There’s a few big factors here - one is the amount that insurance will cover is extremely low - experienced psychologists won’t make more than $130 a session on most insurance, regardless of speciality or niche expertise. Medicaid is worse - the reimbursement rate is like $70-80 a session (not enough to cover CoL and expenses), AND if you want to bill Medicaid they make you jump through a huge amount of hoops and force you to take on more Medicaid clients. This makes for a situation where those most in need of therapy or counseling are only afforded providers who either work practically for charity, or only the most recent graduates with very little experience - that’s if they can find someone in their area, which is next to impossible given almost no therapist can afford to charge rates so low.
Another problem is the insistence from insurers on only the most “evidence-based” treatment modalities. Everyone taking insurance has to play a dance with them to somehow shoehorn in the use of these or else get denied payment for months. As a result diagnoses and treatment methods that get put into the system are only those approved by the insurer - resulting in a dance that leaves a ton of actually useful individual treatments from being recognized. If it doesn’t bill, it can’t be mentioned, even if it’s working. This can also lead to pretty bad outcomes for clients.
The medical model of treatment is preferred by insurance because it’s the cheapest and quickest to tamp down symptoms but rarely gets to the root cause, especially in the most traumatized populations. Take a homeless person and put them in treatment - they’re probably neurodivergent, traumatized, high ACE score. Making surface symptoms like substance use go into remission doesn’t treat the underlying cause of the substance use.
Lastly, psychologists and therapists can’t make up for the lack of integrated community, sense of belonging and social purpose, and relational support networks that are failing all across society. We are an individualistic society that downplays the value of relational ties, which is part of the reason there is such a need for individual therapy in the first place. Relational trauma, lack of community resources, lack of time to spend with others, lack of social cohesion overall all contribute to a mental health crisis that is intricately tied with the excesses and stunted values of our socioeconomic system. It is an intentional feature, not a bug that people are suffering with little to no recourse.
More money will help, more education and spreading of concepts and ideas will help, but as a society there is a massive amount of work to undertake to slow the engine that produces the social pollution that ends with mass depression, anxiety and worse. It is long overdue.
Another problem is the insistence from insurers on only the most “evidence-based” treatment modalities. Everyone taking insurance has to play a dance with them to somehow shoehorn in the use of these or else get denied payment for months. As a result diagnoses and treatment methods that get put into the system are only those approved by the insurer - resulting in a dance that leaves a ton of actually useful individual treatments from being recognized. If it doesn’t bill, it can’t be mentioned, even if it’s working. This can also lead to pretty bad outcomes for clients.
The medical model of treatment is preferred by insurance because it’s the cheapest and quickest to tamp down symptoms but rarely gets to the root cause, especially in the most traumatized populations. Take a homeless person and put them in treatment - they’re probably neurodivergent, traumatized, high ACE score. Making surface symptoms like substance use go into remission doesn’t treat the underlying cause of the substance use.
Lastly, psychologists and therapists can’t make up for the lack of integrated community, sense of belonging and social purpose, and relational support networks that are failing all across society. We are an individualistic society that downplays the value of relational ties, which is part of the reason there is such a need for individual therapy in the first place. Relational trauma, lack of community resources, lack of time to spend with others, lack of social cohesion overall all contribute to a mental health crisis that is intricately tied with the excesses and stunted values of our socioeconomic system. It is an intentional feature, not a bug that people are suffering with little to no recourse.
More money will help, more education and spreading of concepts and ideas will help, but as a society there is a massive amount of work to undertake to slow the engine that produces the social pollution that ends with mass depression, anxiety and worse. It is long overdue.