But in rural Amador County, where she lives, mental health providers are few and far between, and it took Moen about two and a half years to find help.

“I was actually turned away,” she said. “I was told that my mental health problem wasn’t severe enough. I had to get to a point to where suicide was a thought for them to help me.”

All across the state, but especially in rural areas like Amador County, finding a therapist is challenging. California has a “major, ongoing” shortage of mental health providers, and it’s “especially dire” in rural areas, according to a 2022 survey commissioned by the state. Nearly one-third of California’s residents were living in an area with an insufficient ratio of providers to patients, the report found.

In 2021, state leaders began pouring hundreds of millions of dollars into increasing the pipeline for therapists, but many students say the educational requirements are still too onerous or costly.

Part of the problem is that it takes a long time to become a therapist. Every licensed therapist needs at least a bachelor’s and master’s degree. Psychiatrists have a medical degree, and psychologists often have a doctorate. For the master’s degree route, which is most common, students can take a variety of different paths, including programs in social work, marriage and family therapy, clinical counseling or school counseling. Most master’s programs take about two years and some cost over $60,000. Often, students have to work hundreds of hours in an unpaid internship in order to graduate.

Then, after graduating with a master’s degree in social work or marriage and family therapy, they have to spend at least 3,000 hours under supervision before they can bill most insurance companies for their services. Some graduates take up to six years to meet their required hours before they can make a regular salary as a therapist.

The long road to becoming a therapist

On Jan. 21, 2011, Moen asked a neighbor to babysit her 2-year-old son while she went to work at a local U-Haul store in Cleveland, where she was living at the time. The babysitter attacked the boy, strangling him. Moen said she found her son’s body when she came home from work that evening. She said the babysitter was asleep on the couch.

“For a long time that image was burned into my brain,” she said. “That whole situation is what started my mental health problems: My anxiety, my constant thought of death, and PTSD.”

She moved to the Bay Area, where she became homeless. But in 2017, a friend helped her build a new life in Amador County, where the cost of living is much lower. She found a job at a casino and began reflecting on her own mental health, ultimately deciding that she wanted to become a therapist to help others like her.

She started college in 2021 but it’s unlikely she’ll reach her goal before 2030. With the help of a private scholarship, she started taking online courses at a community college in Orange County but had to stop after being diagnosed with cancer.

She re-enrolled in 2024 and is now taking a full course load while simultaneously homeschooling her daughter. Through the scholarship, she also found a paid internship at a local organization, the Sierra Wind Wellness and Recovery Center, which offers mental health services. She said she’s maxed out her federal and state financial aid, receiving just under $20,000 this academic year, though she said that’s still not enough to cover the cost of housing, food and transportation.

“The money is not the most important part to me,” Moen said. “I’m doing it because I want to be able to add to this lacking workforce. I know that we don’t have enough so I will be one extra person to help.”

If all goes according to plan, she’s set to graduate with an associate degree in social and human services in January, at which point she hopes to transfer to either Cal State Chico or Humboldt and pursue a bachelor’s degree.

Then, to become a licensed therapist, she’ll need at least a master’s degree. Along with two additional years of school — and more if the student is part-time — the master’s degree programs in social work require at least 900 hours in an internship, which is typically unpaid. Master’s programs for marriage and family therapists require 225 internship hours. While social workers and marriage and family therapists can offer similar mental health services, social workers have a broader training and more potential career paths, said Kimberly Warmsley, the former executive director of California’s association of social workers.

For many master’s students, meeting the internship requirement often means quitting a part-time job. While pursuing a master’s in social work at California Baptist University, Assemblymember Corey Jackson, a Moreno Valley Democrat, continued to serve as the CEO of a nonprofit organization, but he left that position in order to take an unpaid internship that would meet his graduation requirements.

In an interview with CalMatters, he said he still has “a little over $40,000” in student debt for that program, plus another $40,000 because he pursued a doctorate.

Are interns employees?

In the Legislature, Jackson helps oversee the state’s licensing board for mental health providers, and he is pushing for a law that would make it easier for some out-of-state therapists to get licensed in California. But the workforce shortage requires major investments and has no easy solution, he said.

“It reminds me of the housing crisis, the homelessness crisis. We have dug such a big hole, especially with so many retirements and people who have left the field.”

A group of social work students across the country is advocating for more graduate students to be compensated during their required internship hours, and the movement, called “Payment for Placements,” has chapters at seven California universities, including San Diego State, UCLA and UC Berkeley.

While social work master’s students are required to work at least 900 internship hours, San Diego State’s program asks its students to work 1,050 hours. For Jacqueline Guan, a student in the program, these required internships “should be compensated labor.” Like Jackson, she said she quit a full-time job in order to take on an unpaid internship.

Organizations and government agencies that offer unpaid internships take on additional liability by hiring graduate student interns and the students get a “unique training opportunity,” said Amanda Lee, the director of field education at San Diego State’s School of Social Work. While these employers aren’t required to pay interns, she said “quite a few students” receive some money, either through their employer or through a fellowship.

Assemblymember Jackson said he “absolutely” supports paying more social work students for their internships but hasn’t pushed for it in the Legislature. “It’s hard to advocate for additional funds for just about anything right now,” he said, referring to the state’s fiscal uncertainties.

Instead, he said he’s interested in expanding loan forgiveness and limited forms of tuition assistance, as well as finding ways to improve social work licensing exams, which have disproportionate pass rates for certain groups of students: those who identify as Black, Hispanic or Native American score lower than their peers.

The ‘toughest’ clients with the fewest mental health workers

In 2022, San Diego County found that it needed roughly 8,100 more mental health providers to meet the region’s demand — but that 7,800 were likely to leave the profession in the following five years, either because of retirement, burnout, or other reasons, such as a career change.

All across the state, mental health providers are nearing retirement, according to the 2022 state survey, which found that roughly 40% of psychologists and certain kinds of therapists were over 50 years old. Demand for mental health services is going up too, especially after the COVID-19 pandemic. 

In 2021, Gov. Gavin Newsom launched a new initiative, pumping $4.4 billion into youth behavioral health, including $700 million to train the next generation of providers, said Andrew DiLuccia, a public information officer with the state’s department of health care access. He said the money has mostly been spent and has created thousands of new scholarships, grants and training programs.

More therapists may soon join the workforce. A 2025 state report found that the number of licensed social workers, marriage and family therapists, clinical counselors and school counselors has increased by about 3% over the last five years.

But those new therapists may not work in the areas with the highest need. In Solano County, where the Bay Area’s suburban sprawl mixes with rural farming towns, recruitment is a persistent challenge, said Jennifer Mullane, director of the county’s behavioral health department. Private hospitals, such as Kaiser, pay better, she said, while many other therapists want to do telehealth or private practice. “We have to compete with all of the Bay Area counties for the same workforce and you can guess how we fare,” she said.

The Solano County behavioral health system served more than 5,300 patients last year, said Mullane, including some of “the toughest clients” — those with mild to severe mental illness, such as schizophrenia or substance use disorders. And yet, she added, “We have the smallest workforce pool to draw from.”

Her department is supposed to have just under 290 positions but she said that about 20% are currently vacant.

Vacancies also persist in Amador County, where Moen lives and which is designated by the federal government as an area with a shortage of mental health providers. Roughly half of California’s counties meet that designation, which reflects the ratio of providers to the number of residents.

“I like it here because it’s beautiful,” said Moen, who lives just below the snow line of the mountains. “There’s just not enough resources.”

She said she was recently inducted into an honor society at her community college, and it’s made her more aware of her own potential, including ways to advance policy that might improve her county’s provider shortage.

“I would like there to be a lot more trained providers,” Moen said. “And I would like there to be more affordable, attainable ways to get to these providers.”