Where have all the therapists gone?

January 22, 2023

In the years following the COVID-19 pandemic, the need for mental health care providers has become much more relevant in our society as people across the world began to face overwhelming amounts of loss, financial insecurity and general uncertainty in the world.

According to the Centers for Disease Control and Prevention (CDC), “Symptoms of anxiety disorder and depressive disorder increased considerably in the United States during April–June of 2020, compared with the same period in 2019.”

Their research found that about 40% of the adult population in the U.S. reported a mental or behavioral health condition since the pandemic, with more than 10% reporting seriously considering suicide within 30 days prior to their survey.

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This increase of mental health issues and awareness created a high demand for mental health providers, but it was met with an insufficient number of providers.

According to an article by the Association of American Medical Colleges, more than 150 million people already live in an area that is considered to have a shortage of mental health professionals.

“Within a few years, the country will be short between 14,280 and 31,109 psychiatrists, and psychologists, social workers and others will be overextended as well,” the article said.

The lack of providers has impacted many different communities from schools to the workplace; all have felt the effect of the shortage.

“The truth is, we don’t have enough providers,” said Dr. Jeffrey Kellogg, a clinical child psychologist and professor at SIU. “And so the whole mental health system has been under duress just to try and have enough providers in the midst of having enough hours in the day to see people.”

The justice system has felt the weight of the shortage as well. Dr. Robert “Bob” Morgan, the dean of the College of Health and Human Services at SIU and researcher of mental health and criminal risk, said psychotherapeutic interventions have been proven to be most effective in treating justice-involved individuals, but jails and prisons don’t currently have the capacity to provide those services.

“There’s more inmates than there are treatment providers,” Morgan said.

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But where have all the therapists gone?

The answer is complicated, said Dr. Abby Bilderback, the director of Counseling and Psychological Services (CAPS) and the associate director of the Student Health Services at SIU.

“First and foremost is that there were a lot of changes made to provider eligibility standards when COVID hit,” Bilderback said.

During the pandemic, some states permitted licensed providers to provide telehealth services to clients outside of their state. This opened up their licensing to a much larger audience and created an opportunity for many providers to go into private practice.

Mental health providers also faced the same stressors the rest of the country was struggling to cope with. Just as the rest of the world dealt with loss of friends, family, stability and connection, so did therapists.

The field itself can be a mentally straining one to enter, and with the addition of the anxiety and sadness caused by the pandemic, it isn’t difficult to see how it can cause one to feel motivated to leave the profession.

“Mental health providers are humans as well and, be it COVID or other life stressors, I think that some folks pivoted in terms of their profession, based on their own needs and their own stress levels and some of those things,” Bilderback said. “So, there were a lot of people leaving the field in addition to transitioning to private practice.”

The training and education for mental health providers has changed over the years as well, leading to fewer providers entering the workforce at a more consistent rate.

“I think our training cycles are slow and too small,” Kellogg said. “We’re not training enough providers, and we’re not training them fast enough.”

According to Kellogg, psychologists require around ten years of university training, and the training is becoming more extensive as new developments arise in the field.

“We have a PhD program at Southern, critical child and critical adult psychology, that used to be three years, now it’s closer to five years,” Kellogg said.

Limited faculty has contributed to delayed programs as well. The number of students a program can accept has decreased because there aren’t enough teachers to teach them.

These changes have major impacts on the individuals seeking care, including communities such as people of color and LGBT+.

“If you think about a marginalized group, there’s going to be more barriers to accessing treatment,” Bilderback said. “And so when there’s already barriers in place, an increased number of barriers in place, if you have fewer options or fewer providers, that’s just going to exacerbate some of those barriers that are in place.”

However, one good thing that came from the COVID-19 pandemic was the popularization and expansion of telehealth services. It has opened up services to a larger number of people who may not have had access to counseling and therapy in the past as well as make it more convenient and comfortable for some to seek services.

While there is still a lot of progress to make in providing mental health care to those who need it, expanding society’s understanding and access to care has come a long way from what it used to be.

“If someone’s considering looking for treatment, telehealth services, working with their medical provider could be a good option, but there’s lots of different ways to receive mental health treatment,” Bilderback said.

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