Accessing therapy changed my career trajectory. Let's increase access.

It’s #WorldMentalHealthDay and I’m reflecting that I would not be where I am in my career without high-quality therapy. Unfortunately many people–maybe even you–don’t or can’t access good therapy due to limited insurance networks, income or wealth. Many others have already made efforts at breaking down stigma in going to therapy. Thankfully, you and every professional can play a role in normalizing therapy and expanding access.

During the "stay at home" order in 2020, disparities in mental health care became obvious in my life.

My story sheds light on some issues with access to great therapy in the United States. Despite having gone to therapists in my insurance networks previously, I didn’t truly experience transformative therapy in my own life until that difficult period of at-home isolation in 2020–a time when many of us needed therapy to simply continue earning an income to survive. Speaking with friends and colleagues in the tech industry, I discovered what felt like an open secret among high income earners, hidden from me in my middle-class upbringing. It turned out that people with high incomes or wealth often paid out of pocket, with inconsistent or no reimbursement from insurance.?Meanwhile, the "essential workers" at places like hospitals, grocery stores and childcare centers in my neighborhood likely experienced higher rates of mental health challenges.

Given my middle-class background of origin, and the disparities of the pandemic around me, I was shocked and skeptical of not going to a provider in my insurance network. But as I sought out therapists with specific therapy methods to heal from trauma, I found someone outside my insurance network, paid out of pocket, and mercifully received reduced reimbursement from insurance and most of the rest paid through a Flexible Spending Account. I’m sharing this with you not as a bragging point, but to highlight how truly screwed up this is!!

As I benefit from having a tech-industry income and benefits, it strikes me as completely unjust that too many other professionals cannot access care because they can't afford it. As I recovered from my own trauma in the comfort of therapy, I felt anger at the fact that many people continued to work on the front lines of a scary and uncertain pandemic, often without the support of mental health professionals. As we know from aggregate data, women, Black and Hispanic people and low-income people fell disproportionately into this broad category of "essential workers." Their herculean efforts put in sharp relief that everyone–not just a privileged few–should have access to great therapy.

White-collar professionals have a special responsibility to advocate for increased access to therapy and mental health care.

Have you had the privilege of improving your mental health because of your white-collar professional job? Then you have a special responsibility to join in removing barriers to access.

Here are 3 action steps in solidarity with those who cannot afford and therefore access mental health care:

1. Contact elected officials to prioritize policy solutions, like increasing Medicaid reimbursements for mental health care and reimbursing therapists at similar levels to doctors.

A rising tide lifts all boats–and so is the case with access to mental health care. You can contact your elected officials and ask that they increase the rate that Medicaid pays to therapists and mental health providers. Increased Medicaid reimbursement allows people with the least resources to access good therapy. This could also draw more people into client-facing mental health professions, and it could provide much-needed services to people living with a scarcity of resources and income. Beyond increasing Medicaid coverage rates, you can ask that your elected officials mandate greater parity of insurance reimbursement to mental health professionals compared to other medical providers. If this sounds impossible, it’s not!! From the mid-1990s to the early 2010s, federal policies including the Affordable Care Act raised the profile of mental health coverage in relation to general medical care coverage in the United States.

2. Share the real truths about how you access therapy.

You can be the person who unlocks access for others by sharing your story. I was able to start seeing the therapist I really wanted to work with when friends shared that they submitted their out-of-network therapist’s bill to their insurance for partial reimbursement. I know other people who were able to access low-cost or no-cost therapy through their Employee Assistance Program. Whether it’s asking a therapist about a sliding scale for payment or some other method of access, when you share your access story in a more transparent way, others can learn more about how people actually pay for mental health care.

3. Let your company know that mental health coverage is a priority for you.

If you don’t tell them, they may never know. Share your story of the difference that therapy has made for you to further normalize the conversation around mental health at work. Informing your benefits professionals of such conversations might further help to stress the importance of quality mental health coverage, including benefits like out-of-network reimbursement. Of course, great benefits professionals leverage data of all kinds and diligently work with your health insurer to provide you the best care possible. And yet there is no substitute for sharing your story of benefiting from mental health coverage–and encouraging others to do the same.

I’d love to hear from you in the comments:

• How have you been able to afford and access great therapy? You're also welcome to share if you haven't been able to access therapy due to cost.
• What are the challenges and innovations in access to therapy outside the United States?
• What other perspectives might I have left out because of my own limited lens?