Mental health professionals can't keep up with demand

Two and a half years into a pandemic that caused tens of millions of Americans to become more anxious and depressed, mental health professionals can’t keep up with an unprecedented demand for services.

Bayville psychologist Robert Motta said he is seeing twice as many clients as before COVID-19, and that his six-month waitlist is the longest of his 46-year career.

“I have people calling all the time and I wish I could help them, but I can’t help them,” Motta said. “All the practitioners I speak to are overwhelmed with cases that are in some way related to COVID.”

Mental health professionals said the psychological effects of COVID-19 will remain long into the future, and — combined with a shortage of counselors, therapists, psychiatrists and psychologists — will continue to strain the mental health system. It also sometimes was difficult to find help pre-pandemic, health professionals said.

Federal health surveys reveal the mental health toll the pandemic has taken.

Nationwide, 32.3% of Americans reported symptoms of anxiety or depression between July 27 and Aug. 8, according to the latest Household Pulse Survey from the National Center for Health Statistics and the Census Bureau. That’s nearly triple the 10.8% rate in 2019 federal surveys, although down from a peak of 42.6% in November 2020.

The rising number of Americans with anxiety, depression and other mental health conditions led more people to seek psychological help, exacerbating the pre-pandemic shortage of mental health professionals, said Vaile Wright, senior director for health care innovation for the American Psychological Association.

Nearly two-thirds of psychologists responding to an association survey this time last year said they were unable to accept new clients.

Deborah DeJean, a therapist whose office is in Valley Stream, has triple the number of clients as before COVID-19 and stopped accepting new ones last year.

“I feel really bad when I have to turn people away, but I physically can’t handle it,” she said. “You know what they say when they call? ‘Everyone’s full. I don’t know what to do.’”

The frustration of not being able to find help can worsen mental health conditions, said DeJean, who refers people to other therapists who may have openings, or to hotlines.

Motta said even though he still gets more calls for help than pre-pandemic, the number has subsided somewhat in recent months.

“I attribute that to less fear,” he said.

The percentage of Americans who said they are “very concerned” about the pandemic has fallen from a peak of 65% in April 2020 to 28% on Aug. 25-26, according to weekly Morning Consult polls.

Some — especially those who are older or have health conditions that make them more vulnerable to severe COVID-19 — remain extremely anxious, Motta said.

“A phenomenon like COVID produces within a population an elevated sense of vulnerability and threat,” Motta said. “And that’s what we’re really dealing with. This sense of security and predictability is gone. Suddenly, the environment becomes unpredictable. You don’t know when you’re going to get it and, if you get it, are you going to be impaired?”

Many worry about long-term effects of the disease, he said. Nearly 1 in 5 Americans who contracted the virus still have symptoms three or more months later, according to the Household Pulse Survey.

For those debilitated by severe long COVID, “It can incredibly demoralize them and depress them to the point where there’s an elevation of suicide [risk] for these people,” Motta said. “They feel their life is over.”

There also is the continuing grief of those who lost loved ones to the virus, some of whom don’t seek help until long after the death, said Jeff McQueen, executive director of the nonprofit Hempstead-based Mental Health Association of Nassau County.

Although the pandemic death rate has declined, an average of about 400 people a day still die of COVID-19 nationwide, according to Centers for Disease Control and Prevention data.

Tatiana McLean, a therapist in Huntington, said three of her clients blame themselves for hosting social gatherings at which someone apparently contracted the virus and later died.

“They’re not able to get over the guilt, the shame, feeling like they should have known better … having intense sadness, feeling like it was their fault,” she said.

Jeffrey Steigman, a Port Jefferson Station psychologist and chief strategy officer for the Huntington-based Family Service League, which has 10 nonprofit mental health and substance abuse clinics in Suffolk County, said the time that families spent cooped up earlier in the pandemic caused tensions to surface that still have not been resolved, in addition to leading some to develop alcohol addictions.

“We’re going to feel the effects of the pandemic for years to come,” he said.

McLean said some kids are having an especially hard time readjusting, including those with social anxiety who were thrust back into uncomfortable social situations in school after remote learning.

DeJean said some of her new clients may not have sought help if it weren’t for the convenience of the virtual sessions she began conducting from her Brooklyn home because of COVID-19. Some also prefer virtual sessions because of the perceived stigma of going to a mental health office, she said.

Steigman said the popularity of virtual sessions has allowed his organization to better distribute services. If, for example, the Riverhead clinic has no availability, the client can have a telehealth session with a therapist elsewhere, he said.

McQueen said COVID-19 isn’t the only issue causing an increase in need. There also are the nation’s sharp political divisions, along with racism and social injustice that always have existed, but have been increasingly highlighted in recent years, he said. The spotlight on issues as such increases awareness and anxiety among people of color, said McQueen, whose agency has primarily Black and Latino clients and mental health professionals.

McQueen’s organization has addressed the increased need in part by hiring more peer advocates — people with mental health conditions who are trained to help others.

Wright said peer advocates are one way to address the shortage of mental health professionals.

“We are never going to have a workforce large enough to deliver the traditional mental health care model, which is a weekly 45-minute psychotherapy session,” she said.

Other potential solutions include more group therapy and expanded mental health programs for youth, to catch problems early, she said.

The roots of the shortage date to long before COVID-19, Wright said. A 2018 analysis in the journal Psychiatric Services predicted there would be fewer than 39,000 psychiatrists by 2024, even though the need may be as high as 70,000. One reason: More than half of psychiatrists were expected to retire by then.

Some young people are deterred from pursuing careers in mental health because mental health professionals with advanced degrees don’t on average earn as much money as counterparts in other fields, Steigman said. Insurance reimbursement for mental health services typically is low, he said.

In addition, Wright said, “Burnout can be very high” because of the “emotional burden of helping individuals who have experienced trauma, grief, et cetera.”

There’s a particular shortage of Spanish-speaking psychologists and those from “historically marginalized populations,” she said.

McQueen said caseloads would have risen even more during the pandemic if there were more Black and Latino mental health professionals.

“I think that Blacks and Latinos, when they go to get help, they want to get help from other Blacks and Latinos,” he said. “They don’t feel comfortable going to a doctor to discuss their problems if their doctor is not like-minded or doesn’t understand where they come from, what their traumas and their troubles are.”