PHOTO CREDIT: Jennie Carr
My phone rings three times a day with the same message: my teenage (daughter) needs someone to talk to. I try to be my usual calm self. I ask certain intake questions. I say there may be a wait list. For the first time in my social work career there is a demand that no one saw coming. For the first time we can perhaps get more business, more money, help more people, be important even. It's quite seductive in a field where starting salaries can be no higher than 35,000$ per year at the height of your powers. We are used to having no pensions, no respect, shoved aside by doctors and nurses, even psychologists. We are those people who deal with things like broken homes, getting medicaid, working out a bus route. I once had three interviews and then no callback for a job that was 3 decades below my level. If you work in a clinic, you get bean counters checking your every move while real people suffer with real problems, waiting, waiting for help. In many cases, whether it's the inner city or the suburbs they wait.
Now comes covid. For a while I rode that wave by booking more and more appointments. It became very alluring to be wanted, needed and in demand. But it soon became much too much. We therapists talk a good game about self-care but we rarely practice it so well. We have to practice what we preach. So now how to get off the roller coaster. Cutting back and taking higher paying clients is one way, creating even more demand. But once you're in the insurance racket everything changes. You are forced to accept drastically lower rates and compelled to do endless paperwork. Most in my area have opted out of all that. What does that do to the people who have really emergent needs?
My colleagues are saying some very very simple things. It comes down to access and money. None of this is new. Medicaid and Medicare do not typically include other types of licensed mental health professionals. In addition the regular insurance company's jobs are to limit care. It's that plain. When the incentive is the bottom line, and not care, everyone suffers. Healthcare becomes a privilege, not a right. Therefore it's the neediest who get the least help. I work with solidly middle class families, those working for their benefits and wanting to use them. According to another therapist, Jennifer Rowe, LCSW, "prior authorizations, lack of reimbursement, constant resubmissions to obtain payment for service..." created a barrier. Yet most of my peers are "out of network" because they themselves can't live on the fees that the network pays us. We in private practice have no benefits. This is why our rates may seem high. Rates for therapy around the NY area range anywhere from $60 to $350 per session. If you happen to need a prescription along with that, psychiatric evals can start as high as $850 for the initial evaluation.
Access and money.
Now every teenage girl needs someone to talk to. That's great news! They were locked up for 18 months of their incredibly stressful lives, at the exact moment their brains were seeking comfort from their friends and their bodies were going through monumental changes. The isolation, languishing and depression would be putting it mildly. These kids were flattened. Lifeless, listless, empty, you name it. I'm surprised there wasn't a new diagnosis called childhood burnout. My colleague, Gayle Skovron, LCSW of Nyack, NY said, "We ignored and stigmatized mental health for too long. This is the fall out of torn families, lack of community and greed." Another Clinic Director, Max Benezra, EdM, MA, LMHC, from Sound Shore Counseling in NY reported, "We experienced such an increase in referrals during the pandemic, especially with teens, that we hired more therapists and still did not have enough therapists to meet the demand. Additionally, the tiresome nature of insurance reimbursement, particularly when telehealth was first being instituted during the pandemic, made it all the more difficult to provide our patients with the support they sorely needed." Lastly, and this is an extremely overlooked dilemma, according to NY therapist Jessica Hazard, LCSW,
"Some difficulties I have been experiencing in my private practice is that parents can clearly see their children are suffering but want them to "snap out of it" and "behave like they used to." It is hard for them to see their kids having a tough time and so they want the healing and behavior change to happen rapidly. Having to tolerate that it will take time is proving difficult for them. I have a patient who has historically been a very good student that is currently failing two classes. They have never even come close to failing something so the parents are demeaning her and putting tons of pressure to perform as she once did. Some of the work is with the parents realizing the pressure is adding to their struggles and making it more difficult to do the things they once did. And it also feels challenging to me as a clinician because if parents are not liking the "results" they can get rid of me prematurely even if both the teen and I feel we are doing good work together.
The rest is history. No policy changes were made besides a brief covering of copays and of course telehealth. Bold for the short term but what if you still had a high deductible and your teen girl was putting gashes in her arm out of boredom? I was contacted by the parent of triplets -- they all needed therapy. There was a time this would have been a perfect gig for me. I said no. The mother was desperate. I said I would help her. But I can no more help them than help myself. I let my hair go grey. My wise therapist told me, "having more patients does not make you a better therapist."
"The report cited significant increases in self-reports of depression and anxiety along with more emergency room visits for mental health issues. In the United States, emergency room visits for suicide attempts rose 51 percent for adolescent girls in early 2021 as compared to the same period in 2019. The figure rose 4 percent for boys." --https://www.nytimes.com/2021/12/07/science/pandemic-adolescents-depression-anxiety.html
Where is the policy change here among all the statements? We wait.