Michael Siracusa was struggling. Changing his prescription for antidepressants would help, he thought. But getting an appointment turned out to be complicated.
“When I started to look, on my own, for a psychiatrist, I had very little luck,” said Siracusa, who lives in Whitefish, Montana. While his therapist — a provider who doesn’t write prescriptions — gave him a referral, there were no appointments available for six to eight weeks.
For a person grappling with mental health amid a pandemic, that seemed very far away. “If I’m being honest, I wasn’t doing great,” he said. “It felt like no matter what I was doing, I couldn’t get the help that I was looking for, or that it was out of reach.”
At a time when the ongoing pandemic is straining mental health, many people are going without care altogether. Experts say the pandemic is worsening a shortage of mental health care providers that far predates the current crisis.
Even before the pandemic, one in five Americans had a diagnosable mental health condition, according to the Substance Abuse and Mental Health Services Administration. More than half received no treatment at all, found a report by the nonprofit Mental Health America.
A lack of care compounds the consequences of mental illness. With nearly 41% of Americans struggling with mental health issues related to the pandemic, according to a US Centers for Disease Control and Prevention survey, treatment is an increasingly scarce resource.
Whether you find help at all may depend on where you live, who you are and how much you have to spend.
What it’s like for providers
“In the beginning, I increased my hours significantly,” said Akua K. Boateng, a psychotherapist in Philadelphia. “I still have a waiting list that’s one to two months. That’s never happened to me before.”
As civil unrest increased in the wake of George Floyd’s death in May, Boateng received even more calls, many from people suffering from anxiety and racial trauma. “It’s been a really big challenge for people of color to find, and be paired with, practitioners that are culturally sensitive and like-minded,” she said. “Covid has just exacerbated that for so many people.”
Eventually, Boateng realized that she couldn’t sustain the increased hours indefinitely, something she heard from other professional colleagues.
“I began to have a little burnout,” she said. “I was doing all that while still being in a pandemic myself, and experiencing all the things everyone else was going through.”
Everyone’s working as hard as they can
“Everyone’s been working as hard as they possibly can,” agreed Todd Essig, a clinical psychologist and psychoanalyst who is on the Covid-19 advisory team at the American Psychoanalytic Association. When Essig turns away a prospective patient, he offers suggestions of other practitioners. These days, they often return empty-handed.
“They come back several weeks later and check to see if I have any openings, because they have not had better luck elsewhere,” he said. “That has never happened (to me) prior to the pandemic.”
Like Boateng, Essig emphasized that problems in mental health care predate Covid-19. He pointed to dwindling reimbursements by insurance companies to in-network providers that have led some practitioners to decline in-network status, pushing their prices beyond the reach of many seeking care.
“The pandemic is exposing fault lines that should have been corrected years and years ago,” Essig said.
Disparities in care
While individuals in any community may face hurdles when seeking mental health care, the shortages are not distributed equally.
“In more than half the counties — and most of them were rural — there were no mental health providers,” said Paul Gionfriddo, president of Mental Health America, a nonprofit with a mission to address the needs of those with mental illness. Even in urban areas where care is theoretically available, finding a provider can be hard.
“We’ve seen consistent patterns where even if people were listed as available and taking new patients, they frequently aren’t either available or taking new patients,” Gionfriddo said.
Rural dwellers aren’t the only people going without.
“There are a lot of differences based on race, gender and age,” Gionfriddo said. Young people are the group most likely to miss out on mental health treatment. “We often overlook the problems of children,” he said. “They have historically been the neediest of populations, and they’ve historically been least served.”
Men are also less likely to get the care they need, Gionfriddo said, partly because they wait longer to find help. And despite greater willingness to seek out 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 especially high risk, Gionfriddo explained. “People who identify in that population are significantly more impacted by mental health concerns,” he said. “They have some of the greatest needs, but least understood, recognized and served needs.”
Is technology the solution to the crisis?
Mental health care was scarce before the pandemic. Now, increased demand has made the shortage worse. But in the scramble to adapt mental health care delivery to Covid-19, telehealth may be a silver lining.
“It’s helping, in that it does provide some greater access in areas that typically had no access at all, or limited access,” Gionfriddo said. “We’ve advanced about 10 years in telehealth in one year’s time.”
The pandemic has forced some changes to insurance, too. “Up until the pandemic, the Medicare program would not cover a telephone conversation,” he explained. “Phone calls are reimbursable now.”
Telephone care is important because video chat might not be available to people without broadband internet. In rural areas, that includes nearly a quarter of the population, according to the Federal Communications Commission.
New technologies, such as therapy by text or chat, are also promising, Gionfriddo said. Different groups need different kinds of care, and new technologies make it easier to spread services among a relatively diffuse population.
“This gives us the capability of micro-targeting information and resources, and actually building sufficient demand within smaller communities,” he said. “It won’t have to be done at just a local level.”
Telehealth won’t solve every problem
But while telehealth can bring care to areas with few providers, it won’t solve America’s mental health care shortage.
“It doesn’t expand the number of providers,” Gionfriddo said. “It just distributes them a little differently.” Underscoring the importance of sustainable, long-term solutions, he noted that emotional distress related to the pandemic could last far beyond a vaccine.
“The mental health impacts of this that are being felt today will play out for many years to come,” Gionfriddo said. And, he explained, some of the gravest consequences of untreated suffering — including suicide — can take a long time to appear.
“Nobody will know whether the suicide rate went up as a result of the pandemic for at least a couple years,” he said. But focusing on 2020 suicide rates would be the wrong question entirely, he added, because suicide is often a late-stage event that may occur after years of suffering.
“You actually have to look at the suicide rates over the next 15 years to get a sense of how deeply the pandemic affected the mental health of the nation,” Gionfriddo said.
Finding — and asking for — the help you need
If you’re looking for mental health care, experts say it’s important to start immediately. Despite shortages, help is out there. If you have health insurance, a good place to start is by calling the insurer’s information line to ask for contact information of in-network providers.
Otherwise, community mental health centers are an important resource; referrals are also available via the Substance Abuse and Mental Health Services Administration.
After weeks of phone calls and delays, Siracusa found a psychiatrist who could write a new prescription for antidepressants. It made a difference. “Since I switched my medication, I felt like 100 times better,” he said. “Everything isn’t as much of a struggle as it was, which is super relieving.”
One problem, Siracusa said, is that the symptoms of depression and other mental illnesses can make it hard to stay motivated while looking for care. It’s easy to give up when things feel so difficult.
If that’s what you’re struggling with, Siracusa recommended asking a loved one to offer some logistical support. When he told his wife about the shortage of care, she volunteered to make calls on his behalf.
“That was really helpful,” he said. “It kind of took the burden off of me.”
Referrals to mental health services in your area are available — in Spanish and English — from the Substance Abuse and Mental Health Services Administration (SAMHSA) hotline: 1-800-662-HELP.