Washington Lawyer - November/December 2022 - 9

TOWARD WELL-BEING
A Crisis in Mental
Health Care Access
By Denise Perme
Crisis, " " tsunami, " and
" overwhelming " are the
words mental health
practitioners use to describe our
country's current need for mental
health services.
The level of demand in every state far exceeds
the availability of care. There are many counties
where, if you searched within a 100-mile radius,
you would find only one psychiatrist, one social
worker, or one counselor in these mental
health deserts.
According to the National Alliance on Mental
Illness, 21 percent of U.S. adults (52.9 million
people) suffered from mental illness that year.
That means one in five adults experienced
symptoms of anxiety, major depression, bipolar
disorder, post-traumatic stress disorder, obsessive
compulsive disorder, or other mental health
conditions. The statistics are alarming, but more
distressing is the fact that less than half of adults
with mental illness received treatment that year.
Millions of people are denied necessary care
not because they haven't sought it, but because
they have no access to it.
Finding a therapist or psychiatrist during the
last couple of years has been extremely challenging.
This is true even in densely populated
areas like Washington, D.C. Resources such as
the D.C. Bar Lawyer Assistance Program (LAP)
have referral databases to help clients find therapists,
so it is worth reaching out to LAPs or
employee assistance programs, but these resources
have noticed changes in therapists'
availability.
" My waiting list is six months long at a minimum, "
says Meg Cusack, a therapist licensed
in the District. " Therapists don't even have
to advertise - that is how bad the need is. "
Cusack took her profile off an online marketing
resource for therapists because she was getting
too many emails from people seeking help.
Seeing the demand for care but having no
ability to help people was emotionally draining.
" I was spending 30 minutes a day emailing
people back to say no because I couldn't take
them, " she says. Cusack feels strongly that
people should be able to use their health insurance
for mental health needs, but she understands
why many practitioners are not paneled
with insurance companies. " Financially, you get
a higher rate if you don't take insurance, " she
says. " There is no paperwork, and no one is
looking over your shoulder. "
It is typical for therapists and psychiatrists in
metropolitan areas to be private-pay only,
meaning they are not in-network with health
insurance companies. In areas where the cost
of living is higher, experienced mental health
providers fill their appointment books with
people who can pay without using health
insurance.
If providers do participate with insurance plans,
they are often completely booked up and have
a long waiting list. People who need to use
their insurance to pay for care are frequently
forced to seek a provider who is out of network
(OON). If a plan even allows OON treatment, it
will come at a significantly higher cost.
The pandemic and faults in our behavioral
health care system are not the sole factors
behind the shortage of mental health professionals.
Many in the health care field joined the
Great Resignation, and there are more therapists
aging out of the field than there are
young professionals joining it. Other factors
include a growing popu lation, expanding
insurance coverage, and younger generations
being more likely to seek out a therapist than
the generations before them. Ironically, by
reducing the stigma of seeking help, a longsought
goal of the mental health field, we may
be further restricting access to treatment.
Can large employers do anything to ease this
problem? Although it wouldn't address the
shortage of mental health professionals, large
employers could demand better insurance plan
options for their employees.
Cusack, who has many lawyer patients, has
noticed that the limited number of insurance
plan options commonly offered by large law
firms restricts access to mental health treatment,
especially for staff. " The powers that be
are making decisions about insurance, " she
says. " Companies can save on the cost of insurance
premiums if they offer plans with high
deductibles or copays. "
While law partners can cover those costs easily,
Cusack says that support staff often struggle
with copays or with paying for sessions until
their deductible is met. Solo practitioners and
those at small firms or nonprofits have the
same difficulty.
Mental health care, a right that should be available
to everyone, is a rare commodity these
days. Like access to justice, access to effective
mental health treatment is increasingly available
only to the financially privileged.
Denise Perme is associate director of the D.C. Bar
Lawyer Assistance Program. If you need help
finding mental health treatment, please email
lap@dcbar.org.
The D.C. Bar Lawyer Assistance Program
offers several free and confidential online
support groups designed to help Bar
members and law students find support
and connection. The Lawyer Wellness
Support Group meets Tuesdays at noon,
and the Women's Support Group meets
Wednesdays at noon. Visit dcbar.org/
LAPsupportgroups for more information.
NOVEMBER/DECEMBER 2022
* WASHINGTON LAWYER 9
http://www.dcbar.org/LAPsupportgroups http://www.dcbar.org/LAPsupportgroups
Washington Lawyer - November/December 2022

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