Even beyond insurance, the system is fucked. My wife finished her master's program and started working under supervision. But, of course, the only places which offer supervision are (generally) community mental health centers. So my wife was fresh out of school, with a client load of 55 people, getting paid $20/hr -- and those 55 people were generally the people with the least resources and support, thus some of the most challenging non-inpatient clients you'll find in mental health.
Beyond that, she learned that these community mental health centers, despite being nonprofits, are still aiming to constantly reduce costs; in her first six months, she saw many support structures for both clients and clinicians cut. This included laying off most of the case management staff, expecting the counselors to pick up the slack. She rarely even had time to keep her (legally-required) notes.
She lasted less than a year before quitting. She's not sure she'll ever go back.
Counselors are being squeezed from both sides here: They either burn out early, or the insurance companies fuck them over in perpetuity.
When I was a student the rule was you had to do a year in community mental health type setting during school as an internship prior to graduation. I forget the exact hours requirement. It was supposed to be a learning experience but almost all of us were just put to work with a full caseload from day 1, paid $0 and hour, and the agency billed on our behalf. It was very burnout inducing to be making nothing working in the setting you describe. Then you’d graduate and get to have the honor of making $15-25/hour, the low end of which was offered over at target.
It’s also why I don’t understand how those programs struggle so much. AFAIK the practice continues to this day and it means they have a sea of interns providing free labor. The interns don’t get the same session rate as a fully licensed therapist but at the same time they literally cost $0/hour, they are slave labor. Medicaid and the community mental health system is built on it. It’s why low SES individuals are by default used to never having the same therapist for more than a few months or so; the turnover is crazy
Beyond that, she learned that these community mental health centers, despite being nonprofits, are still aiming to constantly reduce costs; in her first six months, she saw many support structures for both clients and clinicians cut. This included laying off most of the case management staff, expecting the counselors to pick up the slack. She rarely even had time to keep her (legally-required) notes.
She lasted less than a year before quitting. She's not sure she'll ever go back.
Counselors are being squeezed from both sides here: They either burn out early, or the insurance companies fuck them over in perpetuity.