I have been coping with mental health personally and professionally for my entire life. I would have to say my biggest struggle regarding obtaining care for my own personal mental health is care being available. I run into this same roadblock when trying to help clients obtain mental health care as well.
I always ran into months-long waiting lists to see a counselor and, with no insurance most of my life, I could rarely afford the medications these could-care-less psychiatrists prescribed me.
So, for most of my adult life, I just stopped searching for therapy and other community-based programs, like peer support, as I became discouraged with the costs. This led to many years of self-destructive behavior and, while also battling a substance abuse addiction, a point of complete bottoming out.
Unfortunately, my story falls into the norm as opposed to the exception. Many Americans struggle daily with attempting to gain access to affordable and quality mental health care that is personalized to them and not standardized. The ticket to these needs lies in Medicaid funding.
Guess who just slashed said funding by $1 trillion dollars with his most recent fiscal budget? Mr. Donald Trump, of course.
Trumps Budget Spells Trouble For Mental Health
In his most recent fiscal budget, Trump decreases funding for Medicaid and the Affordable Care Act by $1 trillion dollars. When I think of Medicaid, I think of the elderly. I assume they are the only individuals that are using this insurance. I am incorrect in that thinking.
21% of adults with a mental health illness or concern are on Medicaid, compared to 14% of our general population. Not to mention, Medicaid is the highest payee of behavioral health services in the country.
In many parts of the country, Medicaid is the only provider of insurance that pays for community-based programs. These types of services include mobile crisis services, supported housing for those with a mental illness, and peer support.
The cuts made by the Trump administration to the Medicaid budget includes limiting, and in some states stopping, the expansion of Medicaid. This expansion was set to provide millions of dollars to help communities run their programs.
What Trump did do for us in the mental health community was to create financial incentives for inpatient psychiatric treatment. In 1965, these inpatient psychiatric facilities, known as IMD’s (Institution of Mental Disease), were given fewer incentives due to the horrendous conditions individuals were being kept in due to the low cost.
Trump has increased those incentives. I will allow you to formulate and hypothesize an opinion here.
Private Practice Therapy and Medicaid Coverage
I have been to many a therapist. I have experienced both private practice and community-based groups of practice. I am sure many of us have had experience with one or both.
If you have experienced both private practice and public program based therapy then you know there is a difference. Especially if you are seeking mental health care that is more personalized to a certain area of mental health, such as trauma-related care.
When I have worked with a private practice therapist in the past, I have gotten the best therapy of my life. Not because that therapist was equipped with more training or because said therapist cared more than the other. No, the defining line was cost and quantity.
A private practice therapist rarely accepts insurance, especially Medicaid. Private practice therapists are able to charge whatever amount they feel is necessary and clients generally pay these therapists directly or with their own privately paid for insurance. These types of therapists can also limit the number of clients they take on. And, when the average going rate of a single therapy session is $125–150 dollars, you do not need many clients to live comfortably.
Now, the common complaints of therapists in private practice regarding accepting Medicaid are the delays in being reimbursed and the amount of money offered for reimbursement, usually $60–80 per client with Medicaid. Funny to me how a profession built on helping others strive in their own lives have ended up putting a price on quality of life.
Now, the United States is home to 22,530 psychologists and 41,660 mental health counselors in private practice. Let's say that none of them accept Medicaid. If each of these mental health professionals decided to accept Medicaid and took on two extra clients, imagine the massive numbers of lives they could impact.
By the way, one last food for thought item: A therapist who charges $125 a session, doing two sessions a day five days a week, brings home a salary of $60,000. A session generally lasts 45 minutes. That means many private practice therapists are earning their session rate in less than an hour's time, making their hourly rate the same as a single session cost.
I can see now how a couple of sessions a month that only pay $60–80 and take a while to actually pay would be troubling for those families.
Silver Lining in a Dark Tunnel of Mental Health Care
While the Trump administration has dealt a financial blow to the mental health care field and private practice acceptance of Medicaid is far from the norm, we are not voiceless.
Medicaid is a joint federal and state-run program. This means that, while the budget is handed down on a federal level, the states have a say in who can be eligible for this type of coverage and where this funding lands in the hands of community programs.
If we can rally as a people and speak out to our elected officials we may be able to affect change in policy on a state-based level. We can help hold fundraisers for community programs so they can continue to provide services in the most impoverished of communities.
As therapy providers, we can begin to accept Medicaid insurance on a more widespread level. We can offer our services on a volunteer basis to community programs or begin accepting Medicaid and inviting in the community in this way.
All those on Medicaid, and those with no insurance at all, deserve to have access to the most affordable and most effective mental health services. Those of us with a trauma history deserve to have access to those private therapists who can work with us on alternative and holistic therapies. The mental health community deserves to finally rise from the stigma surrounding it and be able to access services based on need and not insurance.
We can be the change.
We must be the change.
Inauguration Writing Advent Day 16- Prompt Provided by Tiffany Timm
“It is hard to find personalized care for trauma-related mental illness.”