by Elizabeth Rummel, MA, LLP
I’m a therapist and I’m here to sound the alarm.
No, this won’t be yet another article about the shortage of therapists or the national mental health crisis. This is an article about the economy.
Despite the inclusion of mental health care in health insurance policies, there is often still a burdensome financial output required of an individual seeking mental health services - deductibles, copays - and that is IF you can find a therapist who takes your insurance. If you cannot, then you are in the position of having to negotiate with them a rate that you might be able to afford. Even the organizations that were built on the notion of making mental health accessible to all have been increasing their rates. (For example, when they started, Open Path Collective touted negotiated out-of-pocket rates as low as $30 per session. But when they struggled to get commitments from therapists to join their network because therapists couldn’t afford to offer services at such a low cost, they raised their lowest advertised rate - the rate they use to market their network to therapists - from $30 to $50 per session. They have since decreased it again by inviting provisionally licensed mental health professionals to join their network.)
The mental health crisis played into this: more individuals seeking mental health services meant that therapist caseloads were becoming full, meaning therapists could afford to be choosy about who they see and at what rate. They would likely still be able to keep a full caseload. At the same time, during the pandemic the average individual had stimulus dollars to help them meet financial demands for services that they might normally be unable to afford. However, as pandemic stimulus dollars have been eroded, the pendulum is beginning to swing the other direction. So far this fall it seems that fewer individuals are seeking therapy services than in the past several years.
The fall - September, October, and November - tends to be the busy season for therapists, as children go back to school and encounter environments with greater demands for their performance, leading to increased anxiety and depression; as parents’ schedules are freed up during the day because their children are back in school; as people realize they have now met their insurance deductible and will pay less out of pocket for their mental health care. It is only September so it remains to be seen if the early September trend will continue, but anecdotally we are seeing fewer clients seeking services in what is usually our busiest time.
What may come from such a trend is what healthcare has cautioned against for many years when costs climb: 1) many will go untreated and see their mental health decline; 2) many others will delay care until the treatment they require is more intensive; or 3) those who pursue care will do so at the expense of other needs, like rent or groceries.
Like many physical ailments, one’s mental health must be maintained in order to assure that they can remain a functioning member of society. Being too depressed to get out of bed every day is just as debilitating as passing a kidney stone - and many will argue that it is equally as painful. As mental health declines, a person’s capacity to complete work also declines, until they reach such a functional deficit that returning to baseline can mean having to find a new job after being fired; having to recover relationships with family and friends that now suffer from distrust; completing probationary monitoring and paying steep fines for substance-use-related behaviors like DWI. The energy demands of returning to baseline functioning are higher than what would be demanded to maintain baseline functioning, setting many individuals with mental illness on a road paved with despair as their illness remits and recurs on the road back to psycho-emotional self-management.
While this is happening, individuals with mental health struggles utilize more PTO and have higher rates of absenteeism from emotional burnout. They make more mistakes in their work as a result of distractibility and preoccupation, take longer to complete tasks because of mental fogginess, and can at times burn bridges with a business’s clientele because of inattention and unclear communication, or even as a result of becoming disagreeable or even hostile as a result of high stress. They cost the economy more than therapy would cost if it were paid in full by the sectors of the economy whose bottom lines are being stretched by these problems.
I commonly tell my colleagues, “mental health care is palliative care”, in that the focus is on quality of life rather than longevity. But I also believe that mental health care is preventive care, in that it is meant to prevent further harm and loss as a result of the presenting problem. If we spend billions of dollars each year to prevent diabetes, why not spend billions of dollars each year to prevent depression, anxiety, and relational trauma? An individual with diabetes can be a productive member of society, and so can an individual with depression…so long as they have access to treatment and the tools of self-management they need.
When our phone stops ringing with new clients calling for appointments, it’s not because we have suddenly solved the mental health crisis. It’s because the crisis has worsened such that the people who need us have simply given up hope. That has a consequence for all of society and we must raise the alarm now before it is too late.
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