The Intolerable Wait in Line for Mental Health Care

Wait times have ballooned to weeks, even months, across the United States. If you need help now, here are several options.

A good friend suffering from severe anxiety, going on six weeks to see a therapist, recently asked me over coffee, “Do I need to fake a suicidal visit to the ER to get some help?” Her plight is an increasingly common one.

Seven in 10 psychologists across the United States say their wait lists have grown longer since the start of the pandemic, according to the American Psychological Association. Average wait times for mental health services in Texas, as of a report in May, was 143 days. Four months is a long time to be stuck in a holding pattern if you’re depressed or anxious.

“This trend is not going away,” said Vaile Wright, PhD, a clinical psychologist and the APA’s senior director of healthcare innovation, during an interview with The Washington Post.

Behind the neverending lines: A surging need, lack of insurance coverage, and mental healthcare deserts. If you don’t want to get stuck in a line, you’re going to have to get creative and think outside the standard office visit with its cliché couch.

Growing need for help

In recent years, more Americans have developed emotional conditions that need attention. As of May 2023, 30% of US adults have symptoms consistent with anxiety or depression, according to USA Facts, a repository of government data.

No surprise then, the number of people seeking mental healthcare to help alleviate those symptoms has rapidly increased. According to 2022 Gallup polling, 23% of respondents said they had met with a psychiatrist, therapist, or other mental health professional within the prior year. Only 13% had done so in 2004.

All that demand adds up to intolerable wait times. The average wait time for behavioral health services across the country is six weeks, the National Council of Mental Wellbeing concludes. If you’re seeking a specialist with particular skills, expect to wait months.

“I’m watching untreated people suffer, and it’s getting worse and worse and worse,” said Shawn Dobson, a licensed counselor in Smyrna, Georgia, commenting on conditions to The Washington Post.

Behind the neverending lines

The problem has many causes, not the least of which is the pandemic.

“Without a doubt, shortly after the pandemic started, there was a huge demand for our services,” said Daniel Fridberg, MD, associate professor of psychiatry at the University of Chicago, in a May article in The Hill.

Most experts agree that throughout the pandemic, as anxiety, depression, and other mood disorders increased, mental health providers around the country reported an unprecedented groundswell in demand for counseling and care which overwhelmed the system. According to the CDC, in 2019, 18.5% of those aged 18 to 44 had received mental health treatment in the prior 12 months; either medication, counseling, or therapy, and in 2021 the number increased to more than 24%.

“I think there is evidence for the rising rates of depression, especially among young people,” said Mark Olfson, MD, MPH, professor of epidemiology at the Columbia University Irving Medical Center, in The Hill.

Mental healthcare deserts

One-third of Americans live in areas lacking mental health professionals, according to an article in USA Facts. Just as food deserts exist — places where residents have limited access to fresh produce or farmer’s markets — the same regions occur for mental health experts.

As of June 2021, an estimated 122 million Americans live in areas with too few mental health professionals. Some 5,833 regions meet the requirements of inadequate numbers. A whopping additional 6,398 providers are needed to fill the gap.

Deficiencies are unequally distributed across the United States, with those living in rural regions feeling the greatest impact and accounting for two-thirds of the shortage areas. Wyoming and Utah are the biggest losers, with 96.4% and 83.3% of the population, respectively, living amid mental healthcare shortages. New Jersey and Massachusetts have the best record, with only l0.4% and 4.0% of people experiencing shortfalls.

In general, Northeastern states have the fewest issues with the number of mental health experts. For instance, Delaware needs only 15 more mental health providers to fix its shortage. In contrast, Texas would have to add 638 to the rolls.

The effect of therapy deserts: higher suicide rates studies find.

Lack of insurance coverage

Even if you win the therapist lottery and locate a psychiatrist or other mental health specialist with an opening, they may not take your insurance or any insurance.

Many therapists do not accept insurance at all, and for understandable reasons, like poor reimbursement rates and neverending paperwork. In California, 42% of 1,800 therapists surveyed chose not to join any insurance network. Many therapists feel they have more time to see patients if they have less documentation to complete.

As a result, adults are 5.4 times and children 10 times more likely to pay out of pocket for a mental health visit than primary care — just another burden, along with the price of gas. Many people are forced to wait longer for an appointment, since they can’t afford to self-pay and must find a therapist who will accept insurance.

How to best avoid the waitlist

Telemedicine: If you can’t find an available therapist for a brick-and-mortar visit within your zip code, or several zip codes, consider Telemedicine. Your computer screen may just have to substitute for the couch. Mental health professionals are typically licensed at the state level, so if you’re open to the screen, you’ll have many more options.

In response to the accelerated demand, healthcare therapists and clinics provide more services via Telemedicine. In fact, in a recent survey in 2022, 88% of 12,828 mental health facilities offered telehealth services compared to 39.4% in 2021, per a recent JAMA study. With decreased commute time, flexible scheduling, and less inter-office communication, many therapists can schedule more patients.

Platforms like Talkspace and BetterHelp are good starting points for searching for providers. Some of these websites have begun to work with insurance carriers. Contact your health insurance representative to learn if your plan offers coverage for these websites.

Telemedicine may not be your first choice, but it’s better than going a long stretch without seeing anyone. It can help bridge the gap until you can finally see a Psychiatrist in person.

Some patients eventually prefer the screen visits since it cuts down on the time and cost of commute, offers greater scheduling choices, and is easier to fit into your day, especially if you work from home. You can see the doctor from the comfort of your own home. Some also feel a greater sense of privacy since they don’t have to sit in a public waiting room or walk through the outer doors of a clinic.

In fact, of 1200 adults surveyed who tried teletherapy, 63% reported that they found it effective, according to Forbes Health.

If you have to pay out of pocket anyway, why not broaden your horizons and look for a therapist across the state on your laptop?

TikTok: Many mental health experts, especially during Covid, started posting on TikTok to try to reach those stuck at home with emotional issues and provided tips and tricks on improving mental well-being and increasing awareness of the problem. Some professionals continued their internet presence and have millions of followers.

However, TikTok should never be a replacement for therapy. Although, its easy access has allowed mental health specialists to reach a wider audience and de-stigmatize the process of seeking help for emotional health. Here are three qualified therapists with large followings:

• Julie Smith, PhD, is a practicing psychologist from England and focuses on anxiety, depression, relationships as well as other issues. She has around 4.6 million followers. TikTok handle: @drjuliesmith.
• Nadia Addesi RSW, is a psychotherapist and registered social worker from Canada. She concentrates on anxiety, depression, social anxiety, and relationships. She has 2.9 million followers. Handle: @nadiaaddesi
• Melissa Shepard, MD, psychiatrist, is based in Maryland and covers various mental health topics. She has won over 1.6 million followers. Handle: @doctorshephard_md.

While TikTok can be an excellent place to look for guidance, remember only some on the app are qualified to give advice. Never replace TikTok visits with a long-term connection with a professional.

Be proactive: Your best avenue is to act quickly. At the first sign of a mood change, seek help and schedule an appointment. Don’t wait until the issue intensifies. Your appointment may be weeks out, and if the issue resolves, it’s easy to cancel. The most important thing is to book an appointment immediately; we often forget we can easily change our mind later.

Try an App: According to Very Well Mind, which recently rated the ten best mental health apps, these new software programs can help tackle common problems like anxiety and depression and help remove some of the barriers (such as availability) to mental health care. They are immediately accessible, and low cost. The top ten were; Betterhelp, Talkspace, Headspace, Sanvello, Breathe Think Do with Sesame, I Am Sober, Moodkit, Calm, Happify, Worry Watch.

Join a support group: There are many support groups available for those with mental health issues. Members meet and develop a sense of community by sharing experiences and coping strategies. This could tide you over until you see a therapist. Or you may find the gatherings so beneficial you stick with it. Anxiety and Depression Association of America offers a great search engine. You can also Google support groups and enter your city’s name. Many national organizations have local chapters that regularly meet in person or online.

Self-help materials: Thousands of self-improvement books, newsletters, pamphlets, or CDs feature mental health. Consider downloading a psychology-related podcast while waiting for your therapy appointment. Though not a replacement for psychotherapy, these materials can offer different perspectives on improving your thoughts, habits, and circumstances.

Helplines: When self-care is not enough, and you need immediate emotional support, consider a helpline. That caring helpline worker is a free confidant who can help you manage your emotions, connect you with other resources, and offer sympathy. The National Institute of Mental Health offers a list of organizations that provide helplines. Many take calls around the clock.

“I began using telehealth services about two months into the pandemic. It has been a game changer for me and my wife,” Mike Hoffman, a Maryland resident told Telehealth Access for America. “Telehealth has saved me time, money and endless frustration.”