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Who's Your Therapist?

By Atul Grover, MD, PhD, Executive Director, AAMC Research and Action Institute
Oct. 26, 2023
Notes & Insights from the AAMC Research and Action Institute

While I’ve heard this phrase from many of my friends and colleagues, I only recently realized, during a discussion with the Alliance for Health Policy, that we might mean different things when using that phrase. 

And while much attention has been given (appropriately so) to the shortage of psychiatrists and psychologists in the United States, most of those who are in therapy aren’t actually seeing clinicians with a doctoral degree — which makes it more important than ever to examine the clinicians who are providing care to our friends and family and to hold payers accountable for covering mental health care to patients as required under parity laws.

                                                                READ DATA SNAPSHOT 

I’m pleased to share a new data snapshot authored by my colleagues that seeks to help patients, clinicians, and policymakers better understand the answer to the question: “Who’s your therapist?” 

In addition to psychiatrists and psychologists, many other clinicians offer some level of mental health care. For instance, primary care providers report that patients often present to them first with symptoms like anxiety or depression, yet very few primary care practitioners are equipped to deliver integrated behavioral health care. Nurse practitioners (NPs) and physician associates (PAs) also treat patients with mental health disorders, but only 6.5% of NPs and 2.0% of PAs report a primary certification in psychiatry or mental health.  

In fact, as highlighted in this snapshot, when most people refer to “therapist,” they mean mental health counselors, marriage and family therapists, social workers, and others who generally do not have a doctoral degree.  

The data are striking when you consider there are fewer than 100,000 psychiatrists and psychologists in the United States but almost 1 million others who provide some type of mental health or substance use disorder care. And with the advent of numerous virtual behavioral health platforms, it is increasingly important for other clinicians — and insurers — to understand who is providing mental health care and to which patients. 

Recent rules proposed by the Biden administration would finally enforce 2008’s Mental Health Parity and Addiction Equity Act by forcing equivalency between how insurers pay for physical health care and mental health care. This would be a step forward in helping align payment policy with patients’ needs, as we described in a previous brief.  

While Americans obtain most of their mental health care from the hundreds of thousands of counselors and therapists without doctoral degrees, it remains difficult to quantify this care given the out-of-pocket and out-of-network nature of behavioral health care. 

Requiring insurers to reimburse for care provided by qualified, high-quality providers —including all qualified mental health care workers — will improve access to care and allow researchers to collect more data about what works for patients.  

With 1 in 5 adults in the United States reporting a mental illness in 2020, we, as a country, continue to struggle with growing mental health needs. We hope that this resource provides some insight into how policies might continue to expand the training capacity for psychiatrists and psychologists and find ways to more quickly train and deploy the hundreds of thousands of other professionals who provide care to our neighbors and families. 

As always, I welcome your advice and insight.