Dear Therapist: Protests and COVID

Protests and COVID
The Mixture of Protests and COVID

Dear Therapist:

Protests have been happening all week in my city, but I also know COVID is still an active virus out there. Do the two mix? I want to get involved and show my support by marching, but I also want to be aware that we are still in a pandemic and care for others by staying away. What to do?

Sincerely, A Protestor Worried About COVID

Yes, I hear you on this one. Up until Memorial Day the biggest news of the day was staying inside as to not infect others with COVID-19. There are several areas of the country that are still fairly locked down with quarantine in place except for a few things. For almost three months we have been told to social distance.

Now, the protests are on across the nation and there is a need to march together. Social distance is not what we want, but rather social togetherness to show our strength and resistance to the institutionalized racism in America. The time for distance is over in this context. People are coming together as one to protest.

What to do? It is right to realize the virus is active. People think there will be an explosion of cases where all of these protests are happening. So, if you join one my guess is you will not maintain social distance, but you can wear a mask and gloves to protect from droplets from the other and to protect them from yours as well.

If it is just too close contact for you even while wearing a mask, there are many ways to protest besides heading to the marches. Donate to causes, shop at black-owned business, read, speak out, become aware of your privilege and work to change it by becoming honest with yourself, places signs in your car or in the windows of your home.

These are just a few suggestions. This movement is wide and needs so much support in so many ways. Do not think because you are not marching due to COVID, you are not engaging in the struggle. Find ways to do so, embrace them, and add your voice and actions to the cause, while at the same time protecting the health of your community.

Many people feel safe out there or just feel their safety is a secondary concern. For you, who I hear is seeking to abide by the COVID quarantine measures, that is OK too.

It’s a long fight. Do what you can and support everyone else in how they are participating as well.

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Mental Health Crisis in America

Mental Health Crisis in America
Mental Health Crisis Brews in America

I read an interesting article the other day in the Washington Post regarding how the current COVID-19 pandemic is pushing America to the brink of a mental health crisis. I cannot even believe it has taken a severe public health crisis like this one for the media to begin to pick up on how difficult it is for Americans to find and receive quality mental health care today.

Sitting from the vantage point of a therapist, I know this to be true for many reasons. While most articles, like the one in the Post above, focus on access to mental health care, there is something else one has to first realize. Access to mental health care starts with clinicians who are in training to work in the field and serve people in need of mental health services.

It is an unfortunate truth and one not often discussed in the media that to do the work of a therapist, or, as the traditional license is called, a Licensed Mental Health Counselor, is a costly and time-consuming journey. One cannot clinically practice one-on-one therapy with individuals without holding a Master’s Degree in counseling, social work, or marriage and family work. This type of degree takes 3-5 years to complete with significant amounts of debt taken on to complete the degree, upwards and over $100,000.

Along this journey, graduate students in training are called to do an internship with a significant number of clinical hours and supervision time spent in order to earn one’s degree. Although a person may have at least 2-3 years of training experience in school, one’s internship is unpaid. People must find paid jobs as they juggle their internship demands.

This is where it strikes me that the mental health system is failing at its core. Community Mental Health Agencies that serve the poor and mentally unwell, a segment of the population that would have very little access to mental health services, are staffed with interns from graduate schools who are seeing these people for free. The core of the mental health services offered to thousands of Americans is valued at an intern level who earn nothing.

From there, graduate students leave school and are permitted their first license. Where I live it is an Associate’s license, which means you have the ability to see patients, but you must be supervised for a set amount of hours as you work toward full licensure, which is additional hours. Often Associate Mental Health Counselors use this period of time to take clinician positions in mental health agencies. Now they are no longer serving for free, but for $17 to $23 per hour. The average case load for a new Clinician is upwards to 100 clients. Then add in the math of $100,000 of student loan debt.

It is from this vantage point that I see our mental health system failing in America. From the start, when people seek to train to become a mental health clinician, no value is given to the skills that they are learning and employing to help people with their mental health needs. From weighting people down with student loan debt, to not providing any value to the intern seeing clients, and then providing a very low income to the new clinician with a caseload that no one can keep up with — not only are the clinicians burned out, but the system is overwrought with little to no support for people who need tremendous care.

What happens after one has completed her Associate’s license requirements and you are now a fully licensed therapist? Unfortunately, most clinicians leave Community Mental Health and set up their own private practice. Even if the clinician charges a reduced fee, it is often three times the amount one was earning at the mental health agencies. It is unfortunate that the very poor and mentally unwell people in America are left to be churned through by clinicians who are in some training phase of their career burning out without proper care, support, or caseload numbers.

Insurance also plays a roll in the inequity of the Mental Health system in America. Are you in network and, if you are, your patients may benefit, but the Clinician will likely make very little money for their services when all is said and done. If you are out of network, then the Clinician works with the patient to determine the fee. A patient may submit a receipt to their insurance company which may provide them with a portion of the fee they have paid. In this way, the patient has to decide what can they afford given the insurance company will only be reimbursing some of the full fee and that is often after deductibles are met.

All of this to say that when we look at the mental health crisis in America, we need to critically think about how we value our clinicians in training as well as how we value the services provided to the mentally unwell, especially those accessing care through the community mental health agencies. It begins with both parties being valued and supported in terms of money and care.

Until this happens, the system is on crumbling crutches which is going to further lead to the black hole of inadequate care, funding, and a lack of people to serve during crisis such as the one we are in currently.