Back when I was young and idealistic, I worked for several years at an entity that managed mental health case and care coordination. I never provided front line service, that is not what I do, but I routinely saw reimbursement fee schedules for mental health providers. They were absysmal. A master’s level provider could expect to receive between $45 to $70 per hour for their time in an office setting and perhaps $15 more for in-home services. The higher rates tended to be from government programs. That sounds like a lot but that fee has to be able to cover wages, overhead, infrastructure, insurance and education expenses. As a comparison, when I took Kid #2 into the pediatrician last week for suspected croup, the CRNP was able to get paid $108 for a ten minute visit. She can do four or five of those visits in an hour. When I called a plumber over the summer to fix the shower, she got paid $240 for forty five minutes of service. What we pay is a decent indicator of what we as a society value. We value working showers and acute medical care far more than mental health care.
Mental health services have always been done on the cheap, and that means there is very little capacity in the system. Hospitals are more than willing to build $230 million dollar proton beam therapy centers that offer minimal marginal improvement in results for cancer treatment because cancer pays. At the same time, in-patient psych beds have been cut dramatically. Some of this is a long term trend, but a signficant amount has been due to state level budget cuts of the past five years.
Commenter CzarChasm has this to say in an e-mail to me as a front line mental health provider in Virginia concering the Deeds stabbing and suicide: