Why Is It So Hard To Find Affordable Therapy Options?
Finding affordable therapy options can be difficult at the best of times. But it seems to have become increasingly difficult in the past few years. So what is making it so difficult to get access to affordable therapy?
The Difficulties Most People Face When Trying to Find a Therapist
Seeking mental health treatment can be difficult even in the best of circumstances. It takes a lot of courage to admit when you need therapy and even more strength to start the search. In recent years, finding a therapist has become even more challenging and frustrating. People lose hope and become discouraged when there are limited options or too many hurdles to jump through. So what are some of the challenges people are facing when looking for affordable therapy options?
Some of the problems that are creating issues with seeking therapy include:
One of the biggest problems facing the ease of access to therapy is the long wait list times. Many therapists are so backed up that they are not accepting new clients and in some instances, their waitlists are closed. This can be even more of a problem for people seeking specialized care such as care for children, low-income, or substance abuse.
At Boston Medical Center there was a 170-person waitlist in April 2021 and parents waited 10 months to be contacted to receive services for their children. In 2021, the number of referrals for the federal government’s mental health and substance abuse line rose to 1.02 million. Numbers like these make it easy to see why it may be so difficult to find a therapist.
With backed-up waitlists, increased caseloads, and burnout from being overworked, it’s common that those seeking therapy are not getting calls back. The request for therapy has increased in the last few years making it difficult for therapists to respond to every message. On the client’s side, it is frustrating and discouraging when their calls or requests are going unanswered.
Affordability is another big reason that finding therapy is a struggle. Many therapists choose not to take insurance because working with insurance companies can be extremely limiting, challenging, and reimbursement rates can be low.
In fact, according to a recent survey from the California Association of Marriage and Family Therapists, nearly half of the therapists in California do not accept insurance. This is obviously a barrier to finding affordable therapy options as the going rate for therapists in areas like San Francisco and Los Angeles is around $150 to $200 per session.
Lack of mental health professionals
The number of available mental health professionals has been dwindling. Research suggests that there are around 30 psychologists per 100,000 people and 15.6 psychiatrists per 100,000 people. This means there is a ratio of mental health professionals to residents that is smaller than 1 per 30,000 people. This number gets even lower for those living in rural areas with 9.1 psychologists per 100,000 people and 3.4 psychiatrists per 100,000 people. What is more concerning is that The Substance Abuse and Mental Health Services Administration estimates that by 2025 the U.S. will have a shortage of mental health professionals in all areas, not just psychologists and psychiatrists.
Speaking about the lack of mental health professionals also brings up the lack of access. As previously mentioned, the area a person lives in is a factor in finding therapy options. For those living in non-metropolitan or rural areas, the lack of mental health options is even more of a struggle than for those living in urban areas.
The Role That Insurance Companies Play In Lack Of Affordable Access
Some of the responsibility for challenges with finding affordable therapy lies with insurance companies. Navigating the ins and outs of insurance can be a struggle, even more so when the resources are lacking. There are two main challenges with insurance that affect the availability of mental health services. These are:
Inadequate Provider Networks
When people seek mental health services they often go through their health insurance to find referrals for in-network providers. This way there is little to no out-of-pocket cost. But a problem with accessing mental health care through insurance is that there are not enough providers that are in-network and covered by the insurance companies. It seems that going out-of-network may be the only option and not everyone can afford to do that.
Unreasonable Criteria to Qualify for Coverage
Another way that insurance companies have contributed to the lack of affordable therapy is by making it difficult to qualify for coverage. Many insurance companies have used restrictive standards to limit coverage. This makes it extremely difficult for individuals to be covered for services unless they are very ill.
Besides making it difficult for members to qualify for insurance coverage for mental health, insurance companies have also made it difficult for therapists. As previously mentioned, many therapists choose not to use insurance companies due to low reimbursement rates. Therapists feel they are not being paid a livable wage in many places. There are also many hoops that therapists have to jump through in order to get reimbursed at all. This includes restrictions on documentation and note-taking.
How Women Of Color Are Specifically Impacted
As discussed, finding mental health services can be difficult for a variety of reasons. But being a person of color seeking these services poses an even bigger challenge. It can be a struggle to find a therapist who understands your cultural background. In fact, data shows that only 2% of psychiatrists and just 4% of psychologists in the U.S. are Black. This is in contrast to the 86% of White psychologists.
The result of this large disparity between White mental health professionals and those of other racial or ethnic minorities is that people of color who are seeking services have an extremely hard time finding a therapist who may meet their needs.
People of color already carry stigmatized identities and therefore may find it difficult to take on another stigmatized identity like a mental health condition. It has been shown that women and men of color are disproportionately diagnosed with psychotic disorders. Findings have shown that Black individuals are 3 to 4 times more likely to be diagnosed with a psychotic disorder than White individuals. While Latino American/Hispanic individuals were approximately 3 times more likely to be given a psychotic disorder diagnosis than White individuals.
While there may not be an exact reason why this happens, an obvious contributing factor is the presence of racial discrimination and bias within the mental health care system. Women of color are likely to be hesitant to seek therapy services due to this discrimination and bias. In fact, in one study 53% of participants of color reported experiencing microaggressions in therapy.
All of these factors may make it especially difficult for women of color to access affordable therapy services.
How Are Clinicians Addressing Barriers to Care?
Despite the difficulties of accessing affordable care, many clinicians have continued to implement practices to make things more accessible, affordable, and inclusive. These include:
- Using sliding scale payments for low-income individuals
- Expanding services using telehealth options
Until the lack of diversity in mental health programs is adequately addressed, there may be no solution to people of color finding therapists of similar racial/ethnic backgrounds. However, some programs and clinicians seek to:
- Improve education on cultural awareness
- Implement and use culturally sensitive interventions
Until the problems with accessing affordable and appropriate therapy are addressed, the lack of therapy options will continue. There is no doubt that the U.S. desperately needs more mental health professionals, especially including those of diverse backgrounds.
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