In search of a (good) therapist: Insurance, fit, and stigma

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“Unfortunately, there's still stigma around accessing mental health care and insurance companies know it,” says Wesley Boyd. “And there's never been a massive public outcry for justice.” Photo by Shutterstock.

When it comes to talking about the challenges of dealing with mental health, very little attention is paid to the process of actually accessing mental healthcare when you need it. The assumption is often that if you have good health insurance, it’ll be easy — but that turns out to be wrong.   

The system is difficult to navigate, with lists of practitioners are frequently out of area and out of date. 

“[Practitioner] lists overwhelmingly are filled with wrong numbers,” says Wesley Boyd, professor of psychiatry and medical ethics at Baylor College of Medicine and a lecturer on global health and social medicine at Harvard Medical School, who writes about issues of social justice, human rights, and access.  

“They're filled with practices that are full and they're even practices that don't even accept the insurance. So if the lists don't work, for people like you and me and everyone [else] … they work quite well actually for the insurance companies when it comes to turning a profit,” he says. 

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Boyd explains that a shortage of providers and an increase in demand in the aftermath of COVID, combined with an onerous amount of reembursement paperwork, have also meant that many mental health practitioners no longer take insurance because they can keep practices full with patients paying upwards of $150 per a session. 

Boyd says that which treatments will be covered by insurance and the importance of finding the right match are essential. 

“Some of the studies that say the most important and beneficial factor for therapy is the quality of the relationship between the patient and the therapist, and I agree with that,” he says.  

“When it comes specifically to accessing mental health care, people with means have a substantial advantage over those that don't. And it's absolutely heartbreaking,” says psychiatrist and medical ethicist Wesley Boyd. Photo courtesy of Wesley Boyd.

Jonathan Bastian talks with Boyd about why many suffer in silence, struggle to find help, and are ashamed to speak up. Of all the challenges, Boyd says, stigma is the biggest obstacle in accessing mental treatment. Despite laws to ensure parity, mental health and physical health are scrutinized differently by insurance companies. 

“There's still so much stigma that I'm not quite sure what we need to do to overcome it,” he says.  “But we certainly need to do it. I think seeing a lot of celebrities come out and talk about their own mental health struggles is a great start. I think having conversations like this is another way to go.” 

Boyd draws on recent research and studies into the disparity in mental health treatment by the insurance companies and shares his own experience trying to assist others in navigating the system. 

“There is no easy avenue,” he says. “I've assisted friends, I've assisted family members, and it is not easy, to put it mildly — and I'm very well connected in the mental health community.”

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  • Wesley Boyd - Professor of psychiatry and medical ethics, Baylor College of Medicine; Lecturer on global health and social medicine, Harvard Medical School. - @JWesleyBoydMD


Andrea Brody