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Getting Real About the Therapist Shortage

woman looking at big alarm clock

For the past few years, we’ve seen billions of dollars poured into digital mental health companies, including gig therapy platforms like Talkspace and BetterHelp. And yet, despite so much investment, these companies have failed to address a fundamental issue: we don’t have enough therapists. 

Fortunately, there’s now a federal strategy to resolve the provider shortage as part of President Biden’s plan to address the nation’s mental health crisis. It’s about time an issue as complex as this one receives federal attention and strategic investment. 

Let’s break down what it means when we talk about a therapist shortage, and why we believe non-therapy alternatives must be part of the strategy to address it.

There aren’t enough therapists period

How many therapists do we currently have, and how many more do we need? These questions are frustratingly difficult to answer because we don’t have the right data.

Here’s some preliminary numbers.

In the US, there are about 106,000 clinical psychologists, 250,000 clinical social workers, 120,000 licensed counselors, and 50,000 marriage and family therapists. That’s about 530,000 therapists for a population of 330,000,000. 

Mental Health America’s Access to Care tool provides the ratio of mental health providers (including psychiatric) to residents by state. We can see that the concentration (and shortage) of providers varies dramatically across states. Among our target regions, the best ratio is in Washington, DC (190:1) and the worst is in Pennsylvania (450:1). In general, rural areas have a worse shortage of mental health providers.

Using various care models to guide their calculations, SAMHSA estimates that we are about 1.8 million therapists short of what’s needed to effectively treat serious mental illness and substance use disorders. On the other hand, using different methodology, HRSA estimates a shortage of about 238,000 therapists by 2025.

There aren’t enough therapists who accept insurance

The therapist shortage is felt even more acutely when help-seekers search for providers who accept insurance. 

For very valid reasons, like low reimbursement rates and burdensome paperwork, many therapists do not accept insurance. A survey of 1,800 therapists in California found that 42% of therapists chose not to join any insurance network. 

As a result, adult patients are 540% more likely, and children 1000% more likely, to pay out of pocket for a mental health visit compared to primary care. 

The many help-seekers who can’t afford hundreds of dollars per month in therapy fees are forced to compete with each other for the therapists who accept insurance. 

There aren’t enough therapists with the necessary training

Not all therapists are trained to work with all populations or conditions, further narrowing the available provider pool for certain help-seekers.

Graduate school programs often do not train therapists to be competent or comfortable with treating particular conditions, such as eating disorders, autism, substance use disorders, and serious mental illness

We also don’t have enough therapists who are competent in working with people of color. Only 12% of licensed psychologists and less than 20% of clinical social workers are people of color. Almost half of psychologists report feeling less than well prepared to provide services to culturally diverse patients. When it comes to providing therapy in a language other than English, few therapists are able to do so. 

So what do we do?

Clearly, the therapist shortage is a problem that can’t be fixed overnight. The solutions proposed by the Biden-Harris administration are an excellent place to start, along with improvements to insurance reimbursement rates and therapist training. 

Therapy4thePeople offers another solution: connect help-seekers to non-therapy mental health support. 

Support groups, chat services, guided self-help, and other affordable types of support in our directory provide psychoeducation, coping skills, social connections, and practical support. These resources can be especially helpful as preventative interventions for individuals with lower levels of distress who do not yet meet full criteria for a mental health condition. Non-therapy forms of support are often free, grassroots, and developed by people with lived experience. 

Our directory is the only place where help-seekers can find all of these resources, along with affordable therapy.

As mental health advocates committed to increasing access to mental healthcare, we have an ethical obligation to think outside the box. The realities of our current mental health system force us to do so. 

Thank you for supporting us in this work. 

This edition of Progress Notes was first published in our monthly newsletter. Click here to subscribe to our newsletter and get access to Progress Notes a week before it goes live on our website.

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