The pandemic is exacerbating a shortage of child therapists

As the pandemic drags on, children and teenagers endure an unprecedented realignment of daily life.

Isolated in apartments and houses, kids contend with unending pressures—lost contact with friends and normal school life, grown-ups' ubiquity and unwanted attentions, as well as the fear that their futures may be compromised by an invisible, deadly menace.

To help, concerned parents seek child and adolescent psychiatrists and psychologists, along with other counselors. But there aren't enough such professionals to begin with in America, some experts say. And many of those who are working are being inundated by young patients in need.

"Even before the pandemic, there was significant lack of access to child mental health care," said Alex Strauss, a Marlton psychiatrist who treats children, adolescents, and adults. He's also a sports psychiatrist for athletes at Temple University. Lately, Strauss said, he's received a 20% increase in calls from people asking for his help with "pandemic-related difficulties." He added, "With need growing, it can be almost impossible to see someone now. There's a severe national shortage of therapists."

Gail Karafin, a Doylestown psychologist in independent practice, as well as a certified school psychologist in a Bucks County school she chose not to name, agreed. "I shudder when I have to make a psychiatric referral for a child, because it could be a long wait," she said. "It's a case of supply and demand, made more difficult by the pandemic."

Beyond that, many psychiatrists, who are medical doctors able to prescribe drugs, don't take insurance, limiting therapeutic access for many families.

The mother of an eighth-grade boy living on the Main Line said she felt lucky to find a child psychologist after a month of looking. Her name, like those of other parents in this article, was withheld so she could speak openly about private family matters.

"I've gone through a high-conflict divorce," the woman said. "And with COVID stress, I was trying to find someone to offer my son support, but it's been difficult. A lot said they weren't taking new patients.

"It's like the help is there at arm's length, but you can't have it. When I think about families in more crisis than mine, that's a frightening thought."

Throughout America, there are an estimated 15 million children and adolescents in need of therapy from mental health professionals, according to Jeffrey Geller, president of the American Psychiatric Association.

Yet, he added, there are just 8,000 to 9,000 psychiatrists treating children and teenagers in the United States.

"We need 30,000, not 8,000," noted Jodi Brown, a child and adolescent psychiatrist in Bryn Mawr. "Even kids who haven't had psychiatric conditions are needing help to get through this."

There are an estimated 38,000 to 40,000 school psychologists across the country, said Katherine Cowan, spokeswoman for the National Association of School Psychologists. Ideally, the child-to-practitioner ratio should be 500 students for every school psychologist, Cowan said. But the current configuration is 1,400 to one. And professionals' access to children is obviously complicated by school closures.

Among psychologists, just 4,000 out of a total of 102,000 nationwide (around 4%), are clinical child and adolescent practitioners, according to data provided by the American Psychological Association.

"Parents are getting desperate to get their kids the help they need as the pandemic exacerbates the situation," Cowan said. "Everybody is wearing thin."

Unable to find or afford behavioral-health solutions, many parents are rushing their kids to hospital emergency rooms.

Between March and October 2020, the number of visits to emergency rooms nationwide by children younger than 18 for mental health reasons increased by 44% over the same period in 2019, according to the Centers for Disease Control. The number of mental health visits for adolescents ages 12 to 17 was 31% higher; for children ages 5 to 11, it was up 24%, CDC figures show.

The ER trips are indication of parental desperation, say behavioral-health professionals.

"The country is traumatized and the ones being hurt most are children, whose neurological development is being affected after 10 months and counting of house arrest, " said Lise Van Susteren, a Washington, D.C., psychiatrist. "It's a very grave public health problem."

The difficulties families face are very much on display in the Fishtown home of the parents of an 11-year-old boy diagnosed with attention deficit hyperactivity disorder (ADHD).

"For him, his problem wasn't just getting used to going to school at home," the boy's father said. "It was putting our house in turmoil."

It took six weeks to find a suitable psychologist covered by the parents' insurance, he said.

But, because the pandemic loaded the practitioner with so many patients, she was overwhelmed, the boy's mother said. After the boy's initial virtual appointment, the psychologist couldn't see him again for two months, the boy's father said: "It was scary, a nightmare."

Eventually, the boy was able to get more regular sessions, but then he needed the specialized help of a New York psychiatrist once a month. The doctor is an out-of-network provider who charges $425 an hour. "The expense is enormous," the boy's mother said.

Many psychiatrists don't accept patient insurance plans because the reimbursements aren't enough, and the paperwork is prodigious, said Russell Holstein, a psychologist in Long Branch, Monmouth County, N.J. Quite a few psychologists don't take insurance plans, either, other experts said.

That makes their services financially out of reach for many parents looking for help for their kids.

A 2019 article in Psychology Today laid out the problem faced by both practitioners and patients:

"As psychologists who are trying to provide a decent life for their families switch from accepting insurance to accepting only self-pay clients, it leaves even fewer psychologists available to provide therapy to those who cannot afford $200/week (or close to $10,000 per year), for their therapy."

Some patient advocates complain that insurance plans don't offer enough choices for mental health services to begin with, worsening the problem of therapist availability.

On top of that, said Shana Schwartz, a licensed clinical social worker in Ardmore, quite a few practitioners are parents themselves and are precluded from taking on new cases because they need to spend time with their own children who are out of school and unsupervised.

Often, to give parents options, medical professionals suggest moms and dads speak with their kids' pediatricians.

"Because of our training to treat children and teens, many of us are comfortable diagnosing and treating anxiety and depression in kids," said Joannie Yeh, a Media pediatrician. "It can help. Because, I know: Those psychiatrist waiting lists are long."

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