Since the pandemic's onset, more people have sought access to mental health care, and Seattle-area practices have had to adjust their work accordingly. Laura Richer, a therapist and co-founder of Anchor Light Therapy Collective, said the multidisciplinary clinic's caseload drastically changed after 2020.

"We saw a huge uptick in people wanting couples and family therapy, which makes perfect sense, because people were in their homes, they were together all the time, they were teaching their kids online while trying to work online," Richer told the SGN.

Adults aren't the only ones needing support, though. In 2021, 48% of LGBTQ youth wanted mental health care but didn't get it, while 36% did receive mental health care, according to a survey from the Trevor Project.

Erin Karcher, a therapist with Star City Therapy, whose specialties include relationship issues, sexual and gender identities, and neurodiversity, has seen an increase in intake requests from children younger than her normal caseload, who were aged 15 years or older in prepandemic times.

"Just last week, I got a request for a Nonbinary kiddo with ADHD who's 9. I've got younger and younger folks just really needing someone to talk to," Karcher told the SGN.

"It's been really difficult for... adolescents and teenagers to connect with a therapist through their screen because of how much time they had to spend on Zoom for school. They have the same kind of screen fatigue that we do, but they're less capable of regulating it," Karcher added.

Yungee O'Connell, a therapist and director with MEND Seattle, a practice dedicated to an antioppressive and liberatory approach to therapy, found that the pandemic's economic consequences have also changed the access needs for many seeking services. In addition to two years of job loss or fluctuating housing situations, inflation is impacting how people can spend their money, O'Connell told the SGN. MEND Seattle doesn't take insurance, instead offering a sliding-scale $50-70 appointment fee.

"We're seeing clients [having] to leave because they can't afford even the lower fee. While we've tried to make therapy more affordable for folks to increase access, we're finding even that is a hardship for people," O'Connell said.

Long waits for service
The American Psychological Association (APA) reported last fall that the number of psychologists who reported increases in referrals rose to 62% in 2021. The same study found that 68% of psychologists had longer waitlists since the pandemic started, and 65% reported not having the capacity for new patients.

Karcher's practice has been full since before the pandemic, but the last time she had an opening, she was slammed with intake requests.
"I had 12 inquiries in 24 hours, which has literally never happened to me before. I take Premera and I am private pay — I'm pretty limited access," Karcher said.

Anchor Light Therapy hasn't experienced waitlists over the pandemic and has been able to accommodate patients as they increase their staffing, but Richer has faced long wait periods as a client herself.

"There's a therapist that I wanted to start working with for my own personal therapy, and I waited about five months to get in to see her," Richer said.

Burnout has hit mental health care
"The Great Resignation" is a phenomenon that has perplexed employers across all industries. In November, the Bureau of Labor Statistics reported that health care and social assistance saw the second highest number of workers quitting that month.

Burnout has also been highly reported among practitioners. The aforementioned APA study found 39% of psychologists reported an increase in their workload, and 46% reported feeling burned out.

"If you're working in community mental health, or a more government-funded [or] insurance-based program, those are the sites that have been very overwhelmed; I think that's where you're really going to find a lot more burnout. Even in private practice, I would definitely not say I'm burned out, but I have worked more than I ever have before," Richer said.

"[We're] being looked to for answers, and processing and guidance, and not necessarily having a space to take that and do that ourselves," Karcher said.

As a way to provide care to staff and increase their talent pipeline, clinics are retooling the benefits that practitioners are offered, including bigger salaries and sign-on bonuses. At MEND Seattle, other means are being pursued, including access to therapy, acupuncture, and massages, even food, especially for clinical interns whose academic programs might block them from being compensated.

O'Connell also thinks MEND Seattle's focus on prioritizing Queer and Trans BIPOC voices can make the difference for marginalized practitioners who may experience burnout elsewhere.

"Because we are centering QTBIPOC in our community, oftentimes what we hear and feel is that folks find us and feel relief," O'Connell said.

"We do have a pretty robust clinical training program, where we're trying to really have these conversations from an intersectional feminist lens... we like to think of ourselves as being change agents in the realm of economic justice, by trying to redistribute wealth, by launching over [a hundred] women-, BIPOC-, or QTBIPOC-owned practices," O'Connell added.