Is There a Problem in Finding Ongoing Therapeutic Psychiatric Care? Absolutely. But There Are Alternatives.
I have had a psychiatrist for about four years who has been an ideal match for me. Not only did he find the right cocktail of medicine that finally stabilized my bipolar condition, we became friendly and spent a lot of time talking politics. He always had insights and recommendations when I would become depressed or I was caught in a disabling loop of self-recrimination.
However, now he is retiring.
Recently, he sent out a letter with some potential mental healthcare possibilities after his retirement. Trying to replace my skilled psychiatrist led me to understand the massive shortage of psychiatrists that we are facing.
From his list, I chose the psychiatric division of a medical group affiliated with a large hospital network on the North Shore. I was told that I needed to fill out a form that the practice would consider at a weekly meeting. In addition, I could only apply to be seen if I was referred by a physician in the health system. That is because otherwise they would be overwhelmed with applicants. A psychiatrist was interested in my case, so I received an appointment. However, I was informed that it was only for prescribing meds.
I asked about therapy and was told that there was a waiting list of 550 people and when asked if I wanted to be put on the list, I responded to the administrative assistant that, quite honestly, I would die before I got to the top. She apologized and said that they only had seven psychiatrists and that they couldn't meet the demand.
The Association of American Medical Colleges (AAMC) corroborates my experience by describing shortages of psychiatrists around the country:
"Within a few years, the country will be short between 14,280 and 31,109 psychiatrists, and psychologists, social workers, and others will be overextended as well, experts say.
“We have a chronic shortage of psychiatrists, and it’s going to keep growing,” says Saul Levin, MD, CEO and medical director of the American Psychiatric Association. “People can’t get care. It affects their lives, their ability to work, to socialize, or even to get out of bed.”
Not only is there a shortage of psychiatrists -- for a number of reasons including the fact that an estimated 60% of psychiatrists are over the age of 55 and retiring -- the waiting lists for psychiatric care means that those with mental illness cannot have the opportunity to "shop around" for a psychiatrist who meets their needs. If you are lucky enough to find a psychiatrist who accepts insurance (and for seniors that means Medicare, which most psychiatrists don't accept), many individuals need to grab the appointment, whether or not the psychiatrist is someone they are entirely comfortable with.
I know, from personal experience that I needed treatment options. I had a very affable psychiatrist a few years ago who charged me $140 for a once-every-3 months 20-minute medication consultation, cash or credit card only, and no therapy. Such care did not meet my needs.
The good news is that there are alternatives to psychiatrists for talk therapy, including licensed clinical social workers (LCSW's), licensed professional counselors (LCPC's), psychiatric nurse practitioners, and psychologists (PhD or PsyD's licensed). Psychoanalysts are for long-term intensive commitment. They often do not treat more severe mental illnesses and are generally quite expensive.
With some but not all of these potential choices, you are more likely to receive talk therapy than getting an appointment with a psychiatrist who offers it. And you will have more choices to meet your needs for what you want out of therapy.
Some people with mild mental illness choose their primary care physician for meds, but not for talk therapy. But if you choose to go that route, make sure your doctor is familiar with treating mental illness and has a back-up team.
In all cases, you must be the strongest advocate for yourself and get care when you are not in a crisis to enable you to prevent a crisis.
In short, not only do those with mental health challenges need to find daily ways to diminish their illness's effects, they must navigate a system of mental health providers that is becoming increasingly short-staffed.
However, there is a good possibility that you will successfully find treatment, but do not limit yourself to seeing a psychiatrist as the only alternative.
Mark Karlin is retired, after a long career in advocating against gun violence, as a hospital executive and founder of a progressive website. He graduated from Yale University with an honors degree in English.