Building Equity into the Mental Health Profession

Jul 9

Myra McNair

We are experiencing a mental health crisis. Around the country, folks ready to seek mental health services are facing immediate roadblocks to get in to see a therapist as waitlists have reached monumental levels. At Anesis, the time between when someone calls seeking services to when they actually get an initial appointment is between eight and 16 weeks. Historically there has always been somewhat of a wait, but the current situation is dire.

For someone who has accepted that they need additional support, or whose day-to-day situation has been undeniably affected by the symptoms and feelings they’re experiencing, these waitlists can seem intolerable. We’re continuing to do our best to ensure our community can access the services they need, but one of the biggest factors in providing care in a timely manner is the shortage of available therapists who can offer exactly what patients need to feel better.

Shortage of providers

The mental health system is not immune to worker shortages. Around the country, the demand for therapists is vastly outweighing the supply. It’s become a bit of a chicken-and-egg issue:

Therapist shortage → practicing therapists feeling burned out from effects of shortages and pandemic (hey, they’re human, too!) → increased demand in services and support → waiting lists continue to stack up for many providers

This vicious cycle needs attention and creative solutions, otherwise we risk losing even more qualified therapists from the profession and going further down the waiting list hole.

What’s the motivation?

While there is burnout and resignation happening with current therapists, there is also a compounding issue of bringing in enough new therapists to cover the increased demand for services. Unfortunately, the mental healthcare profession is one of the lowest-paying healthcare fields. According to the U.S. Bureau of Labor Statistics, the average salary for a family physician in 2021 was $236,000, whereas the average salary for a marriage and family therapist in 2021 was $50,000.

While it’s true that becoming a physician requires a somewhat greater investment in time, the career path of a therapist also requires additional education and training. For someone thinking about dedicating six years (or more) of their lives and a hefty student loan debt when all is said and done, it’s hard to commit when you realize you might not be able to make a decent living.

On top of that, if potential therapists are planning on starting a family, the realities around child care and additional expenses will most likely become a consideration as well. For many, the factors stack up enough to justify changing tracks or careers from therapy to something more lucrative.

And all this is looking at it from a privileged lens. Imagine the barriers in place for Black and brown people who are already facing wealth inequality, roadblocks to education, and a whole list of additional hurdles that stand in their way of maximizing opportunities? This is disheartening because the need for more Black, brown, and bilingual therapists is critical so that more people can find the right fit with a therapist they can fully connect with.

Help Wanted: Seeking BIPOC Therapists

We need more mental health providers, especially from the BIPOC population. Extra bonus points if they speak a language other than English. Because this community is dealing with the additional challenges of racism and racial trauma, having a provider who comprehends those experiences and what that feels like will create a stronger connection between clients and providers, leading to more successful therapy.

In addition, being able to offer clients a therapist who speaks their home language is key in order for sessions to run smoothly, as clients often feel more comfortable sharing their intimate thoughts and feelings in their preferred language.

At Anesis, we strive to approach therapy with cultural humility and sensitivity because we recognize the need to meet clients where they are. Unfortunately, until we can convince more Black and brown folks to pursue a career in mental health, we will continue to face longer waiting lists in our efforts to match clients with the right providers.

Mental Healthcare ≠ Healthcare

I won’t bore you with the mundane details of insurance claims and figuring out the system of healthcare, but many of the behind-the-scenes details contribute to lack of access and shortages of mental health services. To top things off, the healthcare system is completely separate from the mental healthcare system, which results in two complicated system structures for both clinicians and patients to try and wade through.

For example, whether a therapist is private practice versus clinic-based affects how they bill for services. Private practice therapists typically aren’t able to work through insurance, thus, patients pay out of pocket. Why does anyone want to pay out of pocket if they have insurance? Additionally, private practice therapists often can’t offer scaling fees to clients because they have no other means of making money and would reach a point where they would have to close their business. More barriers for clients hoping to access services.

Different hardships exist for those of us in clinical practice. Figuring out insurance rates, billing rates, and ensuring that everyone is receiving their fair distribution is just one more loophole to providing quality, affordable care. It’s unbelievable the amount of fighting you have to do behind the scenes for claims to be paid out. One additional benefit of a clinical setting is you have the support of a team and someone else to handle billing and other administrative tasks.

But the overarching theme here is “it’s complicated.”

What can be done?

I’d like to think our community can brainstorm creative solutions to alleviate some of these problems and build a more equitable representation of candidates entering the mental health profession. I hope we can find some thoughtful resolutions as we move forward.

Some ideas for progress:

More student loan forgiveness programs
Scholarship pathway programs that encourage student and/or emerging therapists to give back time to communities pushed to the margins
Colleges and clinics partnering together

Currently, Anesis is partnering with UW-Madison’s Department of Psychiatry on a program where students of color who want to work with clients of color can serve a psychiatry residency at our clinic.

Additionally, programs like the National Association of Black Counselors (NABC) are advocating for African American providers and educators in the counseling profession and continue working to recruit Black students who are interested in the profession to become involved in order to increase the number of licensed professional counselors of African descent.

The onset of COVID and the continued traumas that have occurred since the onset of the pandemic have sharply increased the need for mental health services and raised awareness of the crisis at hand. There has been a lot of talk about implementing necessary changes, yet the shortages continue and access remains limited. We can do better.