Therapist and entrepreneur Jessica Bruno, LMFT, knows that matching counselors with clients is a struggle. While more people than ever are facing mental health issues, the waiting lists are long at counseling practices.
Even those clients with insurance can be left on their own to struggle for weeks and even months while they wait for an appointment. Those without insurance and traditionally underserved populations often go untreated.
At the same time, potential therapists — young people with a calling to help those struggling with mental health issues –encounter a number of hurdles entering the profession. After rigorous graduate training, they must earn hundreds of clinical hours to receive even a provisional license, then hundreds more to be fully licensed. Universities offer little help, usually leaving the students on their own to find practices willing to offer internships.
So Bruno came up with a solution. She expanded her own practice, House Call Counseling & Healing Arts, to include a number of student interns. She pairs the aspiring therapists with the patients most in need – often those without health insurance or the means to pay for professional counseling on their own.
Her practice accepts no insurance, instead charging clients on a sliding scale according to their incomes. Many sessions are delivered via telehealth, eliminating the need for overhead like office space. Her therapists work on a contract basis – and her interns have the opportunity to do the same after they have become licensed.
Not having to adhere to the rigid structure of insurance frees up House Call to use interns and to be more creative in how care is delivered.
House Call Named One of Five HEIC Winners
In June, House Call Counseling was one of 5 entrepreneurial companies named winners of the 2nd Annual Health Equity Innovation Challenge (HEIC). The Challenge, sponsored by Atrium Health- Greater Charlotte North Area and administered by the Flywheel Foundation, targets early-stage businesses focused on addressing health care inequities.
HEIC offers winners a cash investment as well as mentoring and coaching from experts in their fields. Winners also have the opportunity to present to potential investors at ConvergeSouth, an annual 2-day conference for entrepreneurs. Bruno is particularly excited about presenting at this year’s conference, which will take place Oct. 3-4 at Wake Forest Biotech Place in Winston-Salem.
HEIC’s strives to provide promising early-stage businesses with the tools they need to grow and become scalable, therefore expanding access to services that improve the mental and physical health of as many people as possible.
“My goal is to significantly scale our program to ensure that everyone who wants mental health counseling is able to access and afford it,” Bruno said.
A Natural Entrepreneur
Bruno started her first enterprise — a photography business — as a teenager. But after college, her career got off to a rocky start in 2009 when a public relations/marketing job lasted only six months before falling victim to the recession. “I had my ‘aha’ moment and thought, ‘I want to go back to school.’”
A counseling graduate program seemed like a natural choice. Bruno had discovered her talent for putting people at ease and encouraging them to open up about their lives when a new friend from Egypt told her his entire life story in one conversation.
“We sat and chatted for hours,” she said. “And he looked at me and said, ‘I just told you my entire life story. How did you do that?’
Bruno became a licensed therapist, working at a hospital and running mental health programming. She loved it, but soon had the urge to accomplish more with therapy.
At first, she practiced alone but realized she wanted to expand her reach through a group practice. Later, as she was building a group practice of her own during the COVID pandemic, she had an idea that could help her profession and young people wanting to become therapists.
The Daunting Process of Becoming a Therapist
Becoming a licensed therapist is an arduous process. In addition to completing a challenging graduate school curriculum, students must intern 600 hours with a clinical site; half of that time must involve direct contact with clients.
And that’s not all. Once students are provisionally licensed, they must continue practicing under professional supervision for hundreds more hours to qualify for full licensure. There are a number of reasons practices may be reluctant to take on interns. They may feel they do not have enough referrals or enough staff to supervise interns.
Ironically, the universities offer little help.
“The school says, ‘Go find an internship,’ but most don’t help them find one. And so there are students who are dropping out of programs because they can’t graduate unless they find a site where they can complete an internship.”
After striking upon the idea of using interns, Bruno advertised the internship opportunity to students. Much to her surprise, she had more apply than she could accommodate in her practice.
“I needed to find a solution for all of them because they were counting on me to help them,” Bruno said. So Bruno called some of her friends working at local nonprofits in Winston-Salem. They included Green Tree Peer Center, which works with those struggling with mental health issues and substance abuse, and Solutions for Independence, which works with people with disabilities. Could those organizations use a student intern to work with their clients on mental health issues, even leading group therapy sessions?
The answer was a resounding yes.
MentalRest is Born to Partner with Universities
Now Bruno is forming a separate enterprise, MentalRest, to focus specifically on the internship component. It will work directly with universities to handle recruitment, referrals, and placement for interns. It will pay the private practices a modest monthly payment per intern for giving them supervision and opportunities to learn the day-to-day activities of a licensed therapist.
Expanding on the nonprofit aspect, every intern working under MentalRest will choose at least one nonprofit to work with, creating a free community support group.
At the end of the internship, the private practice will have the option to hire the newly licensed counselor.
“It’s helping that practice, plus, that practice is getting connected with a local nonprofit, leading to future collaboration and additional resources in the community,” Bruno said.
The formula is a win-win for everyone: The universities get help pairing interns with practices. The students get internships and a chance at post-graduation employment. The practices get extra revenue, a chance to have an intern do some office work in addition to seeing patients who need it most, a partnership with a local nonprofit, and a “community champion” credential from MentalRest for their commitment to supporting the community.
The nonprofits reap the benefit of having professional interns offer counseling services to their clients, particularly for underserved populations such as LGBTQ+ and the unhoused. And the counseling profession gains more therapists.
The holistic approach takes all the parties out of isolated silos, instead inspiring them to cooperate for the community’s benefit.
“We’re not competing. Let’s work together. Let’s pool resources. That’s what I would really like to do through this program,” Bruno said.
Interns Use Creative Approaches
Bruno’s first intern, Nick, showed her how her company can make a difference.
As a male, Nick was already in the minority of those entering the counseling profession. That is unfortunate for male patients who may be hesitant to talk to a female counselor.
Nick “visited the home of a family I had already been working with,” Bruno said. “The dad had a traumatic brain injury from a car accident a few years earlier, and his son was also struggling with some mental health and addiction issues.”
Nick saw a way he could help them both. He is a gardener, and the father and son had always wanted to grow a vegetable garden. So the three of them got to work, planting a garden while talking about their feelings.
“I wasn’t there to see it, but it just makes me smile to picture these three guys right there. They’re planting seeds. They’re moving dirt. And they’re talking about their feelings. They’re talking about life. And you know this is one of the beautiful parts of not billing insurance because insurance dictates what intervention you can use, how long you can meet, whether you conducted that meeting properly, and other things that might stifle creativity.”
And while the pandemic ushered in a new era of convenient remote counseling, it is not for everyone, she added.
A recent client on the autism spectrum, for example, wanted and needed to meet with a therapist in person. The intern came up with walk and talk therapy that perfectly suited the patient.
Unorthodox but effective.
“The world is shifting,” Bruno said, “but a lot of people are being left behind. And I want to change that.”
