Or can be. That’s not the whole problem. It’s super complex and must be addressed holistically. We can’t just blame access and call that a solution.
What’s the problem, you may ask? Well, here are my opinions:
- Mental Health Stigma. For many, it’s seen as embarrassing or shameful to “have to go to therapy.” Treatment is not seen as preventative or as mainstream. It means that you’re losing it, so you have to keep it a secret. I’ve been in therapy for many years. (Like at least 8.) But you’re a therapist, Katie, you’re allowed. THAT’S THE POINT – Everyone should be allowed. It shouldn’t mean that anyone is crazy, but somehow it does. I wasn’t required by my masters program to go into therapy, I chose. And I’m continuing to choose to do so – for personal growth as well as to cope with whatever life throws at me. For me to let you all know that I’m a long-term therapy client is hard. AND I’M A THERAPIST. We can’t get any traction on preventative (or even crisis) care, if we don’t make it okay to go. We must #endmentalhealthstigma now!!
- Community mental health has a ton of potential even though it’s stock full of burned out people. Medicaid services in LA County (known in California as Medi-Cal) are state of the art and life-changing. These services are offered for free to those with the highest level of need. Community mental health has figured out that when you serve the whole person (taking care of basic needs, integrating medical and mental health care, being flexible with location and who is being treated) you’ll have better results. They provide training for mental health professionals to support best practices and increasingly better outcomes. Sure they’re bogged down with bureaucracy and staffed with newbies and burned out people with a shockingly high turnover rate, but the resources are there.
- Insurance coverage sucks. I’ve just mentioned what awesome services you can get for free if you have little financial resources. Surprisingly, if you’re somewhere in the middle, income-wise, you have fewer options. Health insurance companies rarely raise their rates for reimbursing therapists. And before you get all high and mighty about why therapists should suck it up and provide these services– think about that time when you didn’t get a raise or a cost of living increase for 20 years – oh wait, that’s just therapists who take insurance. Unfortunately, not many therapists are in-network for insurance because they can’t live off the reimbursement rates. That means, ironically, the biggest gap in services is for folks who should have access through their insurance. Why is this the case? Much of the problem goes back to stigma. If I start yelling that my health insurance is not adequate to serve my mental health needs, I must first admit (publicly) that I need it. That’s a tough thing for most folks to do. And like most things that have been stigmatized, many people just don’t want to pay for it.
- Therapists are not notoriously good business people. There are a ton of therapists sitting in empty offices, waiting to help you. Maybe they don’t advertise well or respond quickly when you call, but they can be wonderful therapists. It can be challenging to sort through all of the local therapists (especially in Los Angeles County, where I live), so I get that it can be hard to find and choose the right therapist. But they’re here! Anyone with good insurance (especially out of network benefits – see #3) or enough money can get therapy. I promise.
- It’s super hard to become a therapist. Getting a masters or doctorate degree, working under supervision for 3000 or more hours, and taking extensive licensing tests, are just some of the necessary safeguards to make sure we can do the job. However, in addition to these necessary safeguards, therapists are often required to work for free to get those 3000 hours of supervised experience. So, many therapists work a full time job while eking out some hours of supervised training after work. Others will just ride out the training period with little to no money, hoping they can get licensed quickly and find paid work. Due to these conditions, many possible therapists are either not working as therapists or are working for many fewer hours than they’d like. That actually does decrease access to mental health care, but not because it isn’t there, but because it isn’t being paid for. You cannot expect someone to take on treating society’s ills for free.
I believe that access to quality mental health care is critical for our society. I actually appreciate any efforts to increase access for everyone. I don’t think that mental health services should only be provided to folks in crisis or who have tons of money, but rather as a preventative, life improving measure as well. Wouldn’t it be wonderful if everyone was allowed time to go and talk to someone, to get tools to cope with life and all of the difficult things that can come our way, without feeling guilty, or ashamed, or weak? I think access is critical, but not the only piece of the puzzle. The problem is much more complex and we must work together to resolve it.
What are your thoughts on how to make our society better, safer, happier?