I am a Licensed Mental Health Counselor and am also a human being who is trying to “make it” through life relatively unscathed in 2021 America. I am writing this as inspired by World Mental Health Day, but also as inspired by my experience as a clinician and as an American who believes healthcare is an (often neglected) human right.
I’ve seen a lot of awareness brought to mental health over the past year. In part, this is thanks to the courage of Simone Biles and others for normalizing the struggle of maintaining optimal mental health in a world that now seems to encourage everything but. And yes, I am happy to see the catchy hashtag “mental health matters” trending on social media. But the conversation about mental health often stops there, taking a more reductionist approach to assume that mental health awareness is solely predicated upon de-stigmatization. And that’s where we fall short, because mental health awareness is so, so much more than that.
Mental health care does not occur in a vacuum. It is not linear. We don’t just wake up one day and decide to start therapy and then “Voila! All better”. Mental health care is first and foremost- healthcare. Which means, in modern day America, millions of people do not have access to affordable, continuous treatment. For starters, insurance plans and finances often serve as gatekeepers to starting treatment. Does your employer provide you with an insurance plan that covers mental health care? Is there a deductible? Do therapists in your area accept your insurance? What often isn’t spoken about is the nuances and complexities of the insurance processes clinicians are dealing with on the backend. The insurance panel application process and also the reimbursement process is often long, cumbersome, and time consuming for most clinicians. What’s worse, is often times insurance reimbursement rates are so low that they are in no way commensurate with the tuition cost therapists accrue from required graduate level degrees. So naturally, few therapists accept insurance, and the ones that do are usually completely booked with long waitlists. With that being the case, where do we go from here? When we talk about access to care from a financial perspective, what we are often truly talking about is affordability and time. Ultimately this type of access to care translates to one word: privilege.
Insurance and affordability is just one barrier to care. I have seen first hand, as a licensed clinician in private practice, the many, many obstacles preventing patient access to care. For example, every time a patient of mine moves out of state (and given the transient nature of New York City, this happens all too often) I am required to obtain licensure in the patient’s new state of residence. This is a process that should be relatively simple and easy, but since there is absolutely NO license portability between any of the 50 states, it is a process that is nearly impossible. Licensing rules and regulations are vastly different from state to state; in some states it’s completely impossible for any reciprocity at all. For the states that allow some semblance of accessible reciprocity, there is often a costly and time-consuming licensure applications process. For clinicians, this puts us in a precarious position that’s been recently compounded by the collective traumas of a global pandemic. In most cases it’s unethical to discontinue treatment with a client during a major life stressor, such as moving (or a global pandemic). It can also be difficult, or near impossible for the therapist to locate trusted referral sources in the new locale in which the client is moving. However, state guidelines say otherwise. Therapists can face lawsuits, loss of license, and even JAIL TIME if practicing across state lines- even if continued treatment is in the absolute best interest of the client’s wellbeing. Imagine, we live in a country where clinicians who dedicate their lives to holding space for everyone else are threatened with actual jail time for showing up for clients in their time of need. This is the #mentalhealthmatters that no one talks about.
We also have to remember that clinicians are people, too. Mental health care does not occur in a vacuum. Clinicians are not simply these “all knowing” giving machines. The person sitting across the couch from you, or on the other side of the screen, is also human being who can experience the same collective and individual traumas as everyone else. Navigating the draconian mental health system of insurance, and ever-changing telehealth regulations coupled with a lack of systemic supports (health insurance, FMLA, disability, and maternity leave for clinicians in private practice OR a livable wage for clinicians at non-profits) is a complete recipe for clinician burnout. As a result, many clinicians (myself included) have left or have considered leaving the field altogether (particularly after the stressors of working on the invisible frontlines of a global pandemic). But also, many of the clinicians who have the means to “make it work” and continue practicing often have access to the tangible safety nets of intergenerational wealth or the marital supports of health insurance and financial stability. All of this not only contributes to a lack of access to care, but due to other systemic issues, also creates an imbalance in the availability of BIPOC clinicians and subsequent multicultural treatment.
So we can still say “mental health matters” all we want, sure. De-stigmatizing mental health struggles and therapy on an individual level is still important. But it’s equally as important, if not more, to destigmatize mental health care on a systemic level, too. Because really, what the lack of access to care on a larger level is actually saying is “no, mental health doesn’t matter”. Right now, our mental health system is saying “profits matter, capitalism matters, bottom lines and big pharma matter but no, not mental health itself”. So, until we can also speak on the systemic issues that prevent access to care and that disallow for a sustainable, equitable career path for clinicians, “mental health matters” will just be another one dimensional catchy slogan