by: Sandra Davis
Occasionally while browsing Facebook, I’ll see a person asking for recommendations for a counselor or therapist who “isn’t in it for the money.” It stings me – not because I am offended per se – but because the perception that mental health professionals are careless, money-grubbing monsters seems to be the logical result of a much larger problem: mental health services are not affordable to the masses. According to nami.org, 43.8 million individuals experience mental illness in a given year, which costs up to $193 billion in lost income for those people suffering from severe mental illness. Of these millions of people, only 60% of adults and 50% of children actually received desperately needed mental health services in 2018. Accessibility to services is the most common reason – even ahead of stigma – that many people do not receive the care that in some cases, would save their lives. I receive calls on a weekly basis from people seeking therapy who cannot find a therapist who accepts their benefits, or if they do, those clinicians are no longer accepting patients.
So here’s the first question: Why don’t more clinicians accept insurance? The simple answer is that insurance companies are a massive burden (Surprise, surprise!). Their reimbursement rates for clinicians are all over the place, it can often be difficult for clinicians to collect funds (I once chased Aetna over $5000 in the form of weekly 2-3 hour phone calls over the course of a year), and billing is honestly just a bit of a pain. Clinicians who do accept insurance benefits also have trouble taking on new patients because so many other clinicians do not, therefore their schedules tend to remain full.
Next question: Can’t clinicians do more low-cost and pro bono work? Why are they so worried about money? This is an honest question with an honest answer. Most individuals who enter a helping field do so because their calling is truly as healers and helpers. Most accept a certain percentage of pro bono and low-cost work (the industry standard is 10%) and would love to take on more. That said, the typical clinician attended anywhere from 6 to 10 years of education to achieve their degrees. The cost of post-graduate education easily reaches six figures for many of them, so in addition to supporting their families, they are attempting to meet the responsibility of repaying large sums of student loan debt. Therefore, accepting high percentages of pro bono work can mean those clinicians are unable to make ends meet despite their desire to help as many individuals as they encounter.
But therapy is a luxury not a necessity, right? No. For many people, therapy is not only life changing, but also life-saving. Unfortunately the idea of therapy as an indulgent form of bourgeoisie self-care has become mainstream because it is, in fact, expensive. And there lies the rub. Clinicians – who have every desire and intention of helping and healing as many individuals as possible – must charge high fees to compensate for their time and support themselves and their families. The result is often that only people who can afford treatment actually receive it but of course, too many others who need it never end up finding affordable care.
So back to our Facebook friend looking for a clinician “who’s not all about the money.” What is he to do? The long-term solution will take a village…a big one. Mental healthcare (and healthcare in general) must become a larger conversation and we must begin to focus legislation toward better accessibility and reducing the stigmas around mental illness. Student loan forgiveness programs designed to encourage clinicians to work for nonprofit and public sectors should be steadily enforced to incentivize clinicians to accept lower-paying positions. But there are short-term solutions too. Most counties have some form of a low cost mental health clinic, often formerly known as MHMR’s. They now have various names, such as Metrocare and Lifenet. Many private practices – such as Richland Oaks Counseling – also serve as training programs and therefore have interns across various levels of training and who charge a more negotiable range of fees. Additionally, if an individual finds an out-of-network provider they can often seek at least partial reimbursement from their insurance carriers to help offset the cost.
Finally – shameless plug of the day – I recently founded The Willow Field Foundation whose mission is to raise charitable funds in order to provide therapy scholarships to individuals who otherwise could not afford competent care. It is a daunting undertaking, again due to the massive cost of therapeutic services, but it’s worth attempting.
So here’s my Ask: talk about mental health. It’s not shameful to do so. If you’ve had positive experiences with therapy, share those experiences with others. If you need help and are unsure how to go about it, ask! Become advocates among your families, communities, and/or governments about the need and benefit for better accessibility. It will take time and effort but there exists a future where anyone who needs care can receive it without barriers and complications.