When the System Runs Out: Trauma, Disability, and the Fight to Keep the Care That Works

Recovery is possible.

Recovery is possible.

Recovery is possible.

Recovery is possible.

Recovery is possible.

Recovery Dialogues and Sober Stories.

You've found a therapist who actually gets you. Someone who doesn't make you start over every session. Someone who already knows the weight you're carrying and who meets you there. And then one day, you get a notice. The funding ran out. The coverage doesn't apply. The therapist you finally trusted is now out of reach. And there's nothing on the other end of that 1-800 number that comes close. That's not a hypothetical. That's Cynthia's life right now. Welcome back to Recovery Dialogues and Sober Stories. I'm your host, Antonio Matta, and today we're doing something a little different. This is a special episode, and I want to be upfront about why. Cynthia has been on this show before. She shared her story anonymously the first time, and she trusted this space with something real. I went back to her recently, not just as her friend, but as someone who believes her experience deserves a louder microphone and a more complete conversation. Because what's happening to Cynthia is happening to millions of people in this country. And most of them are too exhausted from fighting the system to talk about it. Today, one of them is. You're going to hear from a clinical expert who lives inside this crisis professionally, and from a healthcare and behavioral health access leader who works inside the systems that are supposed to close these gaps. And I'll share some thoughts of my own. Because I wouldn't be honest with you if I pretended this one doesn't land close to home. Let's get into it. The first time Cynthia came on this show, she came anonymously. Today, she's stepping forward. And I don't want to minimize what that takes. Cynthia lives with severe depression, anxiety, and PTSD. She's also a wheelchair user, and she's grieving the loss of her best friend. Let's bring Cynthia into the conversation now. Cynthia, before we get into everything that's been happening, I wanna start somewhere a little earlier. Before you found the therapy through BetterHelp, what did your relationship with mental healthcare actually look like? Had you been in therapy before, or was this really your first real experience with it?

Before I found therapy through BetterHelp, I was living in New York City where I'm originally from, and they have a lot of resources for mental health, and insurance is a lot better up there with covering mental healthcare. So I had therapy. I started off in a program that was 5 days a week for 6 months. And then I graduated from that and went to 2 days a week. Then I did 1 day a week. And then I've stood in therapy. The pandemic hit. I had some periods where I didn't have therapy because I ended up in a place where there were a lot of interns that would come and go, and it wasn't a good fit. So I just went without therapy, but I was doing a lot better in my life then. It was easier to adjust. And Then the pandemic hit. I found therapy again up until I moved back down to Florida, which I grew up here in Florida. And when I came here, I had to leave that therapist. I found therapy here, but my insurance stopped paying for it, and they didn't inform the therapist, and they didn't inform me. That's where I realized Florida is not good with providing sufficient mental health care in terms of the budgeting and insurance. That began the battle I've been having since October of 2022 when the insurance stopped paying the therapist I found here. And since then, up until August of 2026, has been the battle to find good therapy through health insurance.

And then something shifted when you connected with this particular therapist. What was it about that relationship that felt different? How long did it take before you actually felt safe?

When I first connected with this therapist through BetterHelp, I could tell that she was in it for the long run, and it made me feel safe because I'd been trying to find therapy through my insurance here. I wasn't really successful even through— my insurance has an app that you could get therapy directly through the app. And I did actually try that a few times, but I would always get timed out after 3 or 4 sessions. I had one therapist where I had about 6 sessions. And I would get timed out. I never really found out the reason, but I would get pop-ups that said my limit was reached and I couldn't request any more therapy. And that happened for 6 months at a time before I got another 3 or 4 sessions. It felt like those therapists were not really in it. It felt like they were aware this would be short-lived. I remember one time I was in a session with a therapist through that app and I was cut off in the middle of the session and I couldn't message her afterwards. She never messaged me. I got a popup again that I was timed out. So it was tough to feel safe and like I could start any work on myself with the therapist through that app. With BetterHelp, since it was covered by a scholarship from a mental health organization, It felt like the therapist was aware that this is however long I want it to be. And I was like, okay, I could tell that this could be a lasting relationship. I did tell her my scholarship did have an end date, but we didn't focus on that. We focused on connecting and our relationship. I did have other experiences with therapists back home in New York, but I hadn't been through The things that I currently go through now, I have a history of trauma and I'd been through a lot, but I hadn't lost my stepdad at that point. I hadn't lost my best friend. I hadn't lost my mobility. So in the years from 2020 to now, it made it even more important for me to find a therapist that felt invested in the relationship and for me to find a space where I could feel invested. The focus back home in New York was like, I was working to manage certain disorders and things that I have from a trauma history. But then with new layers of trauma being added to it as an adult, it's like this became more of a survival thing and working on literally how to survive trauma that's been coming my way. I did connect with the therapist through BetterHelp. She kept everything tailored to my needs. It wasn't a one-size-fits-all approach. She really listened, and everything was, this is a part of your brain responding because of this. She would break things down in a way that I never heard before. It was very educational. Those things made me feel safe with her because she was listening and she was responding to what I was saying. Those are the things that made me feel safe. Safe and connected to her.

I wanna make sure people really understand what you're carrying day to day, because living with a physical disability alongside depression, anxiety, and PTSD isn't one thing on top of another. Can you help listeners understand what that intersection actually feels like? Not the clinical version, the real one.

I feel like I'm in a chokehold. I grew up here in Florida. I had an abusive childhood. When I left Florida and graduated college, I didn't think that I'd be back here. Florida is not a place I ever wanted to come back to because of the trauma that I had here. But I'm living around the corner from where I grew up, and it's triggering every single day. I get a lot of flashbacks. I get a lot of PTSD and everything. Triggers me. I can't go out and do things without wanting to scream and cry and panic. And it's difficult to live like that because nobody wants to be home all the time, but I feel like I have to be. There was a concert that I was dying to go to in June, and I couldn't go because of the trauma that I feel. It was Not too far from where I grew up. It was in an area that I had been to before and near an area that I used to live in. I knew about this concert from last year, and I was trying to talk myself into it from last year, and I felt pretty good talking to my therapist about it. But then we had to discontinue. I remember telling myself, I'm gonna be able to do it. I felt Good. But when the day came, the flashbacks were pouring in. I was miserable. I was emotional. I was like, there's just no way I can do it. I tried to force myself, but I was like, there's no way. This concert was an artist I've been dying to see. It was affordable. They had wheelchair-accessible seats that were $50. And I'm like, I can borrow $50. It was something that I felt like such a failure for. My whole life is like that, where even if I want to sit outside because I just need a breather, I need some air, it's like I know I am in the area where I grew up in. And even talking about it right now is really tough. It's like I could feel myself as that child that went through abuse and that was surviving here, and I didn't even know it. I could feel it when I was a kid, but I didn't know how much in survival mode I was in. When I had dissociation and things like that, I didn't know what that was. There were so many things I learned. As an adult, when I started therapy in that program in New York, and a lot that I learned from my BetterHelp therapist too, that I had no idea I was experiencing as a kid, just surviving child abuse. And now when I'm here with my disability where I really can't take myself on a vacation, I haven't had a vacation. Since September 2019. I can't take myself on a vacation because I am disabled and I need help. I can't just get out and go drive somewhere on my own because I need someone to help me lift my wheelchair and fold it and put it in the car and get it out. I usually like to hold on to someone's arm when I'm getting in and out of a car because I have a severe spinal condition, which is why I'm in a wheelchair. It's hard because I can't do anything on my own. I have nowhere to go. I have nothing to do. Every day, I'm trying to survive the day. I'm trying to figure out what to do with myself. I do some online volunteer work when I'm up to it. But other than that, a lot of time passes and my quality of life is poor. I try to look for things to be grateful for. I do have a home and I do have food every day. Even though I have severe financial burdens, I've never gone without the necessities. So I do try to be grateful for those things. But I also feel like my overall quality of life is poor. I didn't ask to deal with child abuse. And it's this cycle that I feel all the time. And I have tried to go out to the store. I have only been to the supermarket here one time, and I've been living here for 4 years now. And there's certain places I refuse to ever go to because this is where I grew up, and I experienced child abuse even in public. My father would do things at times in public places. There are places in my area that I would love to go shopping, Or window shopping, but I can't because the way I grew up was so hard. Because of my physical disability, I'm limited, but also my emotional state. There's so many things that I just can't do and I don't want to do here. I feel stuck. I feel like I can't go farther away because of my physical disability. I'd love to take a day trip on a train out of Florida, maybe stay overnight somewhere. and come back, but it's tough to survival mode all the time.

And then the clock ran out. When you found out the sponsored time on BetterHelp was ending, walk me through that moment. What actually went through your mind?

I knew my scholarship had an end date. I was anxious, but I was able to tell my therapist that. But I was also thinking, I'm gonna have to try to find a job. That I don't think I can do emotionally, even if it's a job working from home, like, I don't think I can do, but I think I'm gonna have to find one to pay for BetterHelp. And I was putting myself in a hamster wheel of like, I don't feel capable of keeping up with a job, but I'm gonna have to do that, or I'm gonna have to sell something and I don't have anything to sell. I was going through scenarios. How am I gonna make the money? How am I gonna pay for BetterHelp? I did get a couple of very short extensions. They weren't as long as the scholarship. They were short, but it was something, and I was really grateful. To be honest, transparent, and fair, the folks that handled the scholarship, they didn't leave me high and dry. I had to get to a point where I was on my own, but they gave me a little bit of extra time. They gave me those couple of extensions long enough for me to know, okay, this is really gonna happen. It's gonna end. I won't be able to be here anymore unless I can pay for it. So it was thinking about what am I gonna do? And I was like, maybe if I make a TikTok and I post old photographs I used to take when I was doing photography in New York, maybe I could monetize it. I was thinking of any way to hustle and earn the money and make it myself in an honest way. But I never was able to keep up with social media and content creating. I've tried different endeavors. I've tried content creating on things like how not to get lost in New York City, trying to To see if I can be one of those people that makes enough money doing social media. It never happened, and I just mentally couldn't keep up with it. I felt a lot of pressure, so I stopped doing that. And that's what made me end up doing the campaign I have now on the GoFundMe. It wasn't my first thought. It's not something that I really ever wanted to do. I decided I have to reach out for help because I have to help myself and hope and pray that I'm able to find that on here. And after enough therapy, get back on my feet so that I can get back to those other things and maybe try to do something with content creating or find some kind of job from home part-time and set some goals for myself. I had a lot going through my mind and Every thought led me to where I am now because I did try some of those things. I'm in a place now where I do need assistance, and I have to accept that this is where I am and hope and pray that it'll help me to get back with my therapist so that we can have more time together.

You live in a state where finding trauma-informed care covered by basic insurance is, in practice, Nearly impossible. Tell me what that search actually looked like. How long did you try? Where did you keep hitting walls?

I tried everything and I hit walls everywhere. I did start off finding a therapist here when I moved here, maybe July of 2022. And then in October 2022, the insurance just stopped paying. So Ever since then, I have gone through case management programs directly from my insurance. I've gone through regular doctor's offices to see if a provider can send over mental health referrals. I've called crisis lines. I've done extensive Google searches. I have asked friends. I've asked people I know. I mean, I feel like I have done everything to search for therapy that's covered by insurance. I mentioned before I used an app that my insurance has. I kept on getting timed out after a few times, and each time I only had 3 or 4 sessions. Hard. Even with case managers and folks referring me to places, I would call, but I would not get calls back. There was one place that did call me back. And they seemed ready to start, but I didn't like the people. I had one phone interaction with somebody where I wasn't really doing so well, and I was thinking of the 72-hour observation hospitalization. I know in New York City they call it CPAP, where you stay for a maximum of 72 hours. You make sure everything's okay. If things are not okay, that gets extended. But I thought of doing something like that. For a 72-hour hospital stay. So I called the place, and I know that they have a standalone facility that's not in a regular hospital. It's their own psychiatric hospital. So I had asked them if they do observation, and the receptionist said to me, oh, you mean like at a zoo? And she starts laughing hysterically. And I'm not laughing. And then I don't know who came behind her, one of her coworkers or somebody, somebody that worked there in some capacity came in and asked why she's laughing. And I'm still on the phone. And she repeated what she said to me. She said that she had someone calling asking if we do observation. And she said, oh, like at a zoo? And she tells him that she said that. He starts laughing too. They're both hysterical, and I'm waiting until she's done. And I'm not laughing to see if she noticed that because I'm like, that is such a poor impression of this place. Like, you are the face, you're the receptionist, you're gonna make a joke like that and you're laughing, and I don't find that funny. That's the one place that called me back for therapy, but I—

I'm sorry.

Did not want to go with them because I got such a bad taste in my mouth from that first impression. Other than that, I would try places that did hybrid therapy or just telehealth because I do like telehealth since it's not like I'm forced to go in person and I can go when and if I want to. If I have help going— like that very first therapist I had, In 2022, I was able to go in person a couple of times because I did have a relative that was working from home at the time, and she was able to, to help me get my wheelchair in the car and get over there. That circumstance has changed. I like any kind of method that works for me, and telehealth seems to be the easiest one. I've tried places in other parts of Florida that are only telehealth. And I would just get automated voice machines or these AI assistants that would pick up. So it's been hard to talk to a person or to have anyone call me back. And then I would tell case managers, not getting calls back. It's been a circle of get a referral, try it, don't get a call back. And that's been the experience I've been having except for the time I was with BetterHelp.

And on top of all of this, you're also grieving the loss of your best friend. How has that layered onto everything else? And what does it mean to you to have a therapist who already knows that part of your life?

I've never lost a best friend before, somebody that close to me. And I lost somebody who understood me. It's hard because that person was also in a wheelchair. So we were able to share that feeling and talk about what it was like to be adults who had independent lives in young adulthood and had our own cars and was able to go out and get a job and do things. And we both lost our mobility pretty early on in our adulthood. Right around the same time. He lost his maybe a year or two before I did, and I lost mine in 2022. It's been hard not having somebody who understands that you were thriving and you had a life where you could do things, and then now you can't because you're stuck in a wheelchair. We definitely kept each other going. It's hard to talk about. That's why I feel like I'm talking about it casually, because if I think too deep into it, I'm gonna be emotional. That's why I sound the way I do now. It's been tough when I'm dealing with living a life that the people around me don't understand. My family, even though my family went through trauma with my dad, they process it differently than me. And they're the type that can keep on going, and they've never been to therapy. They've been able to push through. And I'm like, I am not okay. I need a lot of help trying to survive my life and cope with it. And My 2 brothers and my mother deal with it differently than me. Friends don't understand. People not understand child abuse, which is a good thing. But for me, it's hard to feel like I fit in. But this person did not have a childhood like I did. He had a great upbringing, a great childhood. But he tried to understand, and he tried ...to be empathetic and listen to me. It's not that some of my other friends don't. I know they do in their own way, but he took the time to really try. And I think it's 'cause we both had the time to take, because when you don't have your mobility, you have more time. And he was very sick, so we just had the time to try and understand each other and...

Yeah.

relate about life without mobility and losing that and mourning and grieving the people that we were when we were independent, even though we didn't know each other at that point. We met in the beginning of 2022. That's been hard. And other things about it have been hard. But having a therapist that knows the story, became invested in it, it's like the way she talks about My best friend that passed liked him so much, and she's told me that if she got to meet him, because he was a great person and very supportive, and he allowed me to support him. So having a therapist knows why it's hard and knows the background about the trauma and the abuse I've dealt with and feeling misjudged and misunderstood, it just makes it easier to not have to explain that again and for her to recall certain things. So if I were to tell her about something new that came up that was really triggering, she might recall something that I talked about, about my best friend. Like maybe if something happened with an interaction I had that wasn't good, and she would bring up, but did this person treat you this way? Or, you know, how did they— how would they have related to you? Would they have understood you? It would help me piece together why certain unpleasant interactions now can be so triggering besides me having a trauma, but also losing somebody that understood me so well. And the fact that she could recall that in a session and make sense of it would help me understand why I get so triggered with certain things and if a certain interaction with people Or a person might go wrong. It was helpful. It was easier. It was nice to have somebody in on the story, took the time to listen to the story too of my best friend. It didn't get covered in one session. There was a lot to that story. So she took the time and remembered it so well and truly cared about it. Safe and good and useful in other sessions.

There's a particular kind of exhaustion that comes from having to explain your whole story to a new provider from scratch. Have you been through that before? And what does the idea of losing this therapist and starting over feel like from where you're standing right now?

I have experienced that kind of exhaustion, and it is hard to explain and get a new therapist to understand you and repeat yourself because it's triggering. To relive certain things, because with every new therapist, you have to go through an intake process. I've gotten some intakes, and then I didn't get the phone call back after. So I might have gotten that initial intake, but then I have no therapy. So with the issues I've had here with insurance not covering therapy after they started and abruptly stops, and then— I might get an intake. Between that happening and creating uncertainty that I didn't have in New York, I feel another layer of exhaustion that, like, okay, I might be able to explain this, but am I gonna get a callback? Or how long will the therapy be covered? Like, is it worth getting into? Is it worth telling a new person this story? And— Trying to build a rapport when I might not see you after, like, 3 or 4 sessions. It's tiring to do the whole thing over and over again with that uncertainty and everything I've been experiencing here. It makes me want to give up at times. Like, is it even worth it? But I know that I need therapy. I really, really, really need therapy. But there are times where I just want to quit because I'm tired. I'm tired of trying and talking about the beginning. Because I feel like I can't move forward in my treatment if I keep having to go back and get stuck starting over again. It's not good for me. It's not good for anyone to be in that loop. And it's lasted for a long time. Until I can get housing back up north, which I have no idea how long that'll be, that stuff takes forever. But until I can get a place back up north, I'm here dealing with the uncertainty and the limitations of Florida health insurance, and the idea of never being able to see my therapist again is scary. It's scary to think that I might not get to see her again. But if I do get the chance to stay with her and see her again, it would take weight off for sure, and I would feel like we could pick up where we left off and move forward. Instead of going back to the beginning again. I don't have to worry about somebody not calling me back. I would just know because we've established that relationship. Right now, she's aware of the fact that we're on a financial pause. And that's actually the term she came up with, was financial pause. She has told me that she knows I'll be back. She said she doesn't know when, but she said she knows I'll find a way back. That did make me feel like somebody really believed in me. She kind of made me believe in myself, and that's what motivated me to ask for help when all my other efforts to earn the money and find the money haven't been successful. I remember her words that she knows I'll be back. I do want to go back, move forward, and know that I'm not going to be in this loop, and I'll be able to have that rapport however long we can, and it'll lift a burden. One of the many burdens I carry. It'd be nice to have one lifted, to be able to stay with her.

What I keep hearing in everything Cynthia just shared, and what I think you heard too, is not someone asking to be saved. She's asking to keep something that's already working. That's a different ask. And it's a harder one to refuse. As of late 2025, 40% of the US population lives in a mental health professional shortage area. Only about 27% of the need in those regions is actually being met. Approximately 35% of psychiatrists don't accept insurance at all, compared to just 7% of other physicians. The average insurance reimbursement for a therapy session sits at $111, while the average private pay rate is $159. That 36% gap is why therapists are leaving insurance networks at an accelerating rate, and why when you look at an insurer's approved provider list, a significant number of those names Either no longer practice or haven't accepted that insurance in years. Clinicians and advocates call them ghost networks. And in May 2025, enforcement of the Biden-era mental health parity regulations— rules designed to make insurers treat mental and physical health equally— was paused. With enforcement stalled, Insurers have broad discretion in determining coverage limits, making access inconsistent for millions of people across the country. This is the system Cynthia walked into when she tried to find covered care. It wasn't bad luck. It was math. There's one more piece of this I don't want to skip over. Because it's the piece that gets left out of the policy conversation almost every time. Cynthia isn't just navigating a broken insurance system. She's navigating it from a wheelchair while managing mental health conditions that make the navigation itself harder while grieving. Here's what NAMI's research tells us. Many people with disabilities experience traumatic stress due to the painful treatments received for their physical condition, as well as depression and anxiety from the isolation they experience. And physicians often treat the physical issues while viewing mental health symptoms as a byproduct, something secondary, something to manage. Rather than treat. So you're fighting for care on 2 fronts at once, and the system keeps handing you forms. Now I want to bring in 2 experts whose work sits right at the intersection of what Cynthia just described and the system I just walked you through. First, Lori Groh is a licensed professional counselor psychotherapist, and women's mental health advocate based in Milwaukee. As the owner of Shoreside Therapies, she specializes in trauma, burnout, and the compounding mental load that too many people carry without enough support. Lori, I'm glad you're here. And joining us as well, Ronni Chola. Ronni is the face of healthcare and behavioral health access at Pacific Health Group. Where he leads strategic partnerships across healthcare systems, insurance partners, community organizations, and government agencies. His work is focused on one thing: closing the gaps that keep underserved people from getting the care they need. He's a passionate and direct voice on the barriers people face when trying to access support for serious mental health concerns. Welcome, Laurie and Roni. From where you sit, not the policy version, not the textbook version, how would you actually describe the current state of access to trauma-informed mental health care in this country? Let's start with you, Laurie. Then, Roni, you can complete the picture.

Access to trauma-informed care has improved. In that more providers and more organizations are investing in that. But that is a heavy cost for a lot of providers. The training, certification, all of that is a lot for providers. And so what that means for clients is that access probably isn't going to be Very good. When I'm working with clients, they a lot of times have been through different providers. They're not necessarily being heard or understood. Sometimes it's about cultural background differences. There's a lot of therapists out there that aren't trauma-informed, that somebody might come to them with an issue and they might not even know the questions to ask or what types of treatments would be most beneficial. The reality of a client that needs help, not knowing where to start. I think that impacts clients substantially. They're going to be calling different numbers to see, okay, who can see me? A lot of practices do this, but one of the things that we do is if somebody calls us and they're in crisis or in a really difficult spot, We don't just say, we don't have somebody here that matches your needs. We give them at least 3 resources, at least 3 options that we trust, people that we value and believe can help. That should be a part of all practices so that when somebody's calling, they know they're going to leave that conversation with some direction. Even if it's not with the place that they're calling. It's overwhelming for individuals when they're in that state to get the help that they need. And there's costs that become an issue, but we're not recognizing that training on top of our schooling of getting our master's degree that many therapists are still paying back loans for. Does additional, very expensive training And there's a gap because there could be a lot more people getting trained, but it is expensive. The payout for a lot of those clinicians, it doesn't increase what a clinician actually makes when they are doing trainings like that. And that impacts how many people are getting trained, right? A lot of therapists have big hearts and want to pursue these trainings to help. clients, but on the back end, a lot of therapists are getting burnt out and not being able to pay their own bills. So it's creating quite an issue in our field, and that trickles down to the clients.

From the community access side, I see this differently than a clinician would. If somebody were sitting in front of me asking, why is this so hard? I'd tell them because asking for help is already hard enough. Finding it shouldn't make it harder. Life is hard. Maybe you've tried before and it didn't work. Maybe somebody said they'd help and never followed through. Or maybe saying, I need help, took a lot. That moment matters. I'm here now. You're here now. Let's work with what we have right now. We can't change yesterday, but we also don't have to let yesterday make every decision about today. I believe access is a two-way street. If we do our part, we have to encourage people to stay engaged. If you don't have a phone today, but you have email and you're working on getting a phone, okay, let's work with what you have. When that changes, reach back out, let us know, let's keep things moving. And if I see you again, I'm going to ask, hey, what happened? Did you get connected? Did you get the phone? Did you lose the information I gave you? What is it that you need from us right now? And honestly, that's not pressure. That's follow-through. If we say we're going to help, our word has to mean something. If you tell us you want the help, we're going to keep encouraging you to take that next step. Nobody has to do everything at once. But we have to keep showing up. When somebody finally says, I'm ready, we need to be ready too.

Ronnie, you work directly with the systems, the insurance partners, the community organizations, the government agencies. From that vantage point, what does the access gap actually look like on the ground?

That word technically Really stands out to me because somebody can technically have coverage and still be nowhere close to actually receiving care. You can get somebody enrolled, you can submit the referral, you can give them a phone number or an email, and on paper everything looks like it worked. But did it? Did somebody answer? Did the person know what to do next? Did they have a working phone, a reliable email, internet, or even a way to follow up? And if something broke down along the way, did anybody notice? That's the gap I see. Sometimes we get so focused on completing the process that we forget to ask whether the person actually made it through the process. So many handoffs. One organization does its part, another organization does its part, and somewhere in between, the person we're all supposed to be helping can get lost. That's why follow-through matters to me. A referral should be the beginning of the connection, not the end of our responsibility. Sometimes access starts before healthcare. If somebody doesn't have a reliable phone or email, what do you have access to right now? And where can we help direct you so that next step becomes possible? Because I don't measure access by whether we gave somebody information. I measure it whether that information actually helped them get somewhere. And that is the difference between coverage on paper.

There's a phrase I keep coming across in the research, ghost networks. A lot of people listening right now have probably experienced one without knowing there was a name for it. Laurie, can you break that down?

Yeah, ghost networks. This is interesting because this has been around for a long time. I didn't realize that people were using this term back then. Becoming so aware of this phenomenon, but basically insurance directories will showcase their therapists and they might show dozens and dozens of therapists that accept your insurance. And so it will look as though they have many choices, but then when that client starts making those calls, They realize that the therapist might have a huge long waitlist. They might find that a provider no longer accepts the insurance, may not be taking new clients, or that they don't have the trauma expertise the client needs or whatever particular specialty that client needs. This creates a huge problem going back to When somebody's in the worst part of their life and now they're searching around, it's horrible. It's so isolating and people just don't know what to do. Another is that a lot of therapists are with clients all day. They might not be able to even get in touch with an actual person. They might not get calls back. I do understand where the therapist might get overwhelmed. And not be responding. I don't think it's a good thing, but I do get how that could happen. If somebody's seeing 8 to 10 clients in a day, they might not even have the capacity to respond to somebody asking about services. It does put this burden back onto somebody that's already in distress. I don't think it's malice with the directories. They don't prioritize Having up-to-date directories. Sometimes it's just a matter of not updating and they might not update it for years. We still once in a while will get a phone call saying Lori's in network and I haven't been in network for 14 years. It's just because they have something in their system. If you search for a particular thing in a particular way that it'll pop up.

Insurance reimbursement rates for behavioral health visits are significantly lower than for many other medical visits. Laurie, what does that disparity actually do to the ecosystem of available providers? Who bears the cost of that gap?

Well, it doesn't go away. Initially, what happens is the therapist absorbs it. Ultimately, They will receive lower compensation or unpaid administrative work, like not having somebody to answer phone calls. Over time, what happens is a lot of clinicians end up leaving the whole field. Sometimes that cost ends up limiting everybody. So the clinicians at first might be absorbing that, then it goes to the clients. They bear that next level of cost. That next level of cost is not all the time financially, but it's the cost of care not being available. And it's really unfortunate. They might not go, they might not be able to get treatment at all because they're on a waitlist that's very long. And then we go into the families, right? They absorb those effects, caregiving, missed work. Relationship issues and strain, and then financial issues. Employers also bear some of that as well, where some of those costs are really high for a lot of businesses. One of the things we do to help is we have interns that are highly trained and skilled to give a very low sliding scale for those individuals that might need that care. It's one way that I have found that can help make a little bit of a difference, but it is just a drop in a bucket. The other thing is I created with 2 other founders an app for wellness to help businesses reduce their overall mental health costs. So there's things we can all do, things that we can make this area thrive. But it is definitely in a dire spot as far as my lens.

For someone living with a physical disability alongside a mental health condition like PTSD or severe depression, you just heard Cynthia describe it. The barriers don't just add up, they compound. Laurie, can you speak to what that looks like clinically And why this population so often falls through the cracks.

Yes, it does compound. The physical disability and mental health concerns usually go together because if you just think about it, how would they not, right? Physical— our physical well-being impacts our mental health and vice versa. And the system right now sees everything as separate and So like scheduling is a big barrier of going to a lot of different providers and it can be very overwhelming. It can also be hard to advocate for oneself when they have not only physical barriers, but mental health barriers as well. It is a very complex system. The medical system is very complex and same with the insurance system. It becomes challenging to get all the care that somebody needs and have them work together. This is an issue because you might be getting different answers from different people. I've seen this happen even with individuals that are doing quite well and understand the medical field, still struggle with how to get the appropriate care. So the people that have the greatest needs being asked to overcome the greatest number of barriers. This might be inaccessible office, or sometimes the telehealth platforms might not accommodate. They might also have insurance restrictions. And having clinicians who understand both Is a niche as well. I'm gonna plug Amber at Shoreside who does work with both. And Stacy at our practice also works with both. Having that clinician that really does understand how complex it all can be will be able to give that support and help family members understand it because it can be overwhelming. So the financial barriers can also be an issue. You're looking at medical bills, mental health bills, and disabilities that can affect work and employment and income then becomes difficult to cover the expense of that, especially when you start to talk about specialized care and specialized support. That's why that Population becomes one of the least served. It's because the system expects the people with the least amount of resources to be able to perform the most coordination, which doesn't make sense ultimately. Yeah, so there is so many things that can get in the way of care, and you're basically doubling it and then having. Double the issues.

Therapeutic continuity, staying with the same provider over time, is something clinicians talk about as critical. Lori, what does the research actually say happens when someone loses that relationship mid-treatment and has to start over?

Research is clear that the therapeutic relationship is one of the most important parts of somebody getting better and whether or not therapy is helpful. The analysis covering 25 studies and more than 30,000 patients found a reliable association between therapeutic alliance and treatment outcomes. This is a well-held truth in therapy. And so that is why— There's so much focus and education on The therapeutic alliance and relationship because it is a very fragile thing. And so we have to always be paying attention to it and careful with it. With a transfer of care mid-treatment puts the problem of the system back on the client, right? There's a lot of times there's legitimate reasons therapeutically for there to be a transfer. Typically it's because it's outside of that therapist's scope. Yes, sometimes it is financial, but it is extremely exhausting for the client because they now have to rebuild a relationship, especially if a relationship is part of why they're in treatment in the first place. It can be really damaging and they have to retell difficult traumas, stories to a new therapist can be very frustrating for a client. Usually when a therapist and client have a good rapport, there tends to be this really high level of safety. You can do a lot more hard, difficult work when that's strong. You lose that, and that's not a gimme. That's not an easy thing to have with any therapist. There tends to be a shared language, shared knowledge and understanding of the client's history and patterns. It is more than just— with other conditions, you can send those medical records much more than information. And so that's why it becomes very frustrating when the system gets in the way of that. Really clear example is when somebody moves. It is very strange to me that we still have these systems in place that say, unless you're licensed in a particular state, you can't see that client. Sometimes you have to be in the same place as the client. There's rules that get in the way of the continuation of care. For a client, insurance changing happens for a lot of clients. And so they have to change therapists. This erodes progress. The rebuilding of a relationship has to restart.

In May 2025, enforcement of the Mental Health Parity regulations was paused. Laurie, for someone who isn't a policy person, which is most of my listeners, what does that actually mean for a real person trying to find care right now?

This is not my area of expertise, but it did have a shift in the accountability of insurances. Saying that mental health therapy is covered is one thing, but the reality is another, right? You can have a list of 20 providers on that insurance panel, But as you start calling, they're not on that insurance panel any longer. And what some of this does is that makes insurances less accountable for things like that. So are mental health providers leaving networks because reimbursement's too low? Probably for a lot of times. But questions like that, they don't really have to answer. So they can say that they pay for therapy even though there might not be an available provider. So the promise of equal coverage is there, but harder to hold the insurers accountable.

Ronni, you spent your career building the partnerships that are supposed to close these gaps across insurance systems, community organizations, Government agencies. When you look at someone like Cynthia, what does her situation tell you about where those partnerships are still failing?

I can't really speak to the business model of a specific platform, but that question points to something larger. If somebody finds a pathway to care that works for them, but cost or coverage keeps them from using it, That's an access issue. That's why, from my perspective, telehealth is another important pathway to care. The more legitimate pathways people have to connect, the better chance we have of reaching them. But what matters to me, a pathway only works if people can use it. People don't all start from the same place. What works for one person may not work for somebody else. So instead of asking whether telehealth is the answer, we should be asking, does it make access easier for this person? And that's where listening to the community matters. We can sit inside organizations and talk all day about what services are available, but the people trying to use those services can tell us where they're getting stuck. If we listen to that, we can build better pathways. Because to me, access isn't about how many options we can say we offer. It's about whether somebody can actually use one of those options to reach care. And that's where I think telehealth belongs in this conversation, not as the answer for everybody, but as a tool. But as another opportunity for somebody to get connected.

For someone navigating both a physical disability and a serious mental health condition, trying to hold on to care that's already working, what does the path forward actually look like from a systems standpoint? Ronnie, what needs to change and where does that change have to start?

Listen to the people who are trying to access care. Because sometimes the barrier that looks small can feel enormous to the person on the other side of it. And then we have to do something with what we hear. Healthcare providers, community organizations, public agencies, insurance companies— we all have different roles, but the person trying to get help shouldn't have to understand how all of our systems work. That's where partnerships matter. We need to talk to each other, share what we're learning, pay attention to where people keep getting stuck, and build stronger pathways so somebody isn't constantly being handed off and asked to start over. For ordinary people listening, don't underestimate what it means to show up For somebody. Listen, treat people with respect. Help them find the next step if you can. If you tell somebody you're going to do something, follow through. Trust isn't built through promises. It's built through what we do after we make them. We may have different roles in this, but the responsibility is shared. If we want people to keep showing up for help, we have to keep showing up for them.

I'd like you both to close out the segment with this last question. Ronny and Laurie, for someone who has found a therapist that works, built something real, and is now losing that access because of cost and coverage gaps, what's your message to them Directly. Ronnie, let's hear from you first, then Lori can deliver your message.

Don't let this setback convince you that you're back at the beginning. You found somebody you've trusted, you built that relationship, you did the work. Losing access to that person doesn't erase any of that. I'm not going to tell somebody in that situation that it's easy, Because it's not, but don't stop asking what's possible. Ask about your options. Ask whether there are other resources or pathways available. Reach out to the people and organizations that may be able to help you navigate what comes next. And if the first answer is no, that doesn't necessarily mean there isn't another path. Don't disappear. From your own journey because another barrier showed up. You've proven that you can take the first step. Now keep on taking the next ones. And for those of us working on the access side, this is where our responsibility comes back in. Listen, help people understand what options they have, point them in the right direction, and Follow through, because somebody who loses access to care shouldn't also lose the feeling that somebody is still willing to help them find their way forward. That's what I'd want them to know.

Don't give up. A lot of times the therapist ends up taking the financial burden, but a lot of therapists accept it. Ask, can we do a financial hardship form? We work something out until I can get a new job. A lot of times therapists will do their best to maintain that care. Ask for some options. If it's meeting that therapist once a month to maintain that relationship and asking for additional homework or reading, I've done that before for people with a discount. It's figuring it out together and your therapist will do the best that they can to help you. If you do end up seeing a new therapist, ask your therapist to have a conversation with them. A lot of times therapists are iffy about sending records. We try to protect that, but you can ask for a conversation. You can ask for a summary. Your therapist is gonna help you usually at least one session to go over some of those things they can take to their therapist that they're moving on to. That's the part that matters the most, that transition is as smooth as possible.

Thank you, both of you. That's the kind of clarity this conversation needed. A clinician and a systems builder looking at the same crisis from different sides of it and arriving at the same place. The people who need care the most are the ones the system makes it hardest for. I know some of you listening are in a version of this right now. So let me share a few things that are actually worth knowing. If you're looking for care and hitting insurance walls, ask specifically about sliding scale fees. Many therapists who left insurance networks still use them. Check if your state has a Mental Health Professional Shortage Area designation that unlocks additional resources. Community mental health centers are required to see people regardless of insurance. They're often overwhelmed, but they're an option. Platforms like Open Path Collective offer sessions at reduced rates with licensed providers. If you've found a therapist and are at risk of losing access, talk to your therapist directly about options. Some have flexibility they don't advertise. Document your treatment history and any insurance denials. That documentation has real value if you ever file an appeal. Know that under the Mental Health Parity and Addiction Equity Act, you have the right to appeal coverage denials. You have 180 days from a denial to file an internal appeal. And if you want to support Cynthia specifically, her GoFundMe is in the show notes. She's raising $2,800 to keep one year of therapy with a provider who already knows her story. Every share matters as much as every dollar. Let me bring it back before we close. Today we talked about 3 things. First, Cynthia's story, a woman living with disability, PTSD, depression, anxiety, and grief who found a therapist that worked, built a real therapeutic relationship, and is now facing losing that access because of cost and coverage gaps, not because she stopped trying. Second, the system that made this possible— provider shortages, ghost networks, reimbursement gaps, and stalled parity enforcement— all working together to make sure the people who need care the most face the most obstacles getting it. Third, what this looks like for people living with disabilities, a population that faces compounding barriers and whose mental health needs are too often treated as secondary to their physical ones. This isn't a problem waiting for a future policy solution. It's a crisis with a present-tense human cost. Before I let you go, I want to bring Cynthia back for a moment because this is her story and it deserves to end in her voice. You started a GoFundMe. That takes real courage. What was it like to make that decision, to ask publicly?

Making the GoFundMe was hard, and I feel guilty. Because it's hard when our economy is not great right now, and a lot of folks are struggling. It's hard to say, hey, I need help. Can you help me? You don't know me. It's hard to feel good about that. But I got to a point where it's like I just had to do it and hope that if anyone's able to, even in the smallest ways, Supported and hope and pray that everything adds up to what I need. That's basically where I'm at. And I've had to tell myself that I wished I didn't have to do this. I tried certain endeavors with social media and tried to come up with different ideas and different ways to make money on my own and look for remote jobs that were super part-time. But I'm like, I just— I just know I can't even keep up with a job right now. So it definitely made me feel like I'm taking the quote-unquote easy way out. But I'm like, there is nothing easy about putting yourself out there and saying, I'm in such a state that I can't really help myself. I need help from strangers. It's hard. It's not something I really ever pictured myself doing. But it's like I just have to. There are times where it's like you have to accept that you may have to do things that you don't want to do just to get by. That's where I'm at. It definitely wasn't easy, but right now I'm just kind of accepting that it's not something that was my first choice, but— I know that having my therapist from BetterHelp is truly what my heart needs. It's what I need as a person. And if I have to put myself out there and ask for help and see if this works and is successful, I won't know unless I ask. It might not be as successful as I'm hoping it will be, but I won't know until I try. With everything else that I tried before this, This is just another thing that I've had to say, well, I have to try it and hope and pray for the best.

If someone listening right now is in a similar situation, disabled, grieving, stuck in that same insurance gap, what do you want them to know?

What I would tell someone in my situation is that if they need to ask for help, For their own livelihood, then ask for help. Because I know that my challenges are pretty unique with living in an area that I grew up in where I dealt with child abuse. It's hard. And I know that, like, I'm in survival mode right now, and somebody else might be living in survival mode, and their situation might be a little bit obscure, you know? And only they know their full story. People can share as much as they want to share, but nobody can really convey what it does to their livelihood, how it affects their quality of life. And we only know that on an individual level. I know how much my heart needs my old therapist. So that's why I'm asking for help. And somebody else who's in my situation, disabled, depressed, PTSD, whatever it is, They know if they can push through, and if that works for them, then do that too. But if asking for help is what's gonna work for them, and if they can't push through, then do that. Do what works for you. Don't feel like you have to push through if you can't. Don't feel like asking for help is so taboo. Like, no, like, we can ask for help. If we need it, it's okay. It's gonna be uncomfortable, but if you really need it to survive and to get by and to try to improve the quality of your life just a little bit, then don't be ashamed. I think people would rather you ask for help than not ask for help and your quality of life gets to a point where you don't wanna be in it anymore. I don't want for myself. I want to enjoy my life. I want to have the therapy that's going to help me. If somebody else needs that, do what you got to do and be willing to talk about it. Be willing to share your story because no one's going to know your story and no one's going to know what you need unless you tell them. And it's something that could save your life.

Cynthia, thank you for trusting this show again, for your honesty, and for being willing to put a real face on something millions of people are living through quietly. Lori, thank you for the clinical grounding and the genuine care you brought to this conversation. And Ronnie, Thank you for showing up and saying plainly what too many people in your position won't, that these gaps are structural, and that's where the work has to happen. If this episode moved something in you, please share it. For an independent show like this one, every share is how we survive and how we grow. A like, a follow, a forward to one person Who needs to hear it. That's how the work keeps going. If you want to support Cynthia directly, her GoFundMe link is in the show notes. She's raising $2,800 for 1 year of continued therapy with the provider who already knows her. And if you'd like to support the show itself, you can find us at gofundme.com/recoverydialogue. If your organization's mission aligns with what we do here—mental health, recovery, access, advocacy—and you're interested in sponsoring an episode or a season, the door is open. Reach out. Let's talk. And if you want to wear your support, our Merch with Meaning collection is live at recoverydialogues.com. Hoodies, tees, mugs, joggers, caps, even cuddle toys. Every piece helps keep this show independent and this community alive. I'm Antonio Mada. Thank you for being in this with us. Take care of yourself and each other. Recovery is possible.

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