The helping profession needs help

Graphic interpretation of a therapist and her troubled patients.

An honor. A privilege. Not just a job. The most rewarding career you could hope for.

This is how people in the mental health profession describe what they do. They serve people, often in the most difficult periods of their lives, and are grateful to do so. And there is certainly a great need for their services.

Half of Americans will experience a significant mental health issue in their lifetime. One in five Americans (about 57.8 million) live with a mental illness during any given year. Yet there are not nearly enough mental health practitioners to help everyone in need.

Why is there a shortage? Unsurprisingly, the answer is complicated. Practitioners say burnout, insurance, over-regulation and outdated policies prevent them from helping everyone in need and drive much-needed talent out of the field.

“THE NEVER-ENDING CONUNDRUM”

Burnout in the mental health profession is “the never-ending conundrum,” says Susan Coyle, CEO of Chartiers Center, a community mental health center located on Mt. Lebanon Boulevard in Castle Shannon. Along with licensed providers—psychologists, psychiatrists and therapists—case managers, clinical support staff, community care workers and paraprofessionals all contribute to the mental health workforce. Burnout doesn’t discriminate; it affects workers at all levels.

Coyle affectionately describes mental health professionals as “do-gooders,” who get into the work knowing it doesn’t pay a lot, but have a sincere desire to help others. They often take their work home with them, which adds stress to a job that can already be emotionally and mentally taxing. On top of that, the demand is too great for the number of workers. Some therapists in community mental health have caseloads of 100 clients, which they manage alongside administrative responsibilities.

With longer-than-ever waitlists, providers are seeing more patients than they would prefer, and 72 percent of providers have reported an increase in the severity of cases since the start of the COVID-19 pandemic according to a new study from the National Council for Mental Wellbeing. As a result, 93 percent of workers report suffering from burnout.

Olivia Frye, licensed professional counselor, co-owner of Collective Wellness, and Mindful Matters Counseling Group on Cedar Boulevard, agreed that the COVID-19 pandemic remains a particular source of stress and burnout. “All of us try to do our best with self-care, but the pandemic just heightened everything. Stigma has gone down, so more people are seeking help, which is good, but it’s rapidly increasing the demand.”

Currently, the mental health workforce shortage is in full swing, with an additional 8,000 professionals needed right now to meet basic demand. This number is projected to skyrocket in just a few years—some studies predict a shortage of up to 31,000 practitioners by next year.

“We are tapped out, even here,” said Christie Hudson, licensed clinical social worker and co-owner of Collective Wellness.

Employers and employees are finding ways to address the burnout. For Coyle, who oversees 130 employees at Chartiers Center, this means training supervisors to better support the staff, creating a culture of gratitude and providing extra time off to celebrate personal days, such as birthdays. For Heather York, a licensed professional counselor at Mindful Matters on Cedar Boulevard, self-care is a big part of combatting burnout. Spending time in nature, walking in the woods and whitewater rafting are all ways to destress and take time for herself outside of her job.

RED TAPE

If you bring up insurance, regulation or funding with providers working in private practice or community mental health, you will hear a resounding groan followed by a litany of frustrations. The overcomplicated, outdated systems in place to pay for mental health care are causing serious issues for mental health professionals.

Navigating the mental health system is already difficult—add insurance to the equation and it can become an insurmountable barrier to care.

In general, issues with insurance and reimbursement happen in two realms—private insurance and Medicare/Medicaid. Private insurers often have high deductibles, making therapy unaffordable for many. Therapy can cost $50-$250 or more per session, which some people pay out of pocket if they haven’t met their deductible. Frye and Hudson say some insurance plans are creating behavioral health coverage services with reasonable copays separate from deductibles, which is a step in the right direction.

Providers deal with their own issues from private insurance companies that routinely fail to provide adequate reimbursement rates for services. This led to a trend where almost half of mental health providers do not accept insurance at all, instead billing patients directly. As Hudson points out, this can create a two-tiered system, where only the people who can afford care receive it.

Using Medicaid or Medicare can be just as frustrating, if not more. Only 36 percent of psychiatrists accept patients with Medicaid, compared to 76 percent of general practice physicians. Again, the reimbursement rates from these programs are not sustainable for many providers.

Graphic interpretation of a therapist caught up in red tape.

DESPERATELY NEEDED POLICY CHANGE

Providers and advocates say public policy needs to reflect reality. For instance, until a new law took effect this year, medical assistance only covered services provided by licensed social workers or psychologists, not licensed professional counselors. Hudson, who has a background in public policy, says this was a huge win for health care professionals and a reflection of the advocacy work done by those in the field.

In addition to Coyle’s role as CEO of Chartiers Center, she is also president of the Conference of Allegheny Providers, a 64-member group that advocates for better policies for patients and providers. From her perspective, policy reform is at the heart of improving the mental health field.

“Providers can’t keep up with the regulations,” she said. “It stresses them out. It’s a lot to keep on their minds all the time.” Public providers are required to participate in numerous audits each year to justify the care provided and keep their licensure. Coyle says consolidating the audits and simplifying the burdensome administrative work would relieve a lot of pressure.

“When we have people leaving work in mental health to go work at Amazon or Aldi, that’s a huge indicator of an issue. They just can’t keep up with all the rules.”

Since 2008, the Mental Health Parity and Addiction Equity Act forbids insurance providers from issuing benefits for mental health and substance abuse treatment at a lower rate than other medical benefits. Although, for the past 16 years, the disparities are still very much alive. A recent Congressional report from the departments of Health and Human Services, Labor and Treasury says insurance companies are not following the law. Of the 156 insurance plans analyzed, not a single one measured compliance with the act.

A new Biden administration proposal would strengthen the 2008 law and require insurers to address the differences between mental health and other medical benefits. If the insurance companies don’t resolve the disparities, they’ll face large fines. The proposal has yet to be adopted but would be a huge step forward in the eyes of many advocates.

Coyle says to create real change, mental health advocates need to keep pushing and working with legislators. She points to state Rep. Dan Miller, who hosts the yearly Disability & Mental Health Summit, as one legislator in the region who listens to and supports mental health issues. “He’s somebody we can go to and know the message will be relayed to Harrisburg.”

UNWAVERING OPTIMISM

While there are certainly challenges to working in this field, these mental healthcare professionals say they couldn’t imagine doing anything else. “This can be the most rewarding career you could ever hope to have,” says Coyle. “But you have to be patient, stay with it, appreciate and honor the people you work with. At the end of it, you can change a life.”

Yet to change more lives for the better, the workforce shortage, systemic burnout, insurance dilemmas and outdated policies will need to be addressed. The No. 1 thing that advocates stress: overarching policy reform is needed to prevent the crisis from worsening in the coming years.

This is the first article in a three-part series on mental health in Mt. Lebanon. Mental health issues have long been swept under the rug—but that is changing, especially in recent years. This series aims to uncover mental health concerns in our community, shed light on areas for improvement and provide support to those in need.