Healing A Broken Mental Health System: Nicole Roder Of Gladstone Psychiatry and Wellness On 5 Things That Can Be Done To Fix Our Broken Mental Health System
An Interview With Stephanie Greer
Provide incentives for providers to specialize in treating undeserved populations, like children, adolescents, people of color, and sexual and gender minorities. All populations are having trouble finding a therapist right now, but it is especially hard for these groups to find care. That’s why I think the government should provide incentives, like tuition reimbursements and grants, for mental health providers who choose to work with an underrepresented population.
The current state of the mental health system is a conversation that echoes in the halls of policy-making, the corners of social advocacy, and within the private struggles of individuals and families. As we continue to witness an unprecedented need for robust mental health support, the shortcomings of the existing system become more glaring. It is within this backdrop that we seek the insight of those who are at the forefront of behavioral health. In this interview series, we are talking to behavioral health leaders, policymakers, mental health practitioners, advocates, and reformers to share their perspectives on healing our broken mental health system. As a part of this interview series, we had the pleasure of interviewing Nicole Roder.
Nicole Roder, LCSW-C, is a bilingual DBT therapist in Bethesda, MD who is certified by the DBT-Linehan Board of Certification. She is intensively trained in DBT, DBT prolonged exposure for PTSD, DBT for parents, couples, and families, and DBT for substance use disorders. In her practice, she treats adults and adolescents with BPD, PTSD, DMDD, SUD, and related disorders.
Thank you so much for joining us in this interview series. Before we start, our readers would love to “get to know you” a bit better. Can you tell us a bit about your background and your childhood backstory?
Sure. First, I’m a mother of four amazing kids. I don’t think anything defines my life as much as motherhood does. I graduated with my MSW in 2001 and worked for 7 years until I had my first child. After that I was a stay at home mom for 12 years, and I loved it. I decided to go back to work as a therapist after one of my children began developing mental health needs and it was incredibly difficult to find affordable, competent care for him. That’s when I realized just how broken our mental health care system was. I felt so powerless. After a while, I realized that one of the best things I could do to change the system was to go back to work, so I did.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
I’ve always been fond of the Serenity Prayer. “God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.” So much power in that one sentence.
Let’s now shift to the main part of our discussion. It is often said that “the mental health system in America is broken”. What does that statement mean to you? From your perspective what is “broken” today?
The main problem is that it’s just so incredibly difficult to find a therapist who is right for you and affordable. The primary means of paying for health care in this country is health insurance. Unfortunately, some people still don’t have comprehensive insurance plans. Even for those who have great coverage, it’s still difficult to pay for therapy with insurance because so many therapists aren’t in network with any insurance plans. And paying for therapy out of pocket can cost between $150-$250 per week, which most people can’t afford.
Part of the reason for this is that there simply aren’t enough therapists. Mental health therapy is delivered by several different types of professionals, including social workers, psychologists, professional counselors, marriage and family therapists, school counselors, and psychiatrists. Together, these professionals make up the mental health workforce. According to the Kaiser Family Foundation, 47% of Americans live in and area with mental health workforce shortage. The National Association of Social Workers (NASW) estimates that the U.S. will face a shortage of 195,000 social workers by 2030. And the American Psychological Association (APA) reports that six in ten psychologists say they have no openings for new patients.
In addition, demand for mental health services has increased dramatically since the start of the Pandemic. According to the American Psychological Association’s 2022 COVID-19 Practitioner Impact Survey, psychologists are seeing higher numbers of patients with anxiety disorders, depression, and trauma-related disorders. The NASW reports that since the Pandemic, four in ten U.S. adults report symptoms of anxiety or depression, and about 60% of parents say that their child is suffering from mental health challenges. Over 46 million people ages 12 and older have a substance use disorder as well. What’s more, one in every five U.S. children needs mental health or social work services, yet only about 20% of those kids receive care from a specialized mental health care provider.
So why are there so few therapists available? Many reasons. I think the biggest one is that insurance reimbursement rates for behavioral health care are extremely low, so providers are having to invest tens of thousands of dollars and many years into graduate school training in order to earn low pay.
What about any bright spots? Do you think there are any elements that we get right in today’s world that we wouldn’t want to reverse unintentionally?
I think it’s fantastic that more people are seeking out mental health care. For many years, there has been a cultural stigma surrounding treatment for mental disorders. I think we’ve made a lot of progress in reducing that stigma, especially among young people.
In your opinion, what are the 5 most impactful things that could help heal the broken mental health system? These could be on any level including training, workforce, policy, culture, equity etc.
1 . Enforce mental health parity in insurance and increasing provider rates, as low reimbursement rates contribute to a large number of providers not accepting insurance. Right now, the law says that insurance companies have to provide mental health benefits that are at least as favorable as their medical benefits. I’m honestly not sure what exactly that means in legal terms. I can tell you, though, that in practice, health insurance companies reimburse mental health providers a lot less than the fair market value for their work. This causes a lot of therapists to choose not to join insurance networks and charge out of pocket fees. Unfortunately, most people can’t afford to pay for that.
2. Encourage people to see a mental health provider for an annual “well-visit” and better educating primary care providers on mental health care. Even with all the progress we’ve made on reducing stigma around mental health care, there are still a lot of people who need to see a mental health professional and just don’t do it. If everyone went in for an annual mental health well-visit, that might help bring to light some problems that they could use help with. In addition, primary care providers need more education on mental health care. Since so many people can’t find a psychiatrist or mental health provider, they end up going to their family doctor for anti-depressants and other mental health needs. Unfortunately, a lot of doctors don’t have the training to treat these issues. If they give ineffective treatment, that just reinforces for the patient that their problems are untreatable, which is the last thing we want.
3. Implement a system that allows providers to be licensed across states rather than having to apply for licensure in each individual state (to make telehealth easier, especially in underserved rural areas). One of the few benefits of the Pandemic was that it made Telehealth more available, which could have the impact of bringing mental health services to people who live in areas without many providers. Unfortunately, state licensing laws make it so that it’s still difficult for patients to see providers who aren’t located nearby. I’m licensed to do therapy in Maryland and Florida, which means when I see a patient over zoom, they have to be physically located in Maryland or Florida. If I want to see patients in another state, I have to apply for a license there. These licenses cost anywhere from $400-$800 each. Not to mention, each state has their own licensure requirements, and some of them are pretty onerous. For example, California requires out of state social workers to take an additional graduate-level course. This does nothing to protect the public. In my opinion, it only serves to generate revenue for states to the detriment of people who need mental health care.
4. Approve a CPT code for billing comprehensive DBT therapy. CPT codes are the codes that insurance companies require providers to use to identify the type of service they are billing for. For individual therapy, the only billing codes available are for plain “psychotherapy.” This works fine for people who need standard treatment for depression and anxiety. However, there are many patients who need specialized care like Dialectical Behavioral Therapy. DBT is an intensive outpatient therapy that helps people who are at increased risk of suicide and engage in risky behaviors like self harm, drug addiction, and more. These patients are typically very dysregulated and need intense treatment that includes several hours of therapy per week and 24/7 access to phone coaching with their therapist. DBT helps keep them out of hospitals and residential treatment centers, which saves insurance companies quite a lot of money. The standard insurance payments for psychotherapy are not nearly enough for therapists who have to provide this level of care. Again, this causes many providers to charge out of pocket fees that many people just can’t afford, even if they desperately need the help. Sadly, many of them end up in emergency rooms multiple times a year for lack of affordable and competent outpatient care.
5. Provide incentives for providers to specialize in treating undeserved populations, like children, adolescents, people of color, and sexual and gender minorities. All populations are having trouble finding a therapist right now, but it is especially hard for these groups to find care. That’s why I think the government should provide incentives, like tuition reimbursements and grants, for mental health providers who choose to work with an underrepresented population.
If all of the items on your list were magically implemented tomorrow what change might we see in the world? What are the signs (big and small) that would show us that the system is being healed?
I think it would be a lot easier for people to find and afford therapy.
What is a project you or others are working on today that gives you hope? How can our readers learn more about this work?
I work for a fabulous comprehensive DBT program in Maryland called Gladstone Psychiatry and Wellness. Our program is certified by the DBT-Linehan Board of Certification, which means that our program has been independently evaluated by the Linehan Board of Certification and found to have a high level of fidelity to the DBT model as prescribed by the creator of DBT, Marsha Linehan. I also volunteer for the National Education Alliance for Borderline Personality Disorder, which is currently advocating for the DBT CPT codes I mentioned. NEABPD does a lot of other great work as well.
How do you see technology shaping the future of mental health care and its accessibility?
Like I said above, I think that Telehealth technology can make mental health care a lot more accessible to people who live in areas that don’t have a lot of providers, as long as the licensing laws are changed to allow providers to see patients out of state.
In your view, how do social factors like poverty, education, and culture affect mental health care and its effectiveness?
This is a huge question! Poverty as an obvious effect on access to mental health care, and education and culture effect people’s attitudes toward receiving care. In addition, a lot of people are more comfortable seeing a therapist who has a similar cultural background to them. Since a lot of racial minority groups are underrepresented in the mental health workforce, it’s harder for clients from those groups to find a therapist they feel comfortable working with.
In light of the growing mental health crisis among young people, what innovative approaches or interventions have proven most successful for children and adolescents?
This is another huge question that I think would take a lot of pages to answer thoroughly. Suffice it to say, there are a number of therapeutic approaches to working with children and adolescents. I’m mainly familiar with DBT for adolescents and DBT for children. Whatever approach a therapist takes, I strongly believe it is essential to work closely with the child’s parents and/or family to get the best results.
We are very blessed that some very prominent names in Business, VC funding, Sports, and Entertainment read this column. Is there a person in the world, or in the US with whom you would love to have a private breakfast or lunch, and why? He or she might just see this if we tag them. 🙂
If you could set me up with Marsha Linehan, I think I’d faint.
How can our readers further follow your work online?
I don’t have any public socials, but my program’s website is gladstonepsych.com.
Thank you for your time and thoughtful answers. I know many people will gain so much from hearing this.
About The Interviewer: Stephanie Greer, PhD is the Co-founder and CEO of Akin Mental Health — a company dedicated to guiding families on their journey supporting a loved one with mental health challenges like bipolar disorder, schizophrenia and severe depression. Stephanie is passionate about this topic from her own personal experience growing up with a mother who struggled with bipolar 1 disorder and found a path forward to overcome the obstacles and live well. Stephanie’s professional experience includes a doctorate in neuroscience as well as design research roles at Hopelab and Apple. Stephanie brings this personal passion together with her world-class science and technology background to support families across the US in their personal journeys supporting loved ones with mental illness. To learn more about Akin Mental Health and join our community, visit us at akinmh.com.
Healing A Broken Mental Health System: Nicole Roder Of Gladstone Psychiatry and Wellness On 5… was originally published in Authority Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.