A2 EZ RE THE WASHINGTON POST.MONDAY, MARCH 7 , 2022
“I justreally need some guide
rails togo throughthisprocess,”
she said, “and thathas not been
available.”
In inte rviews, therapists and
experts cited the obvious causes
of the backlog: the psychological
and emotional toll of long-term
disruption during the pandemic,
prolonged uncertaintyabout the
future, fear of infection,financial
stress from lostjobs, griefover
the deaths of loved ones, loss of
social interaction and, especially
for children, the unnatural cir-
cumstance of isolationat home.
But theyalso noted other fac-
tors. People who might never
have sought therapy are now
more willing to consider it in the
wakeofthe pandemic, led by a
youngergeneration thatsees less
stigma in acknowledging mental
illness, said SaulLevin, chiefex-
ecutive of the AmericanPsychiat-
ric Association, which represents
more than 37,000 psychiatrists.
“Covid in some waysexposed
mental illness to thegeneral pub-
lic thatthe majorityalways ig-
nored,”Levin said. “People have
been accessingmental health
car ealot more now because of
covid.”
Yetinsurance coverageand
training slots for newpsychia-
trists lag far behind the demand,
Levin said.In his Stateofthe
Union address lastweek,Presi-
dent Biden proposedalargein-
creaseinmental health provid-
ers. In afactsheet, the White
House noted thatmore than one
third of Americans live in desig-
nated mental health professional
shortageareas.
“Wemustdramaticallyexpand
the supply,diversity, andcultural
competencyofour mental health
and substance use disorder work-
force—frompsychiatrists to psy-
chologists, peers to paraprofes-she has contacted about 50 pro-
viders, online and by telephone,
withoutfinding one who can help
with the behavioral problems her
5-year-old granddaughter isex-
periencing.Powell israising the
child, who she said suffers signifi-
cant impairment fromexposure
to alcohol in the womb,cystic
fibrosis, trauma and other condi-
tions.
Thechild needs to be seen in
person, an obstacle tofinding
therapy from providers who
largely moved online when the
pandemic began, she said.Powell
recently began meeting with one
specialistonlin e, in the hope that
the practitioner will see her
granddaughter in person in the
next fewmonths.
“There are not enough [provid-
ers] or their specialtydoes not
include whatyou need for your
kid,”she said.“And then of course
the pandemic.”
Gullett,a47-year-old screen-
writer,also wanted to speak with
acounselor in person, which sub-
stantially narrowed her chances
of finding someone.Nowshe is
competing with an untold num-
ber of people who see the chance
to emergefromthe pandemic and
its impactontheir psyches.
“We’reall living through a
mass traumaevent, and thatin-
cludes therapists, so their capac-
itytohelp is understandably im-
pacted,”she said.“And so many
more people need access to care.”
Unable tofind acounselor,she
has turned to self-care: yoga,
journaling,booksongriefand the
online apps thathavesprung up
as stopgaps.LosAngeles County
offered residents free subscrip-
tions to one. She believes other
people mayfindhelp in support
groups,even ones offered online.
But for her,the al ternatives have
been insufficient.HAPPENING TODAY
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9:30 a.m.|TheSupremeCourtissues orders.Fordetails, visit
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2p.m.|TheHousemeets for legislative business.Visit
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3p.m.|TheSenateresumes consideration of thePostal Service Reform
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briefs theSenateForeign Relations Committee onRussia’sinvasion of
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Online therapy,aboon to pa-
tients and clinicians, especially in
rural areas, has dramatically re-
duced no-shows and dropouts by
offering the convenience of coun-
selingat the touch ofabutton.
This hascutintomanycounsel-
ors’ availabilitytoaccept new
clients,experts said.
Some patients also need more
timetoreachtheirgoalsnow,said
Roberts, the Oklahoma therapist,
which also delays the opening of
newslots.
“It’slikethe boxcars are all
crashed and piling up behind,
and everyone is trying tofigure
out how to getthemback on
track,”she said.
D. Giovanni Scott,aprivate
practitioner in the District, noted
thatpeople gave up insurance
and access to employee assis-
tance programs when theylostor
left jobs during the pandemic.To
accommodate demand, she said,
she offersafew people the option
of biweekly therapy sessions
when it is appropriate, and she
triestoretainsomeinsurance-on-
ly clients despite the low reim-
bursement rate. Shekeeps her
waiting listshort, unwilling to
offer unreasonable hope to peo-
ple seeking an opening.
Scott, who is Black, and others
saidracial injustice and 2020’s
protests againstpolice violence
have also sent more people to
their doors.
Crawford, the Boston child
psychiatrist, said the return to
school has allowed teachers and
others to assess the needs of
children who have been seen only
by their parents in recent
months.Theresult has been a
largesurge in referral stoamen-
tal health workforce thathas not
expanded.
“Other adults and teachers are
able to layeyes on thes ekids,”she
said, and theyare “bringing up
concerns about behavioral issues
and emotional issues.”
Accordingtothe American
Academy of Childand Adolescent
Psychiatr y, there are just8,
practicing child psychiatrists in
the United States for the more
than 15 million young people who
need them.Pediatricians are do-
ing initial assessments, Crawford
said, with only the mostsevere
ca ses reaching her.Children con-
sideredadanger to themselves or
othersareroutinelyheldinhospi-
tal emergencyrooms foraweek
or twowaiting for beds in appro-
priate settings, she said.
Some providers hope the crisis
will be used to overhaulamental
health system thatwas created
afterWorld WarIIa nd has always
been crisis-oriented, by infusing
mental health awareness and
techniques into schools, the
workplaceandotherpartsofsoci-
ety. Simply doing more of the
same won’t work,Prinstein said.
Biden’s plan contains some el-
ements of revamping the system.
And there is no doubt thatthe
United States needs more practi-
tioners,experts said.
“The nation is in the middle of
amental health epidemic, and it
is up to behavioral health agen-
cies tofind solutions thatwill
attrac tand retain employees who
can provide access to quality
mental health care,”Brant Rus-
sell,president and CEO of
OhioGuidestone, the nonprofit
agency, said inastatement.
But it won’tbe soon enough for
Gullett and others searching for
help today. “Mostpeople have
given up.Nobody is looking right
now thatI’m aware of,” she said.
“There seems to be noexpecta-
tion thatit’sgoing to change.”Lizzy Raben and AndrewVanDam
contributed to thisreport.variety of data.
“It’sthe worstit’sever been,”
said Kelly Roberts, director of
Graduate Programs inHuman
Sciencesat OklahomaChristian
UniversityinEdmond.“I’venever
seen it likethis.”
At BostonMedical Center,the
safety nethospital for the city,
staffrecently began contacting
parents of children who joined
the 170-person wait listinApril
2021 —a10-month wait for a
chance to receive services, said
Christine M. Crawford,achild
psychiatristatthe center who is
also the associate medical direc-
tor for theNational Alliance on
Mental Illness.
At a20-prac titioner branch of
the nonprofit agencyOhioGuide-
stone in Columbus, the wait list
now holds 150 to 200 names,
nearly double the norm.
Thefederalgovernment’s men-
tal health and substance abuse
referral linefielded 833,598 calls
in 2020, 27 percent more than in
2019, before the pandemic began.
In 2021, the number rose again, to
1.02 million.
When the AmericanPsycho-
logicalAssociation surveyed its
members lastfall, it foundasurge
in demand and newreferrals,
particularly for anxiety,depres-
sive and trauma-related disor-
ders.Yet65percent of the more
than 1,100 psychologists who re-
sponded said theyhad no capac-
ityfor newpatients and 68 per-
cent said their wait lists were
longer than theywere in 2020.
In December,U.S.Surgeon
General Vivek H.Murthy issued
an advisoryon“the urgent need
to address the nation’s youth
mental health crisis.”And onFeb.
1, aSenate committee held a
hearing to address the nation’s
growing mental health and sub-
stance abuse problem.
“Mental health problems often
lag astressor,”said Mitch Prin-
stein, chiefscience officer of the
AmericanPsychologicalAssocia-
tion, which represents 133,
psychologists, researchers, edu-
cators and others.“This is not a
surprise.”
Prinstein and 35 colleagues
predicted the current situation
with remarkable clarityina“call
to action”inthe American Psy-
chologistjournal in August2020.
“The toxic psychosocialstres-
sors thatthe pandemic has creat-
ed (e.g., physical risks, daily dis-
ruptions, uncertainty, social iso-
lation,financial loss,etc.)are well
known to affectmental health
(andtherebyalsophysicalhealth)
adversely,and collectively en-
compassmanycharacteristics
that have been identified as hav-
ing the greatestnegativeeffects,”
theywrote.
It isnearlyimpossibletogener-
alize about thestateofthe entire
mental health profession in a
society as vast and varied as the
United States.Hundreds of thou-
sands of specialists work in a
widevariety of se ttings, including
schools,hospitals,privatecompa-
nies ,nonprofit agencies, free-
standing clinics, outpatient set-
tings and privateoffices.
Traditional one-on-one talk
ther apy is offered by practitio-
ners with significantly different
levels of training,including clini-
cal psychologists, who have doc-
toral degrees; psychiatrists, who
hold medical degrees and can
prescribe medication; clinical so-
cial workers, marriageand family
therapists, licensed professional
counselors and others.
Thefrustration some people
encounter when trying to book
time with one of them points to
the serious consequences of the
two-year-old pandemic and a
mental health system thatsimply
isn’tbuilt to handlecurrent de-
mands.
In Avon,Ind., 24-year-old Row-
an Welch, ateam leader for a
bank, said he has contactedevery
provider within 50 miles on his
insurance plan’s networkwithout
success.“Iamstill looking,after
lookin gina50-mile radius,”
Welch said. “There’s not much
moreIcan do.”
In NewYork, FloraStamatia-
des, agig worker who relies on
insurance she purchased through
the state’sexchange, said sh ehas
been looking foratherapiston
and offfor more thanayear.She
is usingalistprovided by the
ActorsFund, which isavailable to
her through her job asacovid
safety manager forashow now in
rehearsal. She is onalistfor a
possible opening this spring.
“Itnever,everoccurred to me
thatIwouldnot be able tofind a
therapistwhen Ineeded one,”
said Stamatiades, 55, who left her
job with the Actors’ EquityAsso-
ciation in 2018 after24 years.“I
might have to waitafew months.
That occurred to me.That would
have been okay.
“This is not actually anew
problem,”she added. “It’sjust
desperatenow.”
AndToni Powell, an associate
director of clinical qualityfor
UnitedHealthCare in Austin, saidCOUNSELINGFROMA
In pandemic, di∞culty in accessing counseling grows
ALLISON ZAUCHA FOR THE WASHINGTON POST
AngelleHaney Gullettather homein LosAngelesonFeb.28. Afterlosing her fatherinSeptember,she
contacted25 therapists in three months andwas unable tofind asingleoneaccepting newclients.AMANDA ANDRADE-RHOADES FOR THE WASHINGTON POST
PractitionerD.GiovanniScott in D.C. keepsher waitinglistshort,
unwilling to offerunreasonable hope to peopleseekingopenings.THE WEEK AHEAD
MONDAY
TheSupremeCourtissues
orders.TheSenateresumes
considerationofthe PostalService
ReformAct.TheSenateForeignRelations
Committeeis briefedonRussia’s
invasion ofUkraine.TUESDAY
PresidentBidentravels to
Fort Worthtodeliver remarks
regardingveterans.TheSenateForeignRelations
Committeeholdsahearing on
Russia’sinvasionofUkraine.WEDNESDAY
Bidendelivers remarks at the
SenateDemocrats’retrea tinD.C.TheHousemeets for legislative
business.THURSDAY
Jobless claimsfor theweek
ended March5are expected at
218,000.FRIDAY
Bidendelivers remarks at the
House Democrats’retreatin
Philadelphia.0
1m
2m
3m
4m
5m
7-dayavg.
Feb. 29,2020 Jan. 2021 March 6
0
200 k
400 k
600 k
800 k
1m
1.2m
7-dayavg.
Feb. 29,2020 Jan. 2021 March 6
0
2k
4k
7-dayavg.
Feb. 29,2020 Jan. 2021 March 6
As of8p.m. Sunday
79,250,
555 ,112,
957,
44,
1,
369,3 46
Total
DEATHS
Total
VACCINE DOSESADMINISTERED
Newcoronaviruscases, deaths and
vaccinedosesin theU.S., by dayTotal
CASES
7-dayaverage
7-dayaverage
7-dayaverage
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