How to meet increased demand for 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 Physician 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. 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 4 in 10 practitioners feel burned out because of the increased pressure, according to APA’s survey. And the public is suffering as well: 30% 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:

Maximize your initial contact

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.

Use shorter, more focused interventions

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.

Form groups

"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 the APA Services "How to Do Group Therapy Using Telehealth" fact sheet. Or seek extra training from APA (see the article "Keys to Great Group Therapy" for resources) or the American Group Psychotherapy Associationopens in new window.

Take advantage of tech solutions

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 Tessopens in new window 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 appsopens in new window staff have vetted that offer additional help with depression, anxiety, insomnia, substance use, and other issues.

Advocate for yourself and the field

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 Wexner 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."

Just because pandemic-related distress is prompting more and more Americans to seek help from psychologists doesn’t mean clinicians have to work longer and longer hours. Technology can help, says Jeffrey J. Magnavita, PhD, ABPP, editor of Using Technology in Mental Health Practice (APA, 2018).

"There already weren’t enough clinicians to treat people, and COVID has made it much worse," says Magnavita, whose Connecticut practice, Glastonbury Psychological Associates, has been swamped with new patients coming in for the first time and old patients coming back for more help. "Technology is really a godsend."

And it’s not just a matter of teletherapy, whose widespread adoption Magnavita estimates has been advanced by a decade or so by COVID-19. Consider these additional ways that technology can help you to serve more patients:

Keeping would-be clients engaged. Many practices are now so busy they have waiting lists. Technology can serve as a bridge to provide support to individuals who are waiting to see you. Options range from the artificial intelligence-driven mental health "chatbot" Tessopens in new window (see main article) to apps that guide users in practicing skills like mindfulness, tracking moods, or performing other homework between your therapy sessions. For more information, see the APA Services article "The New World of Apps," the APA Division 18opens in new window (Psychologists in Public Service) article "Meeting Needs in the Moment," and the APA presentation "Using Apps in Clinical Practice." The APA Services column "Let’s Get Technical" also reviews the latest apps.

Boosting your efficiency. Making administrative and other nonclinical tasks more efficient can free up more time for seeing patients. See the APA Services "Technology in Practice" section for a roundup of resources on automating your practice and more. Technology can even help clinicians keep up to date: An online learning platform called StratPsych developed by Strategic Psychotherapeuticsopens in new window, LLC—a company Magnavita founded—distills the latest research and practice trends for busy practitioners.

Simplifying clinical decision-making. Technology can also help reduce time spent figuring out how best to help patients. One example is a web-based measurement and feedback system called FFT-Care4opens in new window—based on work by psychologists Tom Sexton, PhD, and Len Bickman, PhD—which provides information that therapists using the Functional Therapy Approach can incorporate into their treatment planning and sessions with patients.

Taking psychology beyond the office. Technology can also serve as a "psychologist extender" that lets patients practice skills—beyond the mental health apps mentioned above—even after they leave your office. Hardware like heart rate variability feedback and neurofeedback devices can help patients practice on their own. And prices for these types of devices have plummeted in recent years, says Magnavita.

Battling burnout in the COVID-19 eraopens in new window
APA and Inteleos, continuing-education webinar, 2020

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Clay, R. A., PracticeUpdate, 2020

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Clay, R. A., Monitor on Psychology, July/August 2020