Higher reimbursements will help our mental health crisis in WA

We are in the midst of a mental health crisis. According to a recent report by Millman, last year only 27.7% of the psychiatric need was met across the United States. While affordability was a factor, access to care was the No. 1 reason for the disparity. More than half of Americans live in areas with a significant shortage of mental health care access, and another 40% live in counties with a partial shortage.

While Washingtonians have a positive view of the value of mental health care, our state ranks among the lowest in the nation in serving people with mental health issues. Nearly a quarter of Washington residents will battle a mental health or addiction problem at some point in their lives, yet there is a significant gap in providing care to those individuals.

An assessment by the state of Washington reports that there is only one mental health provider for every 360 people (in the state). In some counties, however, that ratio is as high as one provider for every 3,378 people.

The problem of access is two-pronged. The long-term issue is that there are not enough people going into the field of mental health care to meet the need. The short-term issue is that of the ones who are in the field, many do not accept insurance, limiting affordable access for the average consumer.

The scope of these issues is complex, but both can be boiled down to one critical point: Mental health care professionals are chronically undercompensated in our health care system. If we want to significantly improve access to mental health care, then we must pay therapists what they are worth.

The issue of under-compensation becomes clear when you look at the financial reimbursement rates from insurance companies. The average reimbursement for a one-hour therapy session in Washington is about $121, according to the Washington State Healthcare Authority.

This is only for the session itself, however. Clinicians are not compensated for their time documenting the session for the client’s medical record, coordinating care with other clinicians, developing individual treatment plans or preparing for each client’s individual session. To put this into perspective, in medical care, a practitioner can bill multiple codes for one single session. Additionally, clinicians report challenges with even getting paid and log multiple hours calling insurance companies to dispute denied claims and collect on back balances.

The average $121/hour reimbursement must sustain a clinician’s entire business, whether at an agency or private practice, and leave enough for them to take home. This is increasingly problematic when considering the education level required to deliver mental health care. At minimum, a master’s degree is required, and a Ph.D. in clinical psychology is notoriously among the lowest-paid doctoral degrees.

For these reasons, many private practitioners choose not to accept insurance. They are better compensated by collecting payment directly from clients and can spend their time focused on delivering quality care rather than grappling with insurance billing. 

Add to all this the reality that therapy and other forms of mental health care are incredibly taxing services to deliver. They are emotionally demanding, requiring the clinician to stay active and attentive for the entire hour, while helping clients work through difficult and painful issues. Most clinicians cannot sustain eight straight hours of therapy a day and deliver quality care.

To make an immediate impact on the state’s mental health crisis, we must start valuing the role of clinicians. Raising reimbursement rates is the fastest way to do this at scale, while increasing affordable access. If we don’t, we will continue to see burnout in the industry and a lack of providers. 

Let’s raise the rates and pay therapists what they are worth.