Why the Mental Health Referral Process Is So Cumbersome (and What to Do About It)

Why the Mental Health Referral Process Is So Cumbersome

(and What to Do About It)

by Joyce Chu, Ph.D., Clinical Psychologist

From the moment I became a therapist, it seemed that whenever anyone in my life had issues that rose to the level of needing therapy, they would contact me to help them find a therapist. Each time I got that message, I got a little feeling of panic—someone was counting on me to help them find an important helper in their life. Oftentimes, I had no idea where to start looking, as my network didn’t always extend to that specific area or issue. I ended up desperately reaching out to my own colleagues in search of someone who might know just the right person to refer. 

I have also been on the receiving end of those frantic messages—several per week!—from other professionals, looking for good referrals from colleagues they trust. In this day and age, I am struck by how inefficient a system this is.

I started to wonder how a person ends up finding their treasured therapist. I asked around and was surprised to hear that most people had found their therapist through friends—or friends of friends. Sometimes, they even had to call and meet with ten therapists before finding one that felt right.

During a person’s most stressful time, having to go through such a nerve-racking process feels like adding insult to injury. For therapists who are trying to make referrals, it’s also stressful—and time-consuming.


The process of finding a therapist hasn’t changed much over time and is pretty antiquated—you expend a lot of manual effort, or play a game of telephone with people you know, just to get one name.

I decided to talk with my therapist friends to see how things were on their end. It turns out their methods weren’t all that much better.

Therapists were spending considerable amounts of time (either their own, or their office managers’) returning voicemails and fielding inquiries—referring people to other providers when they were either full or not a good fit. Many therapists felt it was their ethical duty to connect every patient with services, trying to find the right resource for them. Not only was that taking a lot of energy and time, but it took away from the ability to see additional patients.

These days, we can find pretty much everything else through more efficient, trusted networks online. We use Nextdoor—a community of neighbors—to find a plumber, a dog walker, or an electrician. We use Yelp—a community of public reviews—to find a place to eat dinner, a museum to visit, or even an optometrist.

But finding a therapist is uniquely different from any of those other things. For most people, it’s a much more private matter than looking for a plumber or an electrician. The match also needs to be more personalized than for an optometrist or a restaurant. The connection with a therapist needs to be a trusted connection, and oftentimes a very personalized and private connection. It seems these are some of the reasons why the process of finding a therapist has remained something to ask of friends, or friends of friends.


I began to realize that these pain points around finding a therapist and providing referrals needed help from modern technology. If we can streamline the process of finding almost every other product or service we need, why not also mental health services?


TherapyRoots logo

Hence the birth of TherapyRoots—an online platform for mental health professionals. We hope to alleviate the immediate pain point of making referrals, and we believe TherapyRoots can serve a longer-term purpose of providing a helpful, welcoming community for therapists.

We envision a mental health-focused community centered around making trusted and personalized referrals. A place where my therapist friends can build their practices by easily receiving referrals from their friends, or friends of friends. A place where therapists (or even school counselors or medical doctors) can spend less time returning voicemails and finding resources for patients—and easily just click a few buttons to find trusted referrals. 

Join us in building TherapyRoots into a modern solution that makes finding and receiving mental health referrals easier and more accessible.

Telehealth Resources for Therapists during Covid-19

A few useful COVID-19 resources for mental health providers, including:

  • information related to running your telehealth practice
  • resources that you can give patients,
  • and information about relevant rules and regulations

For clients:

  • The National Alliance on Mental Illness (NAMI) published a guide that may be helpful for some of your clients during COVID-19

About running a telehealth practice: 

State-by-state legal guidelines regarding telehealth for therapists:

Solidarity and Affirmation that Black Lives Matter

Resources for Therapists and Their Clients on Racism and Radical Healing

These past several weeks have been devastating as we have witnessed the brutal and unnecessary murders of George Floyd, Breonna Taylor, and Ahmaud Arbery. We stand in solidarity against the racism and violence that has been perpetrated against Black people in our country for centuries. To add further injustice, the COVID-19 pandemic disproportionately afflicts Black communities. We unequivocally affirm that Black Lives Matter.


One of the main reasons we built TherapyRoots was to make mental health services more accessible, especially to those who need them the most. In this time, we’ve chosen to support these organizations which focus on breaking mental health stigma, specifically in the Black community, and delivering mental health services to Black communities:

Therapists’ roles in conversations about race and radical healing from racial and ethnic trauma are more salient and pertinent than ever. Yet these roles and conversations are daunting in isolation. With this in mind, we highlight several relevant resources for both therapists and their clients:

Resources for Clinicians:

Resources for Clients:

We as a society and as individuals have a long way to go to eradicate racism and the continuing effects of white supremacy, and we pledge to continue to do our part to fight and stand up for equal rights for Black Americans. 

We welcome any additional suggested resources. Just comment here or email us and we’ll update.

In solidarity,

TherapyRoots

Suicide Management During COVID-19 and Social Distancing

Suicide Management During COVID-19 and Social Distancing

Tips and Guidelines for Mental Health Providers

by Joyce Chu, Ph.D., Clinical Psychologist

Managing a suicidal crisis for clients during the COVID-19 pandemic can be daunting for mental health providers. Stressors for our clients may be heightened across the board, increasing everyone’s baseline level of risk; yet, with social distancing guidelines, it can feel like we are restricted in our options to support clients. In this blog article, I’ll discuss aspects of suicide management that remain the same and those that need modification during these trying times — tips and guidelines for mental health providers.

The Key Takeaways:

  • Screen more widely and more often
  • Reassess your clients’ suicide risk levels given new or exacerbated risk factors, or a decrease in protective factors
  • Create new safety plans or update existing safety plans for social distancing considerations
  • Renew your understanding of clients’ “suicide stories” or suicide-specific case conceptualizations
  • Connect with clients’ key supports (and set up Release of Information forms)
  • Re-evaluate access to lethal means for clients at high risk.

First, Screening and Assessment. The good news is that the bread-and-butter tool of a therapist –the clinical interview –is something that is largely preserved while doing telehealth. You can ask about suicidal thoughts, intent, plan, means, attempts, and other behaviors on phone or video just as you would in person. Remember to ask about suicide directly, while also considering interview techniques that help clients to feel more comfortable talking about sensitive or stigmatized topics (e.g., the CASE approach, pp. 29-56).

ModificationsScreening and Assessment. Many of the tools that you give by paper-and-pencil can be asked verbally by clinical interview as well. A short Columbia Suicide Severity Rating Scale is a helpful and well-validated option.

Screen more widely, and more often. During the COVID-19 pandemic, more of your clients may be at risk, and your clients who are typically at elevated risk may be triggered more often. Don’t be shy to increase your screening efforts.


Determination of risk level. Our clinical models and approaches for determining suicide risk level still apply during the COVID-19 pandemic. For example, social distancing doesn’t change the fact that we consider the balance of certain risk factors and protective factors/reasons for living to inform our determination of risk level. Nor does it change our consideration of suicidal ideation and behaviors for determination of risk.

Modifications – Determination of risk level. However, it is important to realize that COVID-19 and social distancing may:

  • Trigger certain risk factors — loss of income, social isolation, feeling of hopelessness, and discrimination, are just a few examples of risk factors that may be triggered during this pandemic.
  • Exacerbate other existing risk conditions — existing mental health concerns such as depression, psychosis, obsessions or compulsions, bipolar symptoms, and others may be harder to manage amidst the increased stress of the COVID-19 pandemic.
  • Neutralize or even take away certain protective factors — other protective factors or coping strategies – like meeting up with friends in person, going to the movie theatre, or deriving meaning from one’s job – may be gone, or no longer viable.

Reassess suicide risk level. With these potential changes in risk and protective factors, it is a good time to revisit your assessment of your clients’ risk levels to understand how they are doing during these stressful times.


Keeping our clients safe / safety planning.

Basic principles of safety planning still hold during the COVID-19 pandemic. The six main parts of a safety plan (warning signs, coping strategies, people and social settings that distract, people to ask for help, professions to contact during crisis, and ways to make the environment safe) still apply. Stanley and Brown (2012) or the Suicide Prevention Resource Center’s guidelines are good references.

Going through the act of creating a safety plan together, having clients generate their own ideas and discussing their reasons for living, having your client actually write it down, and discussing how they would actually use the safety plan in a time of crisis – are all things that we can still do to effectively manage suicide risk.

Modifications – Safety planning. However, remember that during the COVID-19 pandemic, some clients who didn’t need them before, may now need safety planning. Clients may also benefit from social-distancing friendly self-care plans (i.e., identifying ways to exercise, stay connected, eat healthy, balance child care, work, and do pleasurable activities) as a part of a safety plan.

Safety plans may also need modifications for social distancing. Are there new warning signs? Coping strategies that involved close social contact that need to be converted to video conferencing? You may need to make sure your clients can feasibly contact key social supports during social distancing. In addition, some clients may be confused or reluctant to reach out to 911 or other emergency services during the pandemic, which may warrant a closer discussion about when to use these services, along with permission to do so in a real crisis. It may be a good idea to remind your clients of social distancing-friendly resources like the 1-800-273-TALK (the National Suicide Prevention Lifeline) or the Crisis Textline (texting HOME to 741741).

Update your clients’ safety plans now. Perhaps the most important point is now is a good time to update your clients’ safety plans. Review and update them together, making sure they are applicable for social distancing.


Treatment planning / recovery

Our key treatment principles for suicide recovery apply during COVID-19 and social distancing. Stable and secure therapeutic alliance is key for long-term recovery, and collaboratively developing a suciide-specific conceptualization or “story” is still important to understand how to prevent future suicidal behaviors. Identifying skills to problem solve suicidal behaviors or cope with suicide triggers, self-management of safety planningm and access to crisis services are still essential components.

As always, remember that documentation is incredibly important – write down what you did and why you did it, and be more thorough rather than less.

Modifications – Treatment planning/recovery. Three key considerations for treatment planning during social distancing and COVID-19 include:

Renew your understanding of clients’ “suicide stories” or suicide-specific case conceptulizations. Realize that your client’s “suicide story” – what thoughts, emotions, dynamics, or situations trigger suicidal thoughts or behaviors and the story (or chain of events) by which suicidal thoughts/behaviors develop – may change in light of new life situations of COVID-19. It may be a good time to discuss and re-formulate your understanding of clients’ suicide stories and explanatory models, and modify treatment plans accordingly. Are there new skills needed for your client to progress on their path to recovery? New distress tolerance, problem solving, or emotion regulation skills?

Connect with clients’ key supports (and set up Release of Information forms). If your client is at heightened risk, it may be worthwhile to consider Release of Information forms (ROIs) and connecting with important people in your clients’ life – particularly someone with whom your client is sheltered. Is there someone that can be part of your client’s safety net during shelter-in-place, who knows that they may need extra support? If a crisis arises, will you be able to contact your clients’ key supports?

Re-evaluate access to lethal means for clients at high risk. It may be a good time to evaluate whether your high at-risk clients have access to lethal means for a suicide attempt, and discuss ways for them to remove their access to these means.

Whatever your client’s situation, don’t forget that consultation with colleagues is a standard part of care for suicide management. You’re not alone – reach out for help and consultation when you need it! With support, we can deliver thoughful and helpful suicide management during COVID-19 for our clients.


Resources

National Suicide Prevention Lifeline: 1-800-273-8255 (1-800-273-TALK)

Crisis Text Line: Text “HOME” to 741741

Emergencies: call 911 and ask for Crisis Intervention Trained (CIT) officer