“When I started looking for a psychiatrist, on my own, I had very little luck,” said Siracusa, who lives in Whitefish, Montana. While his physician – a provider who does not prescribe prescriptions – gave him a referral, no appointment was available for six to eight weeks.
For a person struggling with mental health in the midst of an epidemic, that seemed far away. “If I’m honest, I wasn’t doing very well,” he said. “It felt like what I was doing was not getting the help I was looking for, or that it was out of reach.”
At a time when the ongoing epidemic is affecting mental health, many people are going completely without care. Experts say the epidemic is worsening with a shortage of mental health care providers that address the current crisis.
Whether you seek all the help may depend on where you live, who you are and how much you have to spend.
How is it for providers
Of Psychiatrist Aka in Philadelphia. “Initially, I increased my hours significantly,” said Boateng. “I still have a waiting list that is one to two months. This has never happened to me before.”
Eventually, Boateng felt she could not sustain the increased hours indefinitely, something she heard from other professional colleagues.
“I started burning a little bit,” he said. “I myself was doing all that while living in an epidemic, and experiencing everything else.”
Everyone can work as hard as they want
“Todd Essig,” a clinical psychologist and psychoanalyst who joins the Kovid-19 advisory team at the American Psychoanalytic Association, is working as hard as possible. When Essig becomes a potential patient, he presents suggestions from other physicians. These days, they often return empty-handed.
“They come back several weeks later and check to see if I have an opening, because they don’t have better luck elsewhere,” he said. “This never happened before (for me) the epidemic.”
Like Boateng, Essig emphasized that problems in mental health care predate Covid-19. He hinted at reducing declining reimbursement by insurance companies to in-network providers, leading some practitioners to decline to dis-network conditions, raising their prices until several demands were met.
“The epidemic is exposing fault lines that should have been corrected years ago and years ago”, Essig said.
While individuals from any community may face barriers when seeking mental health care, the shortage is not evenly distributed.
“More than half of the counties – and most of them were rural – said Paul Geoffrido, president of Mental Health America, a nonprofit with a mission to meet the needs of mentally ill people.” – There were no mental health providers. Even in urban areas where care is theoretically available, finding a provider can be difficult.
“We have seen consistent patterns where even though people were available and new patients were listed, they are often not available or new patients are taken,” Gionfriddo said.
Rural residents are not without people only.
“There are a lot of differences based on race, gender and age,” Gionfriddo said. Young people are the most likely group for mental health treatment. “We often ignore children’s problems,” he said. “They have historically been the most in need of the population, and they have historically served the least.”
Gionfriddo said that men also have less need for their care, partly because they wait longer to get help. And despite a greater willingness to care, Gionfriddo said that black people in the United States have less access to mental health services than white counterparts.
The LGBTQ population is also particularly at high risk, Gionfriddo explained. “People who identify in that population are significantly more affected by mental health concerns,” he said. “They have some of the greatest needs, but the least understood, identified and served needs.”
Is technology a solution to the crisis?
Mental health care was rare before the epidemic. Now, increased demand has made the shortage worse. But in the scramble to optimize mental health care delivery for Kovid-19, telehealth may be a silver lining.
“It is helping, in that it provides some greater access to areas that generally had no access, or limited access,” Gionfridd said. “We’ve moved forward about 10 years in telehealth in a year’s time.”
The epidemic has also forced some changes in insurance. “Until the epidemic, the Medicare program will not cover a telephone conversation,” he explained. “Phone calls are now reimbursable.”
Gionfriddo said that new technologies, such as therapy by text or chat, are also promising. Different groups require different types of care, and new technologies have made it easier to spread services among relatively dispersed populations.
“It gives us the ability to micro-target information and resources, and actually create substantial demand within small communities,” he said. “It should not just be done at a local level.”
Telehealth will not solve every problem
While telehealth may care for areas with some providers, it will not solve America’s mental health care shortage.
“It doesn’t expand the number of providers,” Gionfriddo said. “It just distributes them a little differently.” Underlining the importance of permanent, long-term solutions, he stated that the emotional distress related to an epidemic can last longer than a vaccine.
“The mental health effects of this that are being felt today will play out for many years to come,” Gionfriddo said. And, he points out, some of the most serious consequences of untreated suffering – including suicide – can take a long time to appear.
“Nobody would know that the suicide rate resulted in an epidemic for at least a couple years,” he said. But focusing on suicide rates in 2020 would be a completely wrong question, he said, because suicide is often a late event that can occur after years of suffering.
“You really have to look at suicide rates over the next 15 years to find out how deeply the epidemic has affected the mental health of the nation,” Gionfriddo said.
Finding – and asking for – your help
If you are looking for mental health care, experts say it is important to start immediately. Despite the lack, help is out there. If you have health insurance, a good place to start is by asking the insurance information line the contact information of in-network providers.
After weeks of phone calls and delays, Siracusa found a psychiatrist who could write a new prescription for antidepressants. It made a difference. “Ever since I changed my medicine, I felt 100 times better,” he said. “Everything is not as much a struggle as it was, which is super relaying.”
One problem, Siracusa said, is that symptoms of depression and other mental illnesses can make it harder to stay motivated in search of care. It is easy to give up when things seem so difficult.
If that is what you are struggling with, Siracusa recommends giving some logistical support to a loved one. When he told his wife about the lack of care, he voluntarily asked her to call on his behalf.
“It was really helpful,” he said. “It put a burden on me.”