“Mental health is health” has become a common phrase as the COVID-19 pandemic’s toll on mental health becomes clear. Now more than ever, people care about mental health. The pandemic has been good for mental health care in some ways. Policies that once made it challenging to get mental health care by phone or video fell away out of necessity, as we all sheltered in place. Therapists who previously distrusted telehealth as a way to deliver care were forced to use it and learn its benefits firsthand. As a result, the pandemic dramatically increased the reach and accessibility of mental health services.
But the enthusiasm for telehealth glosses over a critical point: The mental health care system in this country is broken — if something can be broken that was never built properly in the first place. The United States has never invested in its mental health care systems the way that we have for physical health. Pitifully low reimbursement rates and chronic, systemic underfunding have led to a largely fractured, overworked, poorly trained and poorly paid workforce, leading to a significant shortage of mental health care providers. There are not enough providers at any level of training. Many mental health facilities are rundown and overcrowded, with long waitlists and poor access to care.
While those in need of mental health treatment may be some of the most vulnerable individuals in society, the clinicians who care for them are rarely compensated for crucial and common parts of their work — engaging individuals in the treatment process or supporting them in accessing needed services. Reimbursement rates are so low that a therapist with a master’s degree working full time in the public system might make as little as $35,000 a year and a psychologist with a doctorate degree may earn as little as $65,000. Many clinicians must work overtime to address the needs of their patients and earn a meager salary far below their worth.
Unsurprisingly, they burn out. As a result, half of the most highly trained professionals in the field do not accept insurance and charge rates that are substantially above what they would receive through insurance. In addition, there is little systematic oversight over the types of training and therapies that these clinicians provide, no compensation to learn the complicated treatment strategies needed to address complex needs, and little monitoring to ensure that individuals receive the treatments that are consistent with scientific evidence.
Half of all Americans will meet criteria for a mental disorder in their lifetimes. To meet their needs requires fundamental and radical change to our mental health system. First, we must ride the tide of public opinion toward transforming our mental health care system. Despite a federal law that requires insurance companies to cover mental health services comparably to how they cover services for physical health, access and reimbursements remain abysmally poor. We must require insurance companies to cover services for licensed mental health providers and enforce penalties for violating parity laws.
Second, we must make permanent the emergency provisions that allow for telehealth to be reimbursed comparably to traditional face-to-face therapy by major insurance companies into permanent policy. Continued policy and financial support for telehealth and other digital tools that facilitate access to care are critical for ensuring that we continue to reach those who traditionally couldn’t access treatment otherwise. And, most critically, we need to advocate for a better and more equitable mental health system by working with policymakers and insurers to raise reimbursement rates and funding for treatment so that we attract clinicians to the field and make it financially viable for them to take insurance.
We concurrently must invest in training and supporting mental health professionals to deliver quality care, hold them accountable for providing this care, and incentivize them to work in the public sector. This will require dedicated resources for the clinical supervision and quality assurance procedures that we know can help clinicians provide higher quality services.
There is no secret, mystical answer to the question of how to solve our looming mental health crisis — the answer is to pay for the support we know is needed. With rising awareness about the importance of mental health, new technologies that dramatically increase access, and the fact that, yes, mental health is health, it’s past time to radically improve the system and start by paying for it.
David Mandell, ScD, is a senior fellow at the Leonard Davis Institute of Health Economics, the Kenneth E. Appel Professor of Psychiatry and director of the Center for Mental Health at the University of Pennsylvania.
The Leonard Davis Institute and Penn Center for Mental Health are hosting a virtual conference today on ways to deliver better mental health care.