Providers predict longer wait times for mental health services. Here’s who it impacts most

Since the start of the Covid-19 pandemic, health care providers across the country have seen an increase in patients of all ages seeking mental and behavioral health treatment. To meet the growing needs of the public and to protect practitioners from burnout, psychologists are exploring strategies to address the mental health workforce shortage.

Psychologists are concerned that, if unaddressed, the shortage could have serious and lasting effects on patients throughout the country, but particularly on people of color because of the limited number of practitioners serving marginalized communities.

“During the pandemic, people gave themselves permission to seek mental health services, but many became discouraged because nobody had openings,” said APA President Thema Bryant, PhD, a psychology professor at Pepperdine University who also saw clients during the pandemic. “This has been particularly challenging for underrepresented psychologists because they hold a sense of responsibility to their communities.”

Researchers and clinicians have been exploring ways to grow the field, such as reducing the financial strain of earning a doctoral degree and encouraging diverse populations to see the benefit of working in mental health.

[Related: Increasing the visibility of providers of color]

The importance of these efforts was highlighted in APA’s 2022 Covid-19 Practitioner Impact Survey, which found that 60% of psychologists were reporting no openings for new patients, and more than 40% were carrying waiting lists of 10 or more patients. About 20% said they saw an increase in demand for treatment from populations of color and younger patients, and the expanding workload is taking a toll. Nearly half of the 2,295 respondents agreed or strongly agreed that they felt burned out.

Results from another recent APA survey suggest that the effects of the practitioner shortage could become even more acute, especially among health service psychologists who treat marginalized populations. More than 25% of those providing services to American Indian/Alaska Native or Native Hawaiian/Pacific Islander populations said they plan to decrease their workload in the next year; those serving Black, Hispanic, and Asian patients also plan to reduce their workload.

“We have been successful in reducing stigma about mental health, but our field didn’t anticipate the effects of this success,” said Morgan Sammons, PhD, former CEO of the National Register of Health Service Psychologists. “We have an obligation to create a new generation of psychologists who can meet the demand for services, especially among underserved populations.”

Training psychologists to hire and manage master’s-level clinicians is one way to increase access to services in communities, said A. Jordan Wright, PhD, a clinical associate professor of applied psychology at New York University and director of a low-fee mental health clinic at the university. “Psychologists at the doctoral level will never be able to fully meet the mental health needs of society because there simply will never be enough of them,” said Wright. “We need to start overseeing larger practices with master’s-level clinicians who we can guide and supervise, and who can offer lower-fee services.”

[Related: Here’s how psychologists are serving patients with lower incomes]

In many states, doctoral-level psychologists, for example, are the only practitioners qualified to perform psychological assessments. In a group practice setting, master’s-level clinicians could cover some of the psychotherapy work to free up time for psychologists to perform assessments.

Running a group practice could also help psychologists hire a more diverse team because master’s-level programs award degrees to a larger number of students of color, according to data from APA’s Center for Workforce Studies. In 2021, 11,871 students of color earned master’s degrees, compared with 2,218 students of color who earned doctoral degrees.

To equip psychologists to lead these practices, doctoral programs need to increase training in the business skills of running an organization, said Wright, a member of an APA joint task force working to redesign doctoral-level competencies in health service psychology. “I never learned about the finances, laws, and regulations involved in hiring other clinicians,” he said. On the job, Wright discovered the importance of differentiating between clinical supervision feedback and business-related feedback for employees. If, for example, an employee is excelling clinically but is often late to meetings, Wright suggests explaining that the timeliness issue is not related to their clinical skills. “If I am not clear about this distinction, then the business feedback can affect the supervisory relationship,” he said.

Another potential tactic for tackling the workforce shortage is an overhaul of the long, expensive doctoral education model, said Sammons. He believes graduate education could be more accessible and affordable by offering the curriculum through year-round school. “A more intensive program means students will spend less time in graduate school, which could lower the cost and allow them to enter the workforce more quickly,” Sammons said. He is eager to see educators, accreditors, and clinicians convene to reexamine traditional training models.

Seasoned professionals are also exploring other alternatives to decrease the financial burden of getting a doctorate. Julie Bindeman, PsyD, founder and codirector of Integrative Therapy of Greater Washington, recently talked to a legislator in Maryland about developing a psychology program modeled after Teach For America. This would allow students in training to get paid for services they provide in a low-income area while earning their doctoral degree. In the current system, paid hours do not count toward licensure. “Many students are acquiring hundreds of thousands of dollars of debt and are not earning anything for the services they provide,” Bindeman said. She saw the impact of the financial strain when she hired graduate student Pamela Blackwell, PsyD, to work 20 hours a week as a paid employee. Blackwell needed this job to cover living expenses during her internship, which included more than 40 hours a week at a student counseling center. “I was working more than 60 hours a week during a pandemic while writing my dissertation,” said Blackwell, who is now working full time as a psychologist at Integrative Therapy of Greater Washington. “I came out of graduate school completely burned out.”

The cost of the licensure exam, which is more than $680 per sitting, can also be a barrier for recent graduates—especially those who do not pass the first time. Studies have shown that White psychologists are significantly more likely to pass the Examination for Professional Practice in Psychology (EPPP) the first time than Black or Latinx psychologists (Sharpless, B. A., Training and Education in Professional Psychology, Vol. 15, No. 1, 2021opens in new window). “I hired several Black clinicians who were brilliant practitioners, but they had to take their licensing exams three or more times before they passed,” said Minnesota-based psychologist BraVada Garrett-Akinsanya, PhD, who owns Brakins Consulting and Psychological Services.

Frustrated by the lack of support for Black clinicians, she started applying for a federally funded state grant that would allow her to cover the cost of the exam and prep courses for Black new hires to her practice. The grant also allows her to give them 40 hours with pay to study for the exam each time it’s taken. The Cultural and Ethnic Minority Infrastructure Grant (CEMIG) also made it possible for her to offer them supervision and mentorship.

Garrett-Akinsanya, who is also the executive director of the African American Child Wellness Institute in Plymouth, Minnesota, is concerned that the addition of the EPPP-2 board exam to licensure requirements could create yet another hurdle for psychologists of color. Through the CEMIG program, Garrett-Akinsanya has been able to hire, train, supervise, and support the licensure of more than 45 Black clinicians throughout the past 10 years.

Psychologists who work in academia see another barrier to increasing the number of psychologists treating marginalized populations: a lack of educators of color. “When students of color are interviewing [for acceptance into a doctoral program], they are looking for faculty who research populations of color and who reflect the cultural backgrounds of the diverse communities they are interested in serving,” said Y. Evie Garcia, PhD, an associate professor of educational psychology and doctoral training director at Northern Arizona University. She helped spearhead efforts to hire more faculty that reflected the community’s population, which included a high percentage of Indigenous Nation residents. Now more than 50% of the professors in the educational psychology department who train doctoral students are from diverse ethnic backgrounds, including Latinx, Indigenous, and Asian American.

As the number of faculty and students of color increased, Garcia recognized that the department needed to offer more support to help them succeed in the face of systemic racial bias in higher education and in the field of psychology. In the fall, she launched a group for faculty of color who could share their experiences with one another, and the group will connect with students of color in the spring to offer support and mentoring. “This was very different from asking people of color to form a diversity committee with existing tasks and expectations,” she said. “This group is a place where people can be honest about what is hard or painful about being faculty in primarily White institutions and what might help.” Garcia said she hopes that as students and faculty connect in this setting, they will share ideas and resources with one another. She will also welcome their ideas about how to instigate changes in the department to better support people of color.

Like Garcia, Michi Fu, PhD, a professor of clinical psychology at Alliant International University who specializes in crosscultural and international mental health, feels a sense of urgency to increase the number of psychologists who can serve marginalized populations. In addition to teaching, Fu works at a community health center and in private practice. Since the beginning of the pandemic, she has seen an increase in the number of referrals for patients who are struggling with more severe issues like suicidal ideation and self-harm behaviors, but waiting lists are longer than ever. Nonprofit organizations treating the underserved lost a disproportionate number of workers to burnout, and it has been difficult to hire mental health professionals because fewer people are applying for the jobs, Fu said.

Although the shortage of health service psychologists is daunting, Fu said there are strategic ways to attract workers and decrease waiting lists in the future. She teaches introductory psychology courses at California State Polytechnic University, Pomona, a school with a high percentage of first-generation college students. In her large lecture halls, she encourages students to consider joining the mental health workforce, especially if they are bilingual. “I explain that they could be my colleague in the future, and they will be busy because the demand for services is so high,” said Fu, who also directs them to fellowships and scholarships that are available. “I tell them about the range of settings where they could work, and I invite them to be part of the solution to the mental health problems in this country.”