Addressing the needs of mental healthcare providers: time, money, and emotional support
Until recently, the idea of therapists needing therapy had never crossed my mind, despite its inherent logic. Like many who have sought therapy, I found myself absorbed in my own personal struggles and tangled emotions, hardly considering the needs of the person sitting across from me — my therapist.
In her book, Maybe You Should Talk to Someone, Lori Gottlieb shares her personal journey as a therapist seeking therapy. Despite having the skills to assist others, she only managed to access the deep level of self-awareness necessary for healing by undergoing therapy herself. As she explains, effective therapists will “see patients as they really are, noticing their vulnerabilities and entrenched patterns and struggles”, a skill her therapist certainly possessed.
In the fall of 2022, while pursuing my MBA at the Stanford Graduate School of Business, my teammates, Aman Chaudhary and Sean Wheelock, and I explored the question of “what do mental healthcare practitioners need,” which is of considerable importance.
A shortage of providers
We are currently facing a considerable shortage of mental healthcare providers (e.g., therapists, psychologists, psychiatrists, nurse practitioners, etc.). In 2021, in Massachusetts, a study by the Association for Behavioral Healthcare revealed that, for every 10 mental healthcare providers entering the field, a staggering 13 are leaving.
The problem goes beyond the state of Massachusetts and more studies shed light on this alarming trend. According to a study completed by the American Psychological Association in 2022, 60% of psychologists had no current openings for new patients. Similarly, the Commonwealth Fund estimated that at least 8,000 more providers are needed to ensure an adequate supply.
Regardless of which statistics we look at, the reality remains — a supply-demand imbalance that leads to patients being untreated or waiting months before they can finally access the care needed. According to Mental Health America, in 2022, over half of adults with a mental illness did not receive treatment. In addition to the impact on patient care, the imbalance puts an immense pressure on providers already grappling with burnout, exacerbating the challenges of providing mental healthcare.
Returning to our question — “what do mental healthcare practitioners need” — , we can now see its significance. By addressing the needs of this critical group, we can better support and retain current providers as well as motivate the new generation to embark on a career in mental healthcare.
My teammates and I conducted more than 30 interviews with mental healthcare practitioners over the span of a quarter at the Stanford Graduate School of Business to find an answer to that question. Through these interviews, we discovered three fundamental needs: time, money, and emotional support.
Before we dive into each of them, let’s first meet Barbara.
Meet Burnt-Out Barbara
Burnt-Out Barbara is a fictional character inspired by conversations with mental health workers. We created her to better empathize with the challenging reality that many providers grapple with.
Here’s a day in the life of Barbara:
- 8am: Barbara comes in early to accommodate patients who want to be seen before work.
- 10am: Her 10am patient doesn’t show up, so she tries calling, but he doesn’t pick up. She is worried because he’s expressed suicidal thoughts. She uses the time to catch up on notes, which she is a couple days behind on.
- 12pm: She sees several more patients, one of which is late so she cuts her lunch short to give him his full hour.
- 3pm: In the afternoon, she tries to ask her supervisor about her suicidal patient, but the supervisor does not have time to talk.
- 8pm: Later in the evening, once home and after her kids are in bed, she does a tele-therapy session through her side private practice to make ends meet.
Barbara is not alone in having to grapple with many competing priorities. Like many others, she is seeking more time, money, and emotional support.
1. Time
“Days are long : it never stops” expresses the sentiment shared by a large majority of mental healthcare providers.
Mental health workers find themselves burdened with a multitude of administrative tasks, ranging from scheduling and note-taking to billing, managing no-shows and cancellations, and handling intake forms for new patients. In addition to these responsibilities, they often devote time to research, teaching, consulting peers on a challenging case, marketing their services to attract new patients, or offering pro bono services. The significant portion of their workdays that these tasks consume leaves providers with less time to spend on patient care or personal matters.
Consider the therapists’ session notes. They serve as useful reminders to therapists and assist them in delivering personalized and continuous care. Moreover, they can be used to process insurance claims and may be required in legal proceedings if the patient poses a risk to themselves or others.
Providers do not dispute the importance of notes — they only wish they would take less time to complete. “I spend at least half of my time documenting”, said one interviewee. Technological companies like SimplePractice, Therapy Notes, and Mentalyc offer promising solutions to address this issue. Yet, our interviews suggest that more can be done in truly eliminating the burden of administrative tasks.
2. Money
During our interviews, I was initially surprised to hear many mental healthcare providers complain about their income. Indeed, according to the Bureau of Labor Statistics, in 2021, the average psychiatrist and psychologist made $250,000 and $100,000 respectively, considerably above the average salary in the US of $58,260.
What I learned, and what the data doesn’t reveal, is the disparity that exists between providers who hold identical titles. Specifically, psychiatrists and psychologists working in private practices, as self-employed professionals, can make two to four times more than a similar provider working in a community clinic, hospital, or school system. The discrepancy is partially the result of low reimbursement rates from insurance companies. Consequently, many providers in private practices decide to stay out-of-network, forgoing insurance acceptance to maximize their income.
Moreover, more than the absolute number, our interviews indicate that it’s the relative number that matters. When comparing physicians’ salaries, psychiatrists are at the bottom of the scale, leaving many feeling undervalued. This ranking is also illustrative of the healthcare system’s inability to properly capture the value of mental healthcare, as highlighted by one of our interviewees: “This goes back to 1960; the outcomes of surgery are more easily measured than mental health care.”
3. Emotional Support
If you’ve ever had someone reveal their deepest, often darkest, life events and feelings to you, then you understand how emotionally exhausting the experience is. Mental healthcare practitioners can have upwards of 20 sessions per week, and more sessions are trying to be squeezed in an already packed schedule.
Providers find fulfillment in their ability to help others. However, being mission-driven doesn’t shield them from the challenges of their job and the level of exhaustion amongst providers is high. According to the American Psychiatric Association and the American Psychological Association, a staggering 78% of psychiatrists in 2020 and 45% of psychologists in 2021 reported feelings of burnout.
Beyond the hours, what takes a toll on the providers’ mental health is the internalized trauma that many struggle to live with and the isolation that comes with an increasingly virtual care delivery model. “The trauma from my patients builds up inside me, and I don’t have any outlet” and “I’ve been doing this for 7 years now, and I just don’t think I can do it anymore” are examples of sentiments shared by our interviewees.
My teammates and I explored solutions to help providers cope with burnout and internalized trauma. During this process, we encountered a surprising issue. The mental healthcare practitioners that we interviewed hated the idea of “emotional support”. They were hesitant to ask for support, fearing judgment from their peers, and were skeptical to begin with about the effectiveness of an emotional support solution. Witnessing this stigma towards peer support from those very individuals who provide mental healthcare was truly unexpected.
We had anecdotal evidence from our interviews that therapists who formed support networks were notably more adept at navigating daily challenges. With this insight in mind, we retained the solution intact and experimented with a distinct value proposition — professional networking solution for vetted providers — which was more positively received. Ultimately, our belief remained constant regardless of the way we labeled it: offering providers a way to connect and bond over shared experiences would help increase retention of providers.
Moving forward
During the pandemic, reduced stigma about mental health coupled with higher rates of anxiety and depression led to a surge in demand for mental health support. Mental healthcare providers deserve our support and patient care shouldn’t come at the cost of the providers’ well-being. Although my teammates and I did not pursue the project further, I hope that others continue where we left off. The need for supporting our providers has never been more vital.
