How to meet increased demand for your services

Are you working longer hours because of the pandemic? You’re not alone.

More people are seeking help for pandemic-related distress, says Kristy Dalrymple, PhD, who directs adult psychology at the Brown University-affiliated Lifespan Physicians Group in Providence, Rhode Island. And the convenience of getting help from home via teletherapy is reducing the number of appointment no-shows, meaning there’s less slack in the system and it is more difficult to take on new patients.

“We try when we can to refer out to other private practices in the community, but it’s the same thing everywhere,” says Dalrymple. “So, we do have waiting lists.”

Almost three-quarters of licensed psychologists who treat patients for anxiety disorders report an increase in demand since the pandemic began, according to an APA survey released in November 2020. Sixty percent of those who treat patients for depression report increased demand. Other areas seeing increased need include stress-related disorders, sleeping problems, and trauma.

But there is obviously a limit to how much more practitioners can—and should—work.

More than four in 10 practitioners feel burned out because of the increased pressure, according to APA’s survey. And the public is suffering, as well: Thirty percent of practitioners surveyed said they simply weren’t able to meet the demand for treatment.

How can you help more patients without harming your own mental well-being? Try these tips:

At Texas Children’s Hospital, behavioral health providers have increased their productivity by an average of 20% but still have waiting lists. To help address increased need, the health system created a new intake protocol specifically for patients and families experiencing pandemic-related distress. All providers now have a few COVID-19 distress-related intake slots on their schedules so that people seeking help should not have to wait more than two weeks for an appointment.

“These are diagnostic intakes not necessarily to inform ongoing, evidence-based treatment but to provide families with appropriate recommendations for functioning right now, during the pandemic,” says Marni Axelrad, PhD, ABPP, the hospital’s clinical program director for pediatric and child clinical psychology. “We make plenty of recommendations for things a child or family can do to hopefully prevent the need for longer-term treatment.” Often the practical tips offered at that initial visit—whether about the importance of sleep hygiene or how to overcome isolation—are enough, says Axelrad. Depending on providers’ level of concern about a patient or family, they may check in again in a few weeks to see if the family has any difficulties implementing the recommendations or any new concerns. They also urge families to call again if needed. In some cases, they recommend evidence-based treatment, either at Texas Children’s Hospital or in the community.

To cut down the waiting list, psychologists at Lifespan are working longer—and different—hours, says Dalrymple, explaining that some now see patients outside normal business hours. They are also working differently. “For people who have been in longer-term therapy and are doing well, that might mean moving more toward maintenance—moving to once-a-month sessions,” she says. “Or it could be shortening sessions from 45 to 30 minutes.”

Lifespan—in collaboration with Care New England, the other major Rhode Island health care system affiliated with Brown—has also launched a free service that allows any health care worker in the state to take advantage of 30-minute support sessions by phone with a psychologist or other therapist. “Some just need to get support in that moment,” says Dalrymple of the service’s users, who can take advantage of the service as often as they need to.

“Group therapy is a very efficient way of delivering therapy, particularly at a time when access is such a big issue,” says Martyn Whittingham, PhD, an associate professor at the Chicago School of Professional Psychology in Washington, D.C., and creator of an approach called Focused Brief Group Therapy. “But groups also promote social connection, which is especially important at a time when loneliness, isolation, and dissatisfaction with relationships are compounding an already stressful situation.”

If you feel you need to brush up on your group therapy skills—or need guidance on such topics as how to protect the privacy of patients meeting in groups via teletherapy—check out APA Services, Inc.’s “How to do group therapy using teletherapy” fact sheet. Or seek extra training from APA (see “Keys to great group therapy” for resources) or the American Group Psychotherapy Association.

At Cleveland State University, the counseling center—which, like most campus counseling centers, was already facing ever-increasing demand even before the pandemic hit—has expanded access by pointing students to a commercially available, psychologist-designed mental health “chatbot” called Tess that students can interact with via their phones or laptops. “She responds back to you with questions to help determine what might be helpful, offers different coping strategies and tools, and sees what you’re willing to try,” says Katharine Hahn Oh, PhD, who directs the counseling center. “She’s like an interactive self-help book.”

Students can also access a website with information on coping with anxiety and depression and other resources. The center also has a list of free apps staff have vetted that offer additional help with depression, anxiety, insomnia, substance use, and other issues.

Psychologists have an ethical obligation to balance taking care of others with taking care of themselves. But approaches to self-care that don’t go beyond the individual level to include asking for help on a broad scale are misguided, argues Laura Boxley, PhD, ABPP-CN, who chairs APA’s Advisory Committee on Colleague Assistance. Instead of focusing on boosting productivity, she suggests, model good boundaries by not taking on more than you can handle and offer empathy and support to overwhelmed colleagues. If you work at a hospital or other institution, push your employer to pay overtime and hire more psychologists. If you’re a clinical supervisor, reassure supervisees that being unable to sustain increased workloads isn’t a personal failing but a reflection of all the demands the pandemic is placing on practitioners both at work and at home.

And get involved with your APA division or APA’s advocacy efforts to push for better funding for psychological services and more systemic changes, says Boxley, an assistant clinical professor of psychiatry and behavioral health at The Ohio State University Medical Center. Self-care can’t be a do-it-yourself activity, she emphasizes. “We just can’t martyr ourselves into a solution for a problem this big,” she says. “There is no yoga, there is no sleep, there is no mindfulness that will compensate for a neglected mental health system.”