Five years after the swell of provider caseloads, some patients still report difficulty finding help and some mental health clinicians tell of struggles to be compensated fairly with cost-of-living increases.
Consider this: Among Americans 18 years or older, one in four reported one or more mental health conditions, one in 10 a substance abuse problem, but only 60 percent received mental health care and merely 12 percent received substance abuse treatment. These figures were shared by former Congressman Patrick J. Kennedy and journalist Stephen Fried in Profiles in Mental Health Courage.1
Patrick Kennedy and his late father Senator Edward Kennedy championed the Mental Health Parity and Addiction Equity Act of 2008. This prevented insurers from imposing limitations on mental health coverage and brought parity between mental and medical/surgical benefits. Gone were session limits and annual or lifetime dollar caps. Higher copays for mental health were disallowed.
After this law’s implementation, one would think mental health care would not have been as vexing 12 years later when the world faced a global pandemic.
Profiles in Mental Health Courage gives voice to dozens of challenges, including those affected by COVID-19. Through the lives of ordinary people who agreed to share, the book highlights how mental illness and addiction wreaked havoc on personal and professional lives. Despite it all, people’s bravery and resilience prevailed.
We can only hope these authors delve next into the obstacles of those delivering mental health care—frontline workers doing mobile crisis and emergency psychiatric evaluations but even more outpatient providers trying to eke out a living amid financial disparity that wasn’t tackled in the 2008 legislation.
Consumers Should Know
The top reason it’s difficult to find a therapy appointment is the shortage of mental health professionals, followed by increased demand and systemic barriers like insurance coverage.
These root causes seem unfathomable given that the US Department of Labor O*Net Online confers “Bright Outlook” status to mental health and substance abuse social workers, licensed counselors/therapists, and psychologists. That projects how professionals will continue to be in high demand.
Problems for providers, however, center mostly around finances: Low reimbursement, burnout, inflation, and, once again, stagnant wages.
For at least four years, the pandemic created larger caseloads than most outpatient providers could manage. One can only sustain an extra heavy workload amid lagging reimbursement before one exits the field, retires, or diversifies to make ends meet and stay less stressed themselves.
Providers Report Disrespect and Nonexistent Fee Adjustments
In rural America, it’s excruciating to find psychiatrists, thus primary care physicians (PCPs) sometimes stand in for specialists. Advanced Practice Psychiatric Nurses (psychiatric nurse practitioners) have that bright outlook distinction across all geographic areas.
Necessity forced us to see how effective telehealth could be but subsequent industries spawned post-pandemic have created ironic challenges for loyal insurance-paneled therapists.
In recent years, Blue Cross Blue Shield providers in the Washington, DC area have become frustrated as they request cost-of-living adjustments (COLA) and are ignored, denied and/or told to join national chains to obtain a rate increase. This often means abandoning a practice that otherwise works effectively.
Dozens of mental health providers report that Carefirst, the region’s BCBS insurer, encouraged them to join Headway, a national chain, or receive no increase. Others had their rate inquiries ignored.
When providers looked into Headway, Alma, UpLift, or similar companies, using Reddit and sites that attract national input, they grew skeptical. Among the findings: class action lawsuits, privacy concerns, a lack of informed consent to clients, slow response times plus billing and customer service snafus.2
They’re left wondering: What’s with reduced fees for independently paneled practices and solo providers? Therapists ask who owns the patient’s file, and how does it work when a provider pays malpractice insurance that covers their services but a national entity makes mistakes? When problems arise, who is on the hook?
Collectively, it steers clinicians away from the ethical and business challenges these conglomerates pose. Those who invested in LLCs, work independently or in small practices, trust their own ethics/business model and remain wary that dangled higher rates later snatched away would render them trapped. Consumers would be stuck with fewer choices.
One psychologist asked whether Carefirst demanded a group sign-on from dermatologists or endocrinologists who request cost-of-living adjustments and higher fees?
A social worker sent five requests to improve reimbursement for CPT codes or session types and surmised that stonewalling correlated to disrespect for mental health providers.
For Those Seeking Therapy
A person on the hunt for therapy services may say, “Well, that’s the therapist’s problem, not mine,” except that if these reasons remain, they will become a patient’s problem very quickly. Thus, what can a savvy mental health consumer do? A few suggestions:
- Visit your insurance company website to look at the profiles of paneled mental health providers.
- Search your zip code, plus other zip codes within your state, if you’re open to telehealth in a broader network.
- Consider that this yields a therapist more in touch with regional world/stressors, able to make local/targeted med management or alternative health referrals. You’ll also have a therapist within your same time zone.
- Realize that fewer third parties involved in your treatment often means a more personal touch.
- Think about billing and other unforeseen issues. Since a majority of therapists are self-employed or work in small practices, many handle their own billing. If problems arise, they communicate directly with you.
- Look carefully at national conglomerates from both the consumer and provider perspectives. Internet searches, now assisted by AI, will yield a wealth of information for you to make wiser consumer choices.
As the journalism adage goes, the lead may often get buried in the details. To benefit consumers and providers alike, we can only hope these provider concerns garner more awareness, journalistic coverage, and ultimately the cost-of-living adjustments clinicians deserve.
To find a therapist, visit the Psychology Today Therapy Directory.
Copyright © 2025 by Loriann Oberlin, MS
