Mental health of Americans worries many professionals

As Americans head into a third year of pandemic living, therapists around the country are finding themselves on the front lines of a mental health crisis. Social workers, psychologists and counselors from every state say they can’t keep up with an unrelenting demand for their services, and many must turn away patients — including children — who are desperate for support.

“All the therapists I know have experienced a demand for therapy that is like nothing they have experienced before,” said Tom Lachiusa, a licensed clinical social worker in Longmeadow, Mass. “Every available time slot I can offer is filled.”

The New York Times asked 1,320 mental health professionals to tell us how their patients were coping as pandemic restrictions eased.

General anxiety and depression are the most common reasons patients seek support, but family and relationship issues also dominate therapy conversations. One in four providers said suicidal thoughts were among the top reasons clients were seeking therapy.

“I regularly wished aloud for a mental health version of Dr. Fauci to give daily briefings,” said Lakeasha Sullivan, a clinical psychologist in Atlanta. “I tried to normalize the wide range of intense emotions people felt; some thought they were truly going crazy.”

The responses to our survey, sent by Psychology Today to its professional members, offer insights into what front-line mental health workers around the country are hearing from their clients. We heard from mental health providers in all 50 states, as well as Washington, D.C., and Puerto Rico.

Nine out of 10 therapists say the number of clients seeking care is on the rise, and most are experiencing a significant surge in calls for appointments, longer waiting lists and difficulty meeting patient demand.

“I live in a rural town, but I still get approximately seven to 10 inquiries a week that I have to turn away,” said Amy Wagner, a marriage and family therapist in Carrollton, Ga. “I know the other therapists in my area are also full and have been since the pandemic started.”

Respondents said the higher demand was coming from both former patients who had returned for care and from new clients seeking therapy for the first time for anxiety, financial stress, substance use, job worries and other issues that have surfaced during the upheaval of the past 18 months. Many therapists say they are counseling health care workers who have been traumatized by caring for COVID-19 patients.

Overall, 75 percent of respondents reported an increase in wait times. Nearly 1 in 3 clinicians said it could take at least three months to get an appointment or that they didn’t have room for new patients at all.

“I’ve never seen it like this before, where everybody is full, and everybody that I know has a waitlist,” said David Goldberg, a clinical psychologist in Birmingham, Ala., who has 10 people on his waiting list. “I hate it that I have to turn so many people away.”

Although the survey wasn’t sent to psychiatrists, who often work with therapists to prescribe medication, we asked clinicians if they had seen an increase in patients’ use of or requests for antidepressants or anti-anxiety prescription drugs. Six in 10 therapists said more patients were seeking medication.

Some clinicians said waiting times for psychiatrists and practitioners who can prescribe medications had also increased.

“I’ve had a client who is suicidal and experiencing depression for the first time in his life have to wait three months to see a psychiatrist for medications,” said Kristin Mathes, a licensed clinical social worker in Bend, Ore. “People don’t have that kind of time when their life is on the line.”

About 13 percent of the therapists surveyed said their practices focused primarily on children and adolescents. Their responses echoed a recent advisory from Dr. Vivek H. Murthy, the U.S. surgeon general, who warned this month the pandemic had intensified mental health issues among the young.

“I don’t have room for anyone else right now, but the calls keep coming,” said Pooja Sharma, a clinical psychologist in Berkeley, Calif. “It might be some years before we have some sense of normalcy in mental health for children.”

“A 10-year-old boy I work with came up with ‘sad panic mode’ to describe his feeling of overwhelm,” said Georgie Gray, a licensed independent social worker in Cleveland Heights, Ohio. “I now use this phrase with other kids, and it resonates.”

Nearly 75 percent of respondents said much of their time was spent helping clients with family and relationship issues. Couples are arguing more and coping with the aftereffects of lockdown isolation, financial and job stress, and having children in online school.

Nate Sawyer, a marriage and family therapist in Durham, N.C., said even though things were opening up more, the couples he sees still don’t have enough time apart. “Couples are less attracted to each other,” he said. “They don’t have time to miss and desire each other.”

Many respondents said the pandemic had also highlighted existing relationship problems that could no longer be avoided, including differences in parenting styles and communication, the division of household chores and spending habits.

“It’s pretty difficult to find a therapist who does couples work who isn’t slammed,” said Chris Davis, a marriage and family therapist in Louisville, Ky. “It feels like more couples are on the brink of separating or divorcing. They’re fighting, their communication is negative, or it seems they’re just apathetic.”

More than half of survey respondents said telemedicine had made their jobs easier, increasing access to therapy for clients and giving mental health professionals useful glimpses into a person’s home life.

“I can see what their rooms look like,” said Kayla Johnson, a psychologist in Houston. “Are they lying in bed during the session? Is it dark in the room? I’ve actually encouraged patients to sit up in bed, open curtains or pick up a bit during our sessions if that is something that they want help with.”

Patricia Garcia Mulligan, a licensed mental health counselor in Port Orchard, Wash., who helps clients explore sexual and gender identity, said telemedicine had allowed her to speak with some of those clients from hundreds of miles away. She works nine to 10 hours a day but still can’t meet the demand.

“I don’t think I’ve had fewer than 20 people on my waitlist,” she said. “It has not let up.”