Mind…Full? 12-Month Waitlists, Too Many Vacancies and Pandemic Pressure: New Zealand’s Chronic Therapist Shortage Laid Bare

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After three years of Covid-induced stress, has seeing a therapist become more common? Perhaps – but the real question is whether you can even get a spot on that coveted couch. Sarah Lang reports on the very real therapist shortage in NZ.

Who could’ve done with a therapy session or two since the pandemic began? Most of us, right?

As well as creating problems such as employment disruption, financial worries and isolation from others, Covid’s grip and the accompanying restrictions have, for many people, caused new issues or exacerbated pre-existing issues like stress, anxiety and sleep problems. At the same time, there’s been a major spike in demand for appointments to see therapists in New Zealand. Coincidence, much?

First, here’s a quick-ish distinction between different types of therapists, who all practice “talking therapy”.  Counsellors help you talk through and deal with personal, relationship or career issues and other life problems. Three thousand counsellors – the majority of counsellors in the country – are registered with professional-membership body the New Zealand Association of Counsellors. Psychotherapists help you work on underlying traits and habits that might contribute to your problems. Psychologists (there are 1850 registered with the New Zealand College of Clinical Psychologists, though some are in ‘non-client-facing’ roles) have an advanced psychology degree plus two years of practical training, and tend to oversee longer-term therapy for deep-rooted issues. This doesn’t mean a psychologist is necessarily ‘better’ than a psychotherapist or a counsellor – it’s just different.

Thankfully, with the help of public-health campaigns like Like Minds, Like Mine, the stigma around mental-health issues has lessened significantly over the years. You could almost call therapy ‘socially sanctioned’. Dr Paul Skirrow, a clinical psychologist and senior lecturer in the Department of Psychological Medicine at the University of Otago, Wellington, is also executive adviser to the New Zealand College of Clinical Psychologists (NZCCP). “I think there’s definitely less stigma in seeing a psychologist; however, I’m not sure that stops it being hard for people to make that first appointment.” And because the stigma hasn’t disappeared entirely, people prefer not to be named in this story.

Jane,* a Wellington teacher, has told close friends and family members, some colleagues and occasionally acquaintances that she sees a private psychologist. “Some colleagues told me they see therapists too, so it’s cool to see people being more open about it.” Jane, who has had the same psychologist for nine years, says three years of the pandemic have hugely exacerbated her stress levels, sleep issues, and relationship problems. “I’m lucky I already have a psychologist, because I know her waitlist is really long. Sometimes, if I’m doing okay, I think ‘maybe I’ll cancel my next appointment,’ partly because other people must need that session.”

Currently, it’s extremely hard to find a private psychologist. Most are booked up for the foreseeable, and have long waitlists. Essentially, demand is far outstripping supply (we won’t get into systemic issues regarding the ‘supply’ side of things, but part of the problem is not having enough postgraduate-training spots). Chelsea*, a Christchurch accountant who has severe anxiety, can’t find a private psychologist. “I’ve been turned away by the three people that I thought I’d be comfortable with after I’d read their bios.”

You can search by area, what you need help for, and other settings to locate a psychologist through the NZ Psychological Society’s PsychDirect Database or The NZ College of Clinical Psychologists’ Find a Clinical Psychologist Directory. You can locate a registered counsellor here. And you can locate a registered psychotherapist. Their respective professional associations hold members to high standards of accreditation, training, professional development, etc, so check whether someone is a member.

Chelsea*, a Christchurch accountant who has severe anxiety, can’t find a private psychologist. “I’ve been turned away by the three people that I thought I’d be comfortable with after I’d read their bios.”

But when you find one, what are the chances of getting a yes? Well, the NZCCP recently surveyed 271 clinical psychologists in private practice, and published the summary ‘Clinical psychologists in private practice are overwhelmed with referrals’. Demand has increased exponentially over recent years, with some psychologists turning away more than 40 clients per month, says Dr Skirrow. “More than half of those surveyed reported that they had completely abandoned offering a waitlist, citing difficulties managing the large number of referrals and risks of leaving people with significant mental-health issues on a waiting list.” Of those who’d retained a waitlist, more than half indicated their wait time was more than three months, and several had a waitlist of more than 12 months.

Tara*, a Wellington mother of two in her 30s, has struggled to find psychological help. She actually works in the “Covid space” – in a public-sector support role, not a clinical role. “When Covid first hit, I naively believed it would be a short-term thing and didn’t mentally prepare myself for the slog of the pandemic. Because of my work, I couldn’t escape Covid: the news, the details, the stress, the anxiety. I couldn’t not think about it.” It took a toll. “By the middle of last year, I was experiencing symptoms of strong anxiety and intrusive thoughts. This wasn’t entirely due to Covid, but Covid had drained my resilience and any reserves I had.” She was also dealing with a difficult relationship and coping with a loved one’s death, and felt untethered and uncertain.

Tara knew she needed some help, but couldn’t find a psychologist. She broadened her search to counsellors. “I probably contacted about 20 psychologists and counsellors before I found a counsellor. We did a phone consult then met a month later, when she could fit me in.” Having had five sessions (that’s all for now, at least), she’s “feeling a bit better”. She’s grateful her employer paid (a total $500) through the Employee Assistance Program (EAP): a confidential employer-employee program that supports individuals facing work-related or personal problems.

“I told a few people, but I wasn’t shouting it from the rooftops. I know others who see psychologists regularly, so I felt no apprehension. No shame. But that might be because of my privilege as a middle-class white woman? I actually think American culture has normalised therapy more, for me at least. Seeing your therapist is considered normal there – at least on TV shows, and people I follow on Instagram.”

Why the therapist shortage?

In New Zealand, it’s perhaps no surprise that private practice is often more attractive for psychologists than a severely overstretched and under-resourced public mental-health system. As of 1 April 2022 – and this was no April Fools’ joke – there were 148 vacant psychologist positions in the public sector (largely in District Health Boards, and also including the Ministry of Education). APEX, the union representing more than 4000 allied scientific and technical health professionals throughout New Zealand, gained this data under the Official Information Act. It also shows that 20% of public-sector psychology positions are vacant nationwide, and annual turnover of staff is as high as 60% in some regions – all leading to a troubling therapist shortage in NZ.

Tara knew she needed some help, but couldn’t find a psychologist. She broadened her search to counsellors. “I probably contacted about 20 psychologists and counsellors before I found a counsellor. We did a phone consult then met a month later, when she could fit me in.”

Dr Skirrow doesn’t want anyone thinking that psychologists don’t care deeply. “Our experience has been that clinical psychologists are generally very dedicated to working in the public sector – i.e. offering free services to people who arguably need it the most. But in recent years the DHB working environment, poor pay and conditions and the availability of work outside of DHBs – with its better pay and conditions – has led to it being much harder to recruit and retain clinical psychologists in DHBs. Many psychologists continue to make their services ‘free’ [for the client] by taking on contracts with ACC, EAP providers, etc., but others find it easier just to offer private appointments.

“One big concern about psychologists moving to private practice would be that you could end up creating a ‘two-tiered’ service, with psychology services being increasingly only available to people who are able to pay.”

Yep. Psychologist appointments are usually somewhere between $160 to $260 and counsellor appointments are usually around $100, though amounts vary.

Sally*, an Auckland-based psychologist, is now in private practice. “I left work in the public system during Covid because it was just so soul-destroying with the lack of funding and ridiculous waitlists, without the resources to manage them. The public system has such strict criteria that hardly anyone fits, so it’s really difficult to get seen.” As a psychologist, that can mean feeling stressed and overstretched, unable to give enough support to the clients you do see, and unable to see those who have serious issues but aren’t considered ‘bad enough’. Sally’s private practice is busy. “I’ve had about 60 referrals so far this year alone, and I can’t see them all.”

Wellington clinical psychologist Dr Nicole Pray currently has a year-long waitlist. “I’ve definitely experienced a surge in demand since Covid, and most of my colleagues are reporting the same. Many have closed their waitlists. It does raise guilt and stress to not be available when we know others are in distress and needing intervention.

“That’s partly why I and other colleagues have begun to offer different approaches, such as educational workshops or groups for learning skills for mental flexibility and better coping. I think others in private work are doing this slowly too. We have to become more creative in how we offer services.”

“I’ve definitely experienced a surge in demand since Covid, and most of my colleagues are reporting the same. Many have closed their waitlists. It does raise guilt and stress to not be available when we know others are in distress and needing intervention.”

Dr Nicole Pray

Dr Pray, who is one of the few properly-trained couples’ counsellors in New Zealand, says demand for this has also risen. She also co-runs weekend workshops for multiple couples (sharing with the group is optional). “Many couples say it [the relationship] has been harder with COVID in play.” After all, being stuck at home together during lockdowns can exacerbate tensions – and in some cases, couples still both work from home.

During Covid restrictions, most therapists began holding sessions online. Currently, Dr Pray is doing about three-quarters of her sessions online but expects that to drop to half or less over coming weeks as Covid restrictions ease.

Having online sessions, which began as a necessity, may be becoming more of a trend for various reasons, including still being cautious about catching Covid, being more nervous about in-person sessions, and of course convenience.

Amy*, an IT manager from Dunedin, thinks the increasing availability of online therapy mean more people are open to therapy as a whole. “That helped me see it as achievable. I tried for ‘face to face’ first, but no luck. I’ve given up looking for a good match and am just trying to find anyone with a vacancy in a few months. Fingers crossed!”

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