Counseling Awareness Month 2024 – Five Trends to Watch in the Field

Meet the Expert: Briana Severine MS, LPC, LAC, CPRP

Briana Severine began her career working in inpatient psychiatric facilities in southern California and continued to pursue her passion for psychosocial rehabilitation in Colorado through private practice. She also served as director of marketing and admissions at a trauma-integrated intensive outpatient program. She was ultimately drawn back to clinical work, which prompted her to found Sanare to bring psychosocial rehabilitation services to the Colorado community.

Severine earned her bachelor’s in psychology from California State University, Long Beach and her master’s in developmental psychopathology from the University of Reading, England.

Demand Leveling Out

It’s no secret that the pandemic was detrimental to the public’s mental health. Financial insecurity, changes to routine, social isolation, and a myriad of other factors all contributed to higher rates of depression, anxiety and PTSD among all kinds of people and populations—causing demand for therapy to skyrocket.  

“Not in my 25-year career have I ever seen that much demand for counseling, private practice, intensive outpatient programs [or] residential treatment programs,” says Briana Severine, owner of Sanare, a psychosocial rehabilitation clinic in Colorado.

In 2022, the Washington Post reported therapy wait lists of three to six months or even longer. While demand has cooled somewhat over the last two years, “we still do have a much larger demand than we had prior to Covid beginning,” says Severine.

One positive side effect that came out of the dire situation was increased public awareness about mental health. Due to the collective nature of the experience, there has been a considerable reduction in the stigma associated with seeking mental help, which has prompted new types of clients to seek therapy that otherwise may not have.

“What we’re seeing, especially in private practice and private agencies, was that during the height of Covid, people that might otherwise never have sought mental health services were seeking mental health services,” says Severine.

The supply-demand imbalance is thankfully not as skewed as it was during the public health emergency, but the need for therapists is still projected to rise. Job openings for substance abuse, behavioral disorder, and mental health counselors are projected to grow by 18 percent between 2022 and 2032, which is much faster than the average employment growth rate across occupations. About 42,000 openings for substance abuse, behavioral disorder, and mental health counselors are projected nationally each year on average over the decade.

Greater Need for Addiction Counselors

It’s also important to note that looking forward, certain mental health specialists will be in higher demand than others. “The biggest mental health crisis that we’re having right now is the opiate epidemic and drug addiction,” Severine says. Indeed, the rate of opioid-related deaths has been growing incrementally for decades, but spiked significantly in 2020 and again the following year.

By 2021, one out of every 22 deaths in the U.S. was due to unintentional opioid toxicity, “underscoring the urgent need to support people at risk of substance-related harm, particularly men, younger adults, and adolescents,” a 2023 study on opioid-related deaths before and after the pandemic points out. However, “the amount of counselors wanting to go in [the substance abuse] field hasn’t really changed,” says Severine.

“We have a big problem in the highest-need areas, which are the areas that most counselors want to avoid. As treatment centers open, they have a really hard time with staffing because people are just not open to working in addiction treatment.”

A shortage of counselors in rural states like Mississippi has left some treatment centers understaffed, which means patients—many of whom could be in dire need of lifesaving care—are sometimes turned away, KFF HealthNews reports. “Especially for the more rural states, those specialty practitioners probably have the longest waiting lists,” says Severine.

The Use of Telehealth is Evolving

Another silver lining of the pandemic is the increased use of telehealth. According to Severine, the modality’s popularity remains strong among mental health practitioners and clients alike: “Most [therapists] had never had any experience with it or hadn’t used it,” she says. “Now, most therapists that I know see some clients virtually and some clients in person.”

One of the most commonly lauded benefits of telehealth is its ability to expand mental healthcare access to patients who have difficulty attending in-person therapy due to scheduling conflicts or physical distance. It also gives patients with particular diagnoses or disorders access to more specialized professionals.

“If you have an eating disorder and you live in the mountains, and there are only three therapists there and none of them are trained in eating disorders, you can now access someone that’s a specialist in your area for support,” says Severine, “Versus [before], those folks typically just had to see whichever therapist was in town and they may or may not be highly qualified in the [type of] support they need.”

According to Severine, telehealth is also gaining traction for tasks like conducting psychiatric assessments and delivering care for intensive outpatient patients. “We have a lot of … people [in Colorado who] wouldn’t otherwise be able to access specific mental health services if we didn’t have the virtual option,” she says.

While private practitioners and clinics incorporating telehealth have thrived, some trendier, 100 percent digital mental health platforms that debuted around the pandemic have struggled to stay afloat. Headspace Health, which offers coaching, therapy, psychiatry and meditation content, laid off 15 percent of its workforce in 2023. Pear Therapeutics, a suite of apps for treating addiction, insomnia, PTSD, and other conditions, filed for bankruptcy and sold its assets the same year.

The APA reports that “a second wave of mental health technology” in 2024 will likely see startups incorporate lessons learned from hasty startups.

Compact Laws Progressing

During the Covid-19 pandemic, many states loosened interstate practice restrictions to quickly expand public access to telehealth services, including those for counseling. In some cases, providers could provide their services to patients across state lines using telehealth.

The measures proved to be a boon during the surge in demand for therapy but were intended to be rolled back at the end of the public health emergency. However, due to the abundant benefits—including expanding access to care and improving patient-provider matching—many states seek to make changes permanent by joining the counseling compact.

The agreement, which began to gain traction in 2021, will allow professional counselors licensed in a compact member state to practice in other member states without applying for multiple licenses. This is already being done within psychology with the PSYPACT agreement, of which 39 states are active members. 

“Now, the momentum is moving forward for counseling,” says Severine. Eleven states (Arkansas, Indiana, Iowa, Kansas, Montana, North Dakota, Oklahoma, Virginia, Vermont, Washington, and Wyoming) joined the compact in 2023, bringing the total number up to 28 members.

Counselors interested in providing services to clients across state lines must apply through the compact. Applications are expected to open in mid-2024.

Payment Parity Movement Gains Steam

Payment parity also became a hot topic during Covid-19 due to the increased use of telehealth.  This refers to requiring insurance payors to reimburse healthcare providers for telehealth services at the same rate they do for the equivalent in-person services. For instance, if a counselor usually receives a $80 payment for a 50-minute in-person therapy session from a particular insurance company, they will receive that same amount when providing the session via telehealth.

Prior to the pandemic, only 10 states required payment parity from insurance providers. However, Covid-19 and the telehealth boom encouraged states to explore parity legislation. One 2023 cohort study showed that the implementation of state-level payment parity laws was associated with measurably increased mental healthcare availability in those states. So, ensuring the continuation of these standards will be important for maintaining the progress made within the past few years, in terms of access. 

Payment parity is predictably unpopular among insurance providers, which prefer to pay providers less when possible—or as Robert Bell, head of the Nebraska Insurance Federation words it, “[They] prefer the flexibility to continue to negotiate telehealth rates separately.”

Lobbyists for insurance companies want to see state legislation like LB 256, Nebraska’s payment parity bill, shot down. However, 2023 was a good year for advocates of the movement. In 2023, Colorado, Hawaii, and Nevada each passed state legislation mandating payment parity. Now, most states have implemented some kind of parity legislation (leaving 21 still without any related legislation in place.)

Hopefully, more states will consider writing similar laws in coming years to ensure that telehealth continues to be a ubiquitous option for clients who depend on it.