“When I started looking for a psychiatrist on my own, I was very unlucky,” said Syracuse, who lives in Whitefish, Montana. While her therapist – a non-prescription provider – gave her a recommendation, there were no appointments available for six to eight weeks.
For a person facing mental health amid a pandemic that seemed far away. “If I’m honest, I wouldn’t do very well,” he said. “It seemed to me that no matter what I did, I couldn’t get the help I was looking for or it wasn’t handy.”
At a time when the ongoing pandemic is stressing mental health, many people go completely without care. Experts say the pandemic is exacerbated by a shortage of mental health service providers, which is long before the current crisis.
If you find help, it may depend on where you live, who you are and how much you have to spend.
As it is for suppliers
“In the beginning, I significantly increased my hours,” said Akua K. Boateng, a psychotherapist in Philadelphia. “I still have a waiting list of one to two months. This has never happened to me before.”
Finally, Boateng realized that he could not sustain the endless hours, which he heard from other professional colleagues.
“I started to have a little burnout,” she said. “I was doing all this while I was in a pandemic and experiencing all the things that everyone else was going through.”
Everyone works as hard as they can
“Everyone worked as hard as they could,” agreed Todd Essig, a psychologist and clinical psychoanalyst who is part of the American Psychoanalytic Association’s Covid-19 consulting team. When Essig removes a potential patient, he offers suggestions from other practitioners. These days, they often return empty-handed.
“They come back a few weeks later and check to see if I have any openings, because they haven’t had better luck elsewhere,” he said. “That never happened to me before the pandemic.”
Like Boateng, Essig pointed out that mental health issues predate Covid-19. He pointed to declining reimbursements by insurance companies to network providers that have led some practitioners to lower network status, pushing their prices beyond the reach of many caregivers.
“The pandemic exposes lines of error that should have been corrected years ago,” Essig said.
Disparities in care
While people in any community may face obstacles when seeking mental health care, gaps are not evenly distributed.
“In more than half of the counties – and most of them were in rural areas – there were no mental health providers,” said Paul Gionfriddo, president of Mental Health America, a nonprofit with a 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 have seen consistent patterns in which, even though people have been listed as available and taking new patients, they are not frequently either available or taking new patients,” Gionfriddo said.
The inhabitants of the rural area are not the only ones missing.
“There are a lot of differences depending on race, gender and age,” Gionfriddo said. Young people are the group most likely to miss mental health treatment. “We often overlook children’s problems,” he said. “Historically, they have been the most needy of the population and, historically, they have been the least served.”
Men are also less likely to receive the care they need, Gionfriddo said, in part because they wait longer to find help. And despite greater willingness to seek care, Gionfriddo said black people in the United States have less access to mental health services than white counterparts.
The LGBTQ population is also at particularly high risk, Gionfriddo explained. “People who identify with this population are significantly more affected by mental health problems,” he said. “They have some of the greatest needs, but the least understood, recognized and served needs.”
Is technology the solution to the crisis?
Mental health care was reduced before the pandemic. Now, rising demand has exacerbated the shortage. But in the struggle to adapt the provision of mental health care to Covid-19, telehealth can be a silver lining.
“It is helpful in the sense that it provides greater access to areas that usually did not have access at all or limited access,” Gionfriddo said. “I advanced about 10 years in telehealth in one year.”
The pandemic also forced some changes in insurance. “Until the pandemic, the Medicare program would not cover a telephone conversation,” he explained. “Phone calls are refundable now.”
New technologies, such as text therapy or chat, are also promising, Gionfriddo said. Different groups need different types of care, and new technologies facilitate the spread of services in a relatively diffuse population.
“This gives us the ability to micro-target information and resources and actually build sufficient demand within smaller communities,” he said. “It won’t have to be done only locally.”
Telehealth will not solve every problem
But while telehealth can bring care to areas with few providers, it will not address America’s lack of mental health care.
“It does not expand the number of suppliers,” Gionfriddo said. “He only distributes them a little differently.” Stressing the importance of long-term, sustainable solutions, he noted that the emotional suffering of the pandemic could last far beyond the vaccine.
“The impact on mental health that is being felt today will be for many years to come,” Gionfriddo said. And, he explained, some of the worst consequences of untreated suffering – including suicide – can take a long time to occur.
“No one will know if the suicide rate has risen as a result of the pandemic for at least a few years,” he said. But focusing on suicide rates in 2020 would be the whole wrong question, he added, because suicide is often a late-stage event that can occur after years of suffering.
“In fact, you have to look at suicide rates over the next 15 years to get an idea of how deeply the pandemic has affected the nation’s mental health,” Gionfriddo said.
Finding – and asking for – the help you need
If you are looking for mental health care, experts say it is important to start immediately. Despite the shortage, help is there. If you have health insurance, a good place to start is to call the insurer’s information line to request contact information from network providers.
After weeks of phone calls and delays, Syracuse found a psychiatrist who could write a new prescription for antidepressants. It made a difference. “Since I changed my medicine, I’ve felt 100 times better,” he said. “Everything is not as big of a fight as it was, which is very easy.”
One problem, Syracuse said, is that 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 you struggle with this, Syracuse recommended that you ask a loved one to provide logistical support. When he told his wife about the lack of care, she volunteered to appeal on his behalf.
“It was very helpful,” he said. “It kind of took my toll.”