Timing Matters for Effective Mental Health Care
Golee Abrishami, PhD
VP of Clinical Care
Octave
Too often, I’ve met people who’ve had to wait too long to get the mental health care they need. They often cite the cost of therapy, the endless bureaucracy of the health care system, or simply not being able to find a good therapist (or one at all).
Before the pandemic, an estimated 11% of American adults reported having a mental health issue but not being able to receive treatment – and that increased to 15%, or about 35 million people, since 2020. Most of the focus has been tackling the affordability problem, which people cite as their No. 1 barrier to getting the care they need. But there are many other factors that determine whether someone can not only get connected to care, but be treated successfully.
Even when people have access to mental health care covered by their insurance, getting an appointment when they actually need it is often a challenge. The shortage of available therapists means long waitlists or infrequent appointments. Several states already tried to address this by requiring insurance companies to get people access to a mental health appointment within a set time, but this creates an unfortunate crack in the system – many people will get that first appointment soon, only to then have to wait weeks or even months for a follow-up appointment.
The timing of mental health care matters. It impacts how quickly you start to feel better, as well as the likelihood of solutions actually working. Think about how the timing of care impacts a fractured foot – the longer you wait, the more likely that fracture becomes a full break, and by the time you finally get into a cast, there could be some longer-term damage to your foot and be harder to heal.
“Think about how the timing of care impacts a fractured foot – the longer you wait, the more likely that fracture becomes a full break, and by the time you finally get into a cast, there could be some longer-term damage to your foot and be harder to heal.”
Research supports that the timing of care matters just as much as, if not more than, the amount of care. In one study, 16 therapy sessions held within 8 weeks were shown to be more effective at treating depression than 16 therapy sessions held over 16 weeks. Unfortunately, many people end up getting the opposite: a long wait to start care, and then a slow dribble of therapy appointments upfront before finding a therapist who can see them more regularly. This not only leads to people unnecessarily suffering for a longer period of time, but it also results in a bigger cost to a health care system (or worse, an individual) that’s paying for more sessions over time.
California recently took an important step to recognize the role of timing in mental health treatment: Starting this month, the state requires that insurers and HMOs make a follow-up appointment available within 10 days after the previous session. It’s a good – and necessary – step, but it will take the whole system, from providers to companies to insurers, to continue changing the standards so mental health care can be more effective.
One of my priorities at Octave is to continue reducing the time it takes for someone to get into regular care with a provider – we already can get the vast majority of our clients into care within 10 days, but we’re aiming to close that gap to just a few days. When you’re struggling with your mental health, every single day matters – and you shouldn’t have to wait weeks or months to start care.
For most people experiencing a mental health issue that’s impacting their ability to function well, I usually recommend weekly sessions as a starting point, so you can establish consistency and build momentum toward your goals. In some cases, for those with more serious needs, twice-weekly could be appropriate. Once you and your therapist have built a strong relationship and are making progress, it can make sense to taper off to every other week, or even monthly, until you eventually feel good enough to manage things on your own. This pace generally will get you feeling better faster, without locking you into an endless schedule of therapy sessions.
What can you do as a person seeking care?
First, if you’re suffering, don’t delay care if possible. There are more resources for support than ever – if cost is an issue, look for community resources which offer reduced fees or sliding scales, and if you have insurance, Octave, as well as directories such as Psychology Today and Therapy Den, can help you find a provider who’s in-network.
Second, be proactive in talking to your provider about your goals for therapy and the right frequency of sessions for you, rather than defaulting to a cadence based on convenience or availability. Having clear agreed upon goals will help focus your valuable time in sessions and get you to where you want to go faster. These decisions can make a big difference to your emotional well-being in the long run.