PUMPING IRONY: A Generation in Need of Therapy — Again

Like many of my peers who came of age during the early ’70s, I recall it as a time of volcanic social change and political upheaval. But I also remember that era for its emphasis on “consciousness raising” and various other exercises in personal development. Self-help books made frequent appearances on bestseller lists, and it seemed like everybody in our little parcel of the American counterculture was pursuing some form of psychological maintenance.

Back then, cost considerations — and a general lack of enthusiasm for conventional medical interventions — persuaded many of us to opt for loosely facilitated group encounters over more professional psychiatric counseling. I joined a handful of men at one point for monthly “co-counseling” sessions, for instance, which only occasionally involved a licensed practitioner.

Fifty years and one global pandemic later, boomers are once again in the market for some therapy. Some surveys estimate that COVID has triggered anxiety, depression, and other mental health afflictions in as many as one in four American seniors. And just as the high cost of professional treatment forced many of us to seek cheaper alternatives back in the day, we’ve encountered similar obstacles in recent years. Fewer than half of those struggling seniors are currently getting the help they need. But new legislation that took effect earlier this month may provide some much-needed support.

The Mental Health Access Improvement Act expands Medicare mental health coverage beyond psychologists, psychiatrists, and social workers — many of whom do not accept Medicare beneficiaries as clients — to include some 400,000 marriage and family therapists practicing around the country. As Maya Goldman reports in Axios, it’s the largest expansion of Medicare mental healthcare coverage in a generation.

“Sometimes it takes a focusing event like a disaster or crisis — which in this case was the COVID-19 pandemic — to bring significant attention to the problem of mental health workforce shortages in Medicare,” noted Sen. Debbie Stabenow (D-Mich.) during a September event celebrating the new law. Stabenow cosponsored the legislation with Sen. John Barrasso (R-Wyo.), who explained that the expansion is particularly critical for seniors living in rural areas where marriage and family counselors far outnumber psychologists and psychiatrists.

But these providers still must register for Medicare reimbursement and agree to accept about 75 percent of the rate the agency pays psychologists — provisions that may explain a tepid response to date. A recent survey of American Association for Marriage and Family Therapy (AAMFT) members found that more than 60 percent of respondents were interested in enrolling in the program, but only about 11 percent had completed the process.

“We just worry that maybe [providers and patients] aren’t getting the message that, ‘Hey, this is a new service that’s available to you’ because it’s such a busy time of year,” Amanda Darnley, the organization’s chief strategy officer, tells Goldman.

Christopher Wirth, a marriage and family therapist at the University of Wisconsin School of Medicine and Public Health, apparently got the memo. He says the Medicare enrollment process took him only 10 minutes to complete and that it will allow him to continue to care for long-term patients who have in the past discontinued treatment and sought a new provider when they became eligible for Medicare.

“One of the reasons that I want to enroll, personally, is that it helps me to provide a continuity of care for the people that I’m working with,” he explains. “For me, it’s a no-brainer.”

Results of the recent AAMFT survey seem to suggest that for other therapists, the decision is much less straightforward. And the disappointing response may render this latest Medicare expansion less useful than its proponents had hoped. I checked a roster of marriage and family therapists in my neck of the woods the other day and found the pickings to be mighty slim. None of those I managed to identify promoted Medicare coverage as part of their online profile.

Here’s hoping that changes in the months ahead, because I suspect the struggling seniors who may be waiting impatiently for practitioners to sign up aren’t quite ready to return to encounter groups, consciousness-raising exercises, and other alternative approaches we once relied upon to remedy our psychological challenges. Even co-counseling requires a willing partner.