The percentage of Americans seeking mental health treatment nearly doubled between 2004 and 2022, with nearly a quarter of the population reporting having consulted a mental health professional in 2022.
There are several reasons for this increase in requests for help. The pandemic, along with other external stressors, has led to unprecedented rates of anxiety and depression across all age groups.
Yet the majority of Americans with mental health problems receive inadequate treatment, if any treatment at all.
People considering seeking help must make many decisions with little information about how to navigate the system available to them.
As a licensed clinical psychologist and director of clinical education for a clinical psychology program at the University of Montana in Missoula, I spend a lot of time thinking about how to improve people’s access to treatment. I also answer many practical questions people have about the process.
It’s a difficult landscape to navigate, especially amid a national shortage of mental health providers.
Knowing when to ask for help
Mental health problems – technically called diagnoses or disorders – are defined by feelings of distress or impairment in one or more areas of your life.
If you want to receive mental health treatment, a diagnosis is often necessary before you can receive services. You should first seek professional advice. Clinicians make diagnoses based on the Diagnostic and Statistical Manual of Mental Disorders, currently in its fifth revised edition.
Get a diagnosis
Mental health professionals include psychologists, social workers, counselors, psychiatric nurse practitioners, and psychiatrists. Many people are first referred to one of these providers through their primary care physician.
There are clear differences between these professions in terms of training and scope of practice, but all require a license. The best way to check if a practitioner’s license is valid or if they have any misconduct convictions is to search for your jurisdiction, the profession (e.g., psychiatrist), and then “license search” or “license verification” to be redirected to your state’s official licensing website.
The training of mental health professionals varies widely within this broad category. Psychiatrists, psychiatric social workers, and some psychologists (in states that allow it) are trained to prescribe medications for mental health disorders. Counselors and social workers typically have master’s degrees that focus on understanding human well-being, psychotherapy methods, and treatment delivery. Psychologists typically have doctoral degrees and have additional specialized training in psychological assessment, research, and supervision.
Which specialist is best for you may be determined by your specific needs, such as an assessment or medications, but pragmatic questions are often key factors.
Paying for therapy
If you’re among the 92.1% of Americans who are fortunate enough to have health insurance, the law entitles you to coverage for treatment that’s comparable to what you’d receive for medical or surgical procedures. However, mental health care remains difficult to access in many parts of the United States.
Exact coverage may depend on your deductible, whether the therapist is in-network, and their fees. Ethical guidelines for all of these professions require that a therapist inform you of their fees, the expected course of treatment, and your rights as a client as early as possible in the treatment process. Unfortunately, not all therapists accept Medicare or Medicaid; these plans often reimburse providers at lower rates than private insurance companies.
Often, the number of sessions covered by insurance is determined by your diagnosis. Your therapist should always be able to tell you what diagnosis you have and what documentation they have submitted to your insurance company. It’s important to know that many mental health providers are limited in the types of insurance they accept, if they do. Check with your health insurance plan to find out your exact coverage for mental health services, including more complex situations like hospitalization or long-term treatment.
Many communities have excellent school-based youth health centers and accredited community behavioral health centers for all ages. These helpful resources often provide a “one-stop shop” for health care and can sometimes provide therapeutic services on a sliding fee scale.
What to expect during a session
The exact type of therapy you will receive depends on several factors: your diagnosis, your therapist’s specialized training, your treatment goals, and your preferences.
Research indicates that certain treatments are particularly effective for specific diagnoses. Pay attention to the therapeutic specialty your therapist offers: some offer specific approaches such as cognitive behavioral therapy, psychodynamic psychotherapy, or dialectical behavior therapy.
Regardless of the type of therapy you receive, you can expect to be asked many questions about your thoughts, behaviors, and feelings. Information about your past difficulties and successes can help clarify treatment goals. Knowing when you began to feel distressed, how it affects your life, and what you would like to change are all important elements in helping your therapist formulate a treatment plan.
Some of the things you talk about in therapy are likely to be painful or difficult, and it is not uncommon for you to sometimes feel worse in therapy than you did before. This is because many people have pushed emotionally difficult aspects of their lives away before coming to therapy. Accepting these experiences by sharing them with your therapist is often beneficial.
Use of medications in addition to conventional therapy
Medication and psychotherapy are often used together. If the person prescribing your medication and your therapist are two different people, you will be asked to sign a liability waiver for each of them so that they can coordinate your treatment.
For example, you may see a psychiatrist only a few times a year, but a weekly therapy session can give your therapist more insight into how you’re responding to medication.
Some conditions may benefit particularly from a combination of therapy and medication. For example, major depression, obsessive-compulsive disorder (OCD), and panic disorder often do better with combined treatment. Sometimes the steps people need to take for therapy to be effective, such as gradually confronting situations that people with OCD fear, are more accessible to people who are also taking effective medications.
Research has long shown that having one mental health diagnosis increases the risk of having another. For example, people with attention-deficit/hyperactivity disorder (ADHD) are often also diagnosed with other disorders such as anxiety, depression, and substance use disorders. Situations where people have more than one diagnosis may also be best treated with a combination of psychotherapy and pharmacotherapy.
Finding the right person
Several research studies have shown that the quality of the therapeutic relationship based on the client’s sense of belonging is an important factor in treatment outcome.
If you feel that there is not a perfect match between what you need and what your therapist is offering, you should continue looking for a better solution.
