There’s Always Been A Shortage Of Therapists. The Pandemic Made It Worse

In April, a TikTok came across my for you page that stopped me in my tracks. In it, Jessica Macnair, LPC, a therapist based in Washington, D.C., was begging people to consider studying to become a licensed therapist. “We need more qualified clinicians in our field,” she urged viewers in her video. “We are absolutely drowning.”

She’s right. Living through an anxiety-ridden election year, a summer of civil unrest, and a devastating pandemic that’s taken the lives of millions drove an increasing number of people to seek mental health care. Nearly three-quarters of psychologists who treat anxiety disorders reported an influx in patients after March 2020; 60% of those who treat depression and about 50% of those who treat sleep disorders say the same, according to a survey from the American Psychological Association.

But those professionals simply aren’t equipped to keep up with the increased demand — and both patients and therapists are feeling the strain. “I have literally been searching for a therapist for months now, and the process has felt really disheartening,” says Angelena, 24. “I've run into everything from they don't take my insurance to they're not accepting new clients to just not even getting a response.”

Jessi Beyer, 22, began her search for a therapist six weeks ago. Since then, she’s found just eight therapists who ticked all of her boxes. “Three of them wouldn't accept my insurance and four of them weren't accepting new clients,” she tells Refinery29. “I'm still waiting to hear back from the remaining one therapist.” Their experience tracks with Macnair’s, unfortunately. “I own a group practice and I have about 40 clinicians, and all of us are booked,” she says. “We were doing well before the pandemic, but every time I take on somebody new, their caseload is full in a week. I took somebody new on Monday, and by Thursday she had a full caseload. That is a record.”

“The shortage really existed historically, it’s just coming to the forefront because the pandemic has had negative effects on mental health,” says Robert Krayn, co-founder and CEO of Talkiatry, an online platform that aims to help you find a qualified psychiatrist. “Instead of creating the problem, [the pandemic] just made it more transparent.”

Rural areas are especially affected by the lack of access to mental health care. According to the American Psychological Association, 33% of counties in the United States have no records of licensed psychologists, with the lowest concentration of licensed psychologists in Southern and Midwestern states. The mental health professionals that we do have access to in this country are alarmingly white — 86% of them, according to the APA — meaning that Black and Indigenous people, people of color, and queer people also face an even larger gap in access to quality, affirming care.

“If we can’t get people access to solid clinicians, we’re going to see problems in the workplace and in schools... it’s just going to have such a ripple effect,” Macnair says. People who can’t get the care they need may be left to cope with issues such as worsening mental health symptoms, an increased risk of substance abuse, lower quality relationships, and difficulty functioning in their day-to-day lives. In the most severe cases, Macnair says that untreated mental health struggles may end up in death. “There are plenty of people who die by suicide because they are unable to get the help they need,” she says.

The problem isn’t just affecting those who need mental health care, either — it’s also affecting the therapists, who have had to deal with an immensely stressful year themselves, while juggling an increasing caseload of people in crisis. “[Therapists] end up working much longer hours because it feels very challenging to say no because we know how difficult of a time people are having with getting an appointment,” Macnair says.

The pandemic has made it harder to access mental health care, but one positive development has been the widespread adoption of telehealth. Virtual sessions have allowed therapists to be more flexible with their hours and see more patients from a wider range of locations, who may have been too far away from them to see earlier, bringing access to areas without. “It’s opened up a whole other world of possibilities for therapy,” Macnair says. "[Telehealth] has helped me to see a client that’s 5 hours away, because anyone in Virginia can see me,” she continues. “I’ll probably never see that client in person unless they drive 5 hours to my office.”

Krayn also says technology can provide us with opportunities to help mental health professionals make better use of their time, which in turn may help them to see more patients in need. That’s why he founded Talkiatry in the first place. “Psychiatrists spend a large amount of their time on administrative duties,” he explains. “There’s been a lack of innovation in psychiatry from a technology side,” and services like Talkiatry are aiming to help providers offer a higher quality clinical care through “automation of administrative duties and tasks.”

But more than anything, we need more people to become therapists and mental health professionals and counselors and psychiatrists — urgently. Macnair doesn’t believe the increased demand for care will lessen anytime soon. “I think the effects from the pandemic will likely be unfolding for years to come,” Macnair says. “I have no reason to suspect this is only short term, unfortunately.” 

Due to the shortage of therapists, Macnair says people looking for care may have to think outside the box. She suggests widening your search to encompass your entire state (since for now, most therapists are still using telehealth services). She even suggests looking up licensed, credentialed therapists on TikTok; many professional creators offer helpful tips. Don’t hesitate to contact a crisis line if you need help, and consider looking for peer-support groups. Macnair says 12-step programs could be a good option for those with addiction. Mentalhealth.gov also has a comprehensive list of organizations that have chapters across the country, like Active Minds and Youth M.O.V.E. National. (You can find more tips for finding therapy here.)

For now, both Beyer and Angelena are going to continue to look for a therapist that’s right for them and their budget. “I probably reach out to one to two new folks every month or so, just because the process has felt so discouraging,” Angelena says. “I wish it was easier.”

“Am I overjoyed to wake up and spend time looking for one each day? Not really,” Beyer says. “Is it worth it, though? Absolutely.”