This summer, Massachusetts General Hospital had a staggering 880 people on its wait list for psychiatric services. The list had grown so large that the hospital issued an unusual plea to its physicians: Stop referring psychiatry patients for non-urgent care.
"Our triage staff is not able to make any progress in this wait list with the current number of incoming referrals," the Aug. 18 letter to physicians said.
Earlier this week, a new letter went out saying the problem still hasn't been solved. "Help is on the way but will be slower to arrive than we had hoped," it said.
Jeffery Huffman, clinical director of MGH's department of psychiatry, said the demand for mental health care has been "so unprecedented" that the hospital doesn't have enough staff to keep up. He said he expects things to improve "over the next two months" with new hires.
The hospital is not unique in its backlog. Over the course of the pandemic, as cases of anxiety, depression and other mood disorders have increased, mental health providers around the country report an overwhelming surge in demand for counseling and care.
"Our doors are getting knocked down," said Kayla Johnson, a licensed psychologist in Tomball, Tex. "I know the need is so great, I wish I could help them, but I'm at capacity."
The American Psychological Association reported last year that 7 in 10 psychologists with a wait list said it had grown longer since the start of the pandemic. "This trend is not going away," said clinical psychologist Vaile Wright, the APA's senior director of health-care innovation.
The Washington Post reached out to more than 300 mental health providers, as well as patients and policy experts, to better understand this "tidal wave of need," as one therapist put it. Though not a scientific sampling, more than half of the therapists who responded described a fraught landscape in which long waits for care - sometimes three to six months or longer - are the norm.
"I'm watching people suffer, and it's getting worse and worse and worse," said Shawn Dobson, a licensed professional counselor in Smyrna, Ga.
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To offset demand, Dobson created a 12-step support group, TraumAnon, which she live-streams weekly on TikTok and Facebook while hosting on Zoom, that draws between 50 to 300 people. She also holds regular "therapeutic retreats" in a woodsy cabin where about 35 people talk about developing coping and other life skills.
"It's so unorthodox, but I don't know what else to do," she added. "People are desperate, and therapists who got into this because they want to make a difference are also desperate."
Steve Schlozman, a child psychiatrist with Dartmouth Health Children's in Lebanon, N.H., said he is beginning to suggest workarounds to the therapist shortage that would have been unheard of even five years ago. He said he has reached out to clergy, school guidance counselors and even soccer coaches to act as de facto therapists for children and adolescents suffering from depression.
"If the kid is really into soccer, we'd make that call and say to the coach: 'I would love for someone to sit down with this kid once a week. If you get scared, or worried, make sure to let us know,' " Schlozman said. "It's a lot of weight on the shoulders of a coach, that's not what they signed up for. Ideally, we'd love to have the kid meet a trained therapist, but there just aren't enough available."
Colleen Lang, a clinical psychologist and founder of a small, six-therapist group practice in Brooklyn and Manhattan, tells potential clients that they can probably see a therapist in about a month if they are willing to meet virtually; in-person sessions, she says, can be closer to a six-month wait.
Several therapists said they have added evening and weekend hours to meet demand. Others said they have hired interns or therapists in training to help. Some have stopped accepting insurance, which means less paperwork, better pay and more time to see patients. But it also means their services are less accessible for people who can't afford to pay out of pocket.
Maya Polon, a public affairs specialist in Sacramento who suffers from generalized anxiety disorder and panic attacks, said her primary care doctor at Kaiser Permanente told her that securing an appointment with an in-house mental health provider would be unlikely because of the backlog. (A spokesperson for Kaiser Permanente said Polon's PCP "will not be responding about an individual patient's care.") Even with an out-of network referral, Polon said it took three months to find a therapist and another eight months to find a psychiatrist to manage her medications.
The process, she said, was humiliating and exhausting: She felt like she was required to prove how sick she was, take time off work to make dozens of calls to fix referral snarls, and call and screen dozens of providers, some who never returned her calls.
"Experiencing untreated anxiety and frequent panic attacks made the process of seeking therapy and psychiatric help feel completely debilitating," Polon said. "Without friends helping me navigate the system, I would never have reached the help I so desperately needed."
As more time passes before people get help, their symptoms, of course, can worsen.
Krista Curl, a licensed professional counselor in Broomfield, Colo., said she's noticed new referrals experiencing more intense symptoms such as suicidal ideation, dissociative disorders and other complex issues.
"This means that folks that would typically be inpatient or at intensive outpatient treatment hospital programs are spilling out into private practice care," Curl said. "I feel this is indicative of a larger mental health crisis."
This crisis is even worse for children and adolescents, experts say. Martha, a single mother of four, who asked that her last name be withheld for the children's privacy, has experienced the crisis up close.
In the spring of 2020, her 10-year-old daughter, suffering from depression, swallowed an entire bottle of ibuprofen. After a two-week hospitalization, the child was discharged with a month's supply of an antidepressant and instructed to find a psychiatrist because the hospital had no provider available.
A nurse educator in Thornton, Colo., Martha said she was unable to find a psychiatrist, and her daughter's primary care doctor did not feel comfortable supervising medications for such a vulnerable child.
When the child's medications ran out, there was no doctor to write a new prescription for a month, and the girl attempted suicide again. "We went through this cycle of no one would take her because of her age, no one would prescribe, no one was taking referrals," Martha said.
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Last year, more than 129 million people lived in a federally designated mental health care "professional shortage area," and fewer than one-third of the U.S. population lived in an area where there were enough psychiatrists and other mental health professionals available to meet people's needs.
The Biden administration is working to increase access to mental health care for adults and children in a variety of ways, said Terri Tanielian, special assistant to the president on the domestic policy council.
The American Rescue Plan, for example, includes about $5 billion to help states expand the mental health workforce, including school-based counselors, psychologists and social workers, and crisis services such as the 988 national suicide hotline and mobile mental health units. It also includes funding to promote mental health and reduce burnout among health professionals.
The president's mental health strategy also proposes to enforce and expand parity laws that require mental health and substance use care to be covered at the same levels as other health care and calls for expanding access to telehealth, Tanielian said. The Department of Health and Human Services announced $315 million for states to "develop and transform" Certified Community Behavioral Health Clinics, which provide 24-hour crisis services for people with mental health or substance use issues regardless of their ability to pay.
Therapists said that, in general, the more specialized the care, the more difficult it is to find a provider.
"It's basically impossible to find a queer competent therapist in Missouri," said Erin Smith, a licensed clinical psychologist in St. Charles, Mo. Smith takes insurance, including Medicaid, and holds open a few pro bono spots.
She sees about 30 patients each week, and her caseload is up to 42 clients. "It's a lot to manage," she said, "but there are so many queer and disabled Missourians that cannot access quality mental health care because providers aren't trained or are ableist or transphobic."
Eldridge Greer, a licensed psychologist in Denver, said there's been a "sea change" in the way many of his clients, predominantly in the BIPOC community, view counseling. Historically, he said "there had been some trepidation about doing counseling, the idea that therapy is a White thing.'"
But attitudes have changed as more athletes and media personalities have discussed their own depression and anxiety and normalized counseling, he said. "It's helped people embrace the notion that they don't have to suffer in silence," Greer said.
If you're trying to find a therapist, the main takeaway from providers is don't give up. Securing mental health care often comes down to sheer persistence.
Linda Siegel, a pediatric critical and palliative care physician in New York City, was spending about $2,500 a month for out-of-network mental health care for her son and herself. After several years, Siegel could no longer cover the costs and stopped her own therapy.
Then, the pandemic happened, her father died, and her depression returned. Siegel said she called or emailed at least 20 providers; they were either not taking new patients or no longer accepted her insurance. She did try two providers, she said, but neither were a good fit.
"It is hard being a physician and being in therapy," she said. Finally, Siegel found a young, in-network therapist who could help her navigate her high-stress work life and find balance. But after just a few months, her employer changed insurance carriers and that therapist was no longer in-network. Siegal was devastated, but eventually the therapist was able to arrange a status change that allowed her to move back into the network.