Last month I wrote a blog titled 5 Tips for Picking a Therapist for Your Teen. It published 7 days ago, and three days after that, I got a text from a dear friend that went something like this:

“…Why is it so ^%$##!!!! hard to find a therapist for my teens??!! Help, please!”

Many parents who call me looking for my help express frustration and defeat about this. They’re rightly upset and resentful that they pay dearly for insurance coverage and can’t find providers. Clearly, there’s still a great deal of confusion, misinformation and missing information about this topic, and it could result in teenage mental health needs going unmet.  One thing that’s been proven time and time again, when children and adolescent mental health needs are not addressed, they can compound and worsen over time.

I’m with you; this is really, really hard. And, I might have some helpful news for you, so read on.

“Why is it so hard to find a therapist? They’re either not taking new clients or I have to pay them out of pocket.”

For families who have health insurance, the Affordable Care Act, ACA (otherwise known as ObamaCare) mandated that insurance policies increase their coverage, but the industry was overwhelmed by the need and was unprepared to responsibly pay for increased coverage, especially when it comes to behavioral health benefits. Even though the ACA went into effect in 2010 and has been in place for almost ten years (and is taking a beating from the current Administration), Americans are still feeling the effects of its growing pains. Some of the biggest stumbling blocks are that despite the increase in coverage, insurance companies didn’t necessarily choose to increase/improve their provider pool. Or account for how increased coverage should translate to a living reimbursement rate for clinicians. There’s been huge fluctuations in  how and with whom insurance companies manage the coverage and provider relations of behavioral health, which results in delayed payment for services to providers. Also, in order for insurance companies to maintain their bottom line (which sometimes seems to be much more important than patient care!), they often delay payment for no discernible reason, which makes patient care vulnerable. Nobody wants to have a balance on their account with their therapist, and no therapist wants to part ways with a client over financial issues. Yuck.

For families who have relied on the ACA’s Medicaid Expansion plan, initially that provided increased coverage. Unfortunately, it was accompanied by a huge uptick in paperwork, supervision and billing requirements, skyrocketing overhead costs that many private practices or small community mental health agencies simply couldn’t afford, so they had to stop providing for Medicaid patients. Medicaid fraud also had a hand in these increased costs, which were passed on to families.

There are many families for whom health insurance is still way out of reach, and we have not figured out how to truly make it a human right to receive affordable, quality care and pay therapists a living wage doing it.

As a result, many clinicians in both agency and private practice settings have steeply increased their client care load for roughly the same amount of income. And they are burning out.

So, what happens to therapists ?

Their options are limited. They can continue to provide care and hope they can take care of themselves and avoid burnout. Some are increasing their rates by dropping off of insurance panels and offering services on a private-pay only basis, which puts therapy financially out of reach for most American families. Many therapists stop working with insurance companies and spend unpaid hours submitting claims to their client’s insurance companies. This is a sacrifice therapists are willing to make because it works great if the insurance company pays the clinician in a timely manner AND the client has a way to provide the therapist their fee up front, but again, it’s out of reach for many families to do so, and there’s wildly variable outcomes with payment times. Therapists might decrease the time they spend with clients and take on another mental health related job to supplement their income. Or sadly, they leave the field altogether.

So, what can I do?

“Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever has.

Margaret Mead

Generation after generation of parents advocate for their children’s needs, and we will continue to do so. Here are some mental health advocacy suggestions:

  1. If you have identified a therapist you think your teen would work well with and the therapist has a long wait time for care, chances are your intuition is right and they might be worth the wait. While it is NEVER a good idea to delay care for crises, it’s possible that other caring people or places can provide enough support until you can get established with your chosen therapist. Pediatricians, coaches, outside instructors, or extended family members may be good resources while you wait. Always have a safety plan in place for risk escalation. And, make sure to ask if, once you do get in, they’ll be able to provide regular appointments.
  2. Complain to your insurance company about the above mentioned hurdles they create to accessing affordable care.
  3.  Write your local congress people, or e-sign emailed petitions advocating for mental health care you may receive.
  4. Ask your child’s teachers and school staff how they respond to behavioral care on campus. Most schools have experienced a surge in student mental health needs that result in decreased learning and social skills from kindergarten to college, and they’re having some success in creating on campus support.
  5. Some city or county agencies offer free mental health awareness or intervention trainings that can bolster your ability to respond to your friend, neighbor, church member, girl or boy scout, or athlete’s need for support. We can help each other. A little goes a long way.
  6. If you have the means, donate to your local mental health nonprofit. They will be happy to tell you how every cent you give will be used.
  7. Call and ask a therapist if they will donate some time to your school, church, athletic or civic group to educate or answer questions about mental health. We can create more free, local, and community access when we share resources.

And without a doubt, many committed and high quality therapists know how to provide effective care with consistency and integrity despite these hurdles. If you know your teen needs therapy, know that it may take some time to find them, but there are many really good and creative therapists who are available to help.

If you are wanting to know more about therapy for your teen, don’t hesitate to reach out to talk about this or anything else that’s on your mind when it comes to parenting your teenager. And, I’m parenting right alongside you.