After a few months of overthinking, I finally started calling therapists who I thought might be able to help one of my sons with, well, being a kid in a pandemic. The responses repeatedly followed a frustrating theme: “We’re full.” “We canceled our waitlist because it was 50 people long.” “No new patients.” “We are on a six-month wait.”
I was initially surprised at how hard it was to find someone, but digging into the data helped clarify the reasoning behind these replies. From the beginning of the COVID-19 pandemic, mental health problems have skyrocketed, with the Centers for Disease Control and Prevention reporting alarmingly elevated numbers of anxiety, depression, trauma and stress-related disorders, substance abuse, and thoughts of suicide. By early April 2020, Americans were suffering emotionally, financially, and physically, reporting myriad disruptions to their daily lives. As a result, more than one-sixth of us started going to therapy, 15 percent began taking medication for mental health issues in 2020, and another 15 percent changed their dosage, according to a survey of 2,000 people.
Even without this increased demand, the logistical hurdles people have to jump before getting real, meaningful mental health assistance can be exhausting, but there are ways to clear them and ensure you or your family members get the help they need as quickly as possible.
What to do if a therapist has a waiting list
When you finally make a call and learn you’re destined for a waiting list, or that there’s no availability at all, it’s disheartening. The pandemic created a massive spike in mental health issues, but didn’t create a correlating spike in new mental health professionals. “It’s not as if an extra 100,000 therapists have been licensed in the past two years—that hasn’t happened,” says Tom Delaney, an associate professor at the University of Vermont’s Larner College of Medicine who researches the effectiveness of mental health programs.
It’s quite the opposite. One poll reported that nearly 1 in 5 healthcare workers has quit during the pandemic, 1 in 8 has been fired, and nearly a third of those remaining have considered leaving. This means patients seeking any type of care—not just therapy—are likely to be turned away, or placed indefinitely on a waiting list. In a New York Times survey of over 1,300 therapists, 1 in 3 said it would take at least three months for new patients to see them, or that they don’t have room for new patients at all.
Back to that waiting list offer: say yes, but also ask for a referral to other recommended professionals they might know have openings, Delaney suggests. “Say: ‘I know you’re filled up, but can you tell me about anybody who works with people like me that you know would do a really good job?’” he says, adding that some will even reach out on your behalf to try to find you an opening. And there’s a lot of turnover in practices,, so a waiting list might move quicker than you think, he explains.
If you’re looking for a psychiatrist—a mental health professional who also oversees medication management—you might have to wait at least a year, according to Bethany Cook, a clinical psychologist who specializes in neuropsychological assessment and music therapy. In the meantime, you can start with a therapist and your general care physician, who can often prescribe mental health medications as well.
How to choose the best therapist for you
In the “before” times, finding a therapist was as simple as asking for recommendations from friends, trusted medical team members, and even online groups. But now, it can involve much more research and digging. Both Cook and Delaney recommend the popular search function Psychology Today offers as the best database for finding a therapist who specializes in your area of need. From there, you can use built-in filters to tailor your preferences by issues, insurance, gender, type of therapy, age, price, ethnicity, sexuality, language, faith, and location. You will be able to see therapists’ bios and are likely to find many who offer virtual therapy.
The only frustrating aspect, Cook says, is that it’s hard for clients to identify if a therapist is PsyPact certified, meaning they can work with patients over state lines (in most cases), as there’s currently no central database for that. Her Psychology Today account notes the states she’s certified in, but not everyone’s does. “If a person in Texas found me on Psychology Today and asked me, ‘Could you be my therapist?’ 100 percent yes. I’m qualified,” the Illinois-based therapist says. However, she might not take insurance based in Texas—another complicating factor—and they may have to pay out of pocket. If you find someone you are interested in working with, ask if they’re PsyPact certified, she says. You can also try searching on TherapyDen, which does not charge therapists a fee to list their practice (a profile on Psychology Today costs a therapist $30 a month).
[Related: Mental wellness apps are basically the Wild West of therapy]
Finally, it can be confusing to navigate the sea of certifications and types of therapy. There are psychologists, psychiatrists, licensed clinical social workers, alcohol and drug abuse counselors, and additional license variations within most of those. “It kind of doesn’t matter what the qualification is, as in our state you still have to show your competency,” Delaney says. He encourages people to focus less on the license and more on the fit, which he says is the No. 1 indicator of a successful therapy experience.
Navigating the rocky waters of US health insurance
In a survey of 2,000 people, more than half of Americans revealed they were “completely lost” when it came to understanding health insurance. This can be a complicating factor for someone seeking mental health care, who might also not have the bandwidth to learn about deductibles, out of network costs, and other confusing terms. Many Americans may not understand that their insurance covers therapy, and even if they do, could be unclear on what types, how many visits, and more.
Your best bet is to make a list, Cook says. She suggests using the Psychology Today database to find five therapists who align with your needs and reaching out to them for availability. Delaney notes that you shouldn’t rely on the provider’s availability status listed on the site, as sometimes spots have become available but the provider hasn’t updated it yet. Once your list is done, Cook says to find each provider’s National Provider Identifier number (NPI), and to have that information ready when you call your insurance company. When you’re ready to make that call, use the number on the back of your card for better results—don’t run an internet search.
If you’ve already looked up potential therapists, Cook recommends asking your insurance company: “Where is the list of providers in network?” or reading them your list so they can verify who is and isn’t in network. Also ask: “What is my deductible?” or “Do I have a deductible?” she says, as this is the amount you are typically responsible for paying before your coverage kicks in. You can also ask if you will owe a copay, and how many sessions will be covered—Cook warns that some insurers put a lifetime cap on how many sessions they will cover.
You can also ask a therapist you really want to work with if they’d be willing to get “paneled” with your insurance, though Cook warns this cumbersome process is part of the system-wide access problem. For one insurance company, it has taken her seven months so far to get in-network, despite their promises of expediency.
How to reduce therapy costs
Since most deductibles restart in January, people might find themselves having to make financial decisions about whether they can afford therapy in the early months of the year. “There are high-deductible plans that include mental health, and if you don’t have the money to pay out of pocket… that’s a real reason to not get mental health care,” Delaney says, explaining that some clients with Medicaid won’t have a copay and some will have a low one, maybe $20. Without insurance, therapy can cost $65 to $250 (or more) per hour.
But that expense itself shouldn’t deter you from seeking help, Cook says. If you know somebody who works in mental health, reach out to see if they can guide you in any way or connect you with useful resources, she says. Also, bring up your cost concerns with the therapist—they may do pro-bono work, and/or have sliding scales based on income.
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If you still can’t find affordable help, Cook recommends looking for a workbook on the specific issue you are dealing with, such as anxiety or addiction, to hold you over until you can see a therapist. She recommends Retrain Your Brain: Cognitive Behavioral Therapy in 7 Weeks, by Seth J. Gillihan, to patients with anxiety, for example. You may also want to try looking for therapists on Open Path Psychotherapy Collective’s website—Open Path is a nonprofit focused on helping people find mental health care at reduced rates. And there are cognitive behavior therapy apps that can help you work through difficult thoughts too, though not all are effective.
Finding a ride to therapy
For the most vulnerable and isolated among us, an in-person therapy session might be the only face-to-face contact a person has with another during the week. That makes transportation both a hurdle and a necessity for some.
“I’ve had a few clients who’ve said, ‘I want to see someone in person—I live alone and need that human interaction,’” Cook says. Delaney notes that some therapy-seekers, such as children, might have to be in-person in some cases.
“Older people, or people who don’t have a driver’s license [might need a ride]. We have really crappy public transportation,” Delaney says. “Don’t be afraid to ask for help.” Some public agencies will help with medical appointment transportation, and Medicaid in some states will cover cab fare for psychotherapy, he says. Start by asking your insurer if any of these options are available, but also ask the therapist how other clients with this issue are working it out.
And we can’t stress this enough: Because these hurdles can seem insurmountable to someone in a mental health crisis or emergency, and therapy can take a while to start, if you are experiencing a mental health emergency, you should visit the nearest emergency room, call the National Suicide Prevention Lifeline at 1-800-273-8255, or text the Crisis Text Line immediately.