I want to share with you what I wish every American knew about mental health amidst this pandemic.
Personally and professionally, I believe that the pandemic is creating a paradigm shift. Some of our institutions and norms will be radically altered forever, and in some spaces, that’s a very positive development. For example, I have advocated for flexible schedules for working moms for almost two decades now, and it’s only under these dire circumstances, that we are finally seeing that flexibility actualized into employment law.
In a similar vein, I believe that the mental health profession and the coaching world is undergoing changes as well. Even before coronavirus arrived, we already had a mental health crisis in America. We have a shortage of therapists, we have increasing rates of suicide in every age/ethnic group, and we have a rampant opioid abuse problem. Now you layer on all the emotional and psychological wear and tear that COVID-19 is having on every single one of us, and you can see that this is a recipe for chaos.
Why do we have a therapist shortage?
Now, I believe that the shortage of therapists is largely due to poor compensation. Similar to school teachers, therapists spend 7 years of their life in college and graduate with a master’s degree to earn an average of $45,000 a year. It’s one of the reasons that I insist on compensating my team fairly.
Lack of Coverage for Telehealth Services
Tele-therapy has been available for over a decade, but it never really caught on until March. The biggest players impacting this have been private insurance companies and Medicaid. Until 2020, they refused to pay for services provided online even though there is an abundant amount of research showing that those services were every bit as effective as in person sessions.
Inequality in the Profession
Now the other thing going on in the background in my profession is inequality. I see it showing up in three significant ways:
1. Accessing higher education and going to graduate school is a privilege in and of itself. Those graduate programs have not always done a good job at valuing diversity, recruiting diverse student bodies, and retaining students of color. So when we look inside those classrooms, we have a rampant whiteness problem.
2. That will lead to the second problem. A lot of potential counseling clients who are people of color feel left out in the cold. If they are seeking a therapist who looks like them or may have had a certain experience similar to theirs and they can’t find that person of color, they may not get the services they need.
3. And then of course, we have a significant challenge in the lack of affordability which equates to a lack of access for a lot of Americans. So as we look at the socioeconomic continuum, if you are an individual of privilege, you can afford to pay for your services out of pocket. If you’re living under the poverty line, your individual therapy may be covered by Medicaid. For many Americans in between those two points, there is a hole that a lot of middle America falls through. Some people are able to navigate around that hole by having coverage through their insurance company, but your insurance company is not one of the good guys in this story as they have such a totalitarian influence over services.
Insurance companies currently cover most individual therapy because they are required to by law under the Affordable Care Act. It’s not because they value therapy or because they believe they should be required to pay for mental health support. They make their lack of value in mental health clear by the price points they offer therapists who contract with them. Those therapists are offered pay rates that are 50% or lower of the market rate. Those therapists cannot make up for a discounted price point by scheduling a high volume of clients. Anyone who is a therapist will tell you that they do not have the emotional bandwidth for that so those contracted therapists have lower wages.
In their contract with an insurance company, the therapist has to agree to not collect a single dollar above the discounted rate that the insurance company is paying them. If removed, that caveat could open up a lot a world of opportunity. If insurance companies were willing to cover half the cost and would allow the therapist to collect the other half, then so many middle-class Americans would be able to afford the price of therapy. We could increase those wages to a living wage for mental health professionals who are two thirds women. These are the reasons why people like myself are able to leverage their privilege to refuse to do business with companies and institutions who don’t value what I do.
Despite all of this, there are some opportunities that COVID has provided despite the hardship. I think one of the best things that you can do as a human being right now is to encourage a coworker, a friend, or a family member you notice struggling to reach out to the therapist. Make it the new norm and help us debunk any stigma that’s still out there about accessing hope. 2020 is going to be the hardest year that many of us will ever live through, and so it’s going to be important that we all give ourselves permission to access hope.
If tele-therapy becomes the new norm, I believe a lot of professionals will be able to eliminate the skyrocketing costs they have been paying for office space because they will no longer need a brick and mortar to do what they do best. That in turn could make them more profitable which lends itself to being more sustainable. If we can we retain more mental health professionals then that will help alleviate the mental health crisis.
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