Nearly 1 in 5 Americans reported having an unmet mental health need (MHA, 2018). So, why aren’t more people getting help? Mental Health America states that the largest obstacles American’s face to obtaining mental health services are finances, education and awareness, and social stigma. (See the facts, stats, and data on Mental Health America’s website. Although these barriers exist for a myriad of reasons, as the providers – and subsequently the gatekeepers to affordable mental health resources – we play a key role. Our role is to remove the barriers to mental health care, not reinforce them.
And we are failing.
We’re failing by not holding ourselves and our counterparts accountable for the responsibility to help fill the gap between mental health issues and accessible healthcare options. As any good therapist knows, it is our failure to acknowledge and accept personal responsibility for our own role in a problem that keeps us stuck.
Acknowledging our own roles and responsibilities is similar to what we assist our clients in doing every day. Psychotherapists, psychologists, and psychiatrists are all in the business of creating change. If we’re going to put an end to the mental health crisis, then we need to take a long hard look at the climate of our profession and commit to joining together to improve it. We exist within a flawed system, and we must shoulder some responsibility for fixing it.
What follows is my take on our roles as professionals, and how we can work to stop perpetuating barriers to mental health care in Colorado, and in America.
Barrier: Accessibility
“It takes forever to book an appointment with someone in this field.”
“I don’t even know where to start”
“No one gets back to me.”
I’ve heard all three of these comments from potential clients in the past week. And I’ve heard some version of them weekly since opening the doors of my private practice. And I’ve had it happen to me as well.
Several years back while looking for a new provider and ran into similar issues. While I don’t remember how many I reached out to exactly, I do remember the two that called me back more than a week later. Their blatant disregard for the urgency of my request was so frustrating that I declined speaking with either of them – despite being without an appointment!
Knowing that I would be writing this today, I went to psychologytoday.com yesterday before I left the office. I searched for providers that specialize in suicidal ideation and emailed the first five. As of writing this (2:30 PM), I have only heard back from two of them.
Responsibility #1: Respond within one business day.
It takes a long time and a lot of courage to decide to reach out and get help. It’s scary enough to feel unheard or unseen by friends and family, what’s worse is when concerns fall on a provider’s deaf ears. Providers can help reduce accessibility barriers by responding to potential clients the same day they seek services, or by providing a specific timeframe in which they can be expected to respond.
We’ll all readily acknowledge the lingering stigma surrounding mental illness. Let’s not disregard this by behaving in a way that perpetuates feelings of isolation and helplessness.
Take the time to respond to all inquiries within one business day. At DMHC we respond to all calls and emails within a few minutes of receiving them. Outside of business hours an out of office response lets people know when to expect to hear from us.
Barrier: Finances
The Colorado Health Access Survey (2017) found that 56% of people did not seek treatment because they were concerned about costs. Similarly, mental health services are significantly less likely to be covered in-network than any other specialty. Here, we start to get at the heart of the issue. People don’t seek help because they’re concerned about how they’re going to pay for it. And when they actually do it’s extremely difficult to find a mental health professional that accepts their insurance.
In 2017 43% of people did not seek treatment because they didn’t think their insurance would cover it. Interestingly, that is virtually the same as the percentage of psychiatrists that don’t accept insurance. Despite the number of people that don’t seek care, providers don’t have to accept insurance because of demand. This is especially the case in high-income urban settings where people can afford to pay out of pocket. As a result, this provides little incentive on the professionals to accept insurance
Transparency
The National Alliance on Mental Illness finds that mental health providers often cite low reimbursement rates and heavy administrative burden as the main reasons for not accepting insurance. In addition, individuals seeking mental health services have concerns about stigma associated with mental disorders and worry about their privacy. They also don’t understand the nature of reports to insurance companies. In turn, providers use language that cites privacy and ethical concerns to justify not accepting insurance. This is confusing and oftentimes misleading.
Mental health professionals are doing the public disservice by not being transparent about why they don’t accept insurance. By and large, professionals that do not accept insurance simply don’t want the added burden for lower pay. And it wouldn’t be fair to blame them for it. However, they are not free from the burden of honesty and transparency.
Responsibility #2: Be transparent and honest about billing and insurance.
It’s understandable not to accept insurance carriers that do not reimburse at rates close to the industry standard. It’s also completely within a professional’s rights to choose whether they accept insurance or not. It is not acceptable to imply that you don’t accept insurance for ethical and privacy reasons yet offer the same information on a Superbill. Out-of-network reimbursement via Superbills requires all of the same information as a regular insurance claim.
When choosing to use insurance a client accepts that you will need to bill for a diagnosis and procedure code. This is the same information that is included on a superbill, which is useless without it. If you’re choosing not to accept insurance, be honest about your reasoning. If you don’t want to provide diagnosis and procedure codes on claims, don’t do it on a Superbill either.
While controversial, there is a case to be made for abolishing the practice of providing “superbills” all together. It’s dishonest and irresponsible. If you’re not in the practice of providing accurate diagnosis and procedure codes for all of your clients, how can you honestly state that producing a Superbill for some doesn’t increase your administrative burden?
**Just to be clear, that is in no way questioning the clinical competency of any provider regardless of how they bill for services. I am simply validating the administrative burden that comes with filing insurance claims for reimbursement. Insurance companies require providers to use the ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) and Common Procedural Terminology (CPT) codes, which is a system used by physicians and other healthcare providers to classify and code all diagnoses, symptoms and procedures recorded in conjunction with hospital care in the United States.
Barrier: Stigma & Awareness
More people talk to their general or primary care doctor (16%) than mental health professionals (14%) about their mental health. This is alarming, and it is not entirely an accessibility issue; it’s an education issue. Data shows that simply having a hard time getting any appointment deters people from seeking care.
Given our position within this industry, we hold an innate responsibility to support people in getting the help that they need. A large portion of that support includes pointing people in the right direction when they are outside of our scope of practice.
Responsibility #3: If you can’t help, assist in finding someone that can.
Feeling rejected or unable to connect with the people around us strips us of our sense of meaning and purpose. The only way to help people recover is to ensure they maintain their dignity and agency throughout the process.
We regularly get calls or emails from people that for one reason or another we can’t take on as clients. But that doesn’t mean we can’t serve them. It doesn’t take a lot of time to assist someone in finding a provider that can help. And it could be the difference between them getting help or continuing to suffer.
Removing Barriers to Care
DMHC does not participate in any practice that perpetuates social stigma. We call on health professionals to do the same. We offer a comprehensive range of services at affordable prices. In line with our ethical responsibility, every DMHC provider sees at least one client pro bono. We also reserve at least one spot in our caseload for a client from Open Path Psychotherapy Collective, where a $49 lifetime membership guarantees access to affordable care. We accept all major insurance carriers and are actively working to accept Colorado Medicaid.
Our mission is to make mental health care accessible, affordable, and shame-free. This is a safe place where equality is not just a belief, it’s a basic human right. Our vision is a world where mental health issues are just as acceptable as the common cold. We practice down-to-earth care through contemporary, empowerment-based relationships. This means that we tailor therapy to your unique needs and your lifestyle.
We specialize in therapy for anxiety, therapy for depression, therapy for adolescent & teen behavior issues, therapy for eating disorders, therapy for body image, and therapy for trauma. If you or someone you know is struggling – reach out for help.
