Laura Lambert, LCSW-C, is the Clinic Director at Columbia Mental Health’s Bowie clinic. She provides supervision to early-career clinicians, drawing on experience across inpatient and outpatient settings and a person-centered, skills-focused approach. She also has a strong background supporting older adults through late-life changes.
In this interview, Laura shares how access to mental health care is changing, the role of telehealth, where insurance and licensing still create barriers, and how social workers advocate for equity across the DMV and beyond.
How access is changing
How has the landscape of access shifted, and what role has telehealth played?
I have been in the field in some way for almost 20 years and licensed for more than 15. I am originally from a more rural area, so I have seen access look different. In more recent history, things like the pandemic, school shootings, and the Black Lives Matter movement brought mental health to the forefront. We talk about it very differently now than when I first got into the field.
COVID was terrible for a lot of reasons, but it opened up telehealth in a way we had never used before. That meant more people had access to services who maybe did not have access before. People in rural areas, people who are homebound, and anyone with transportation issues could connect. For a while there was a laxing of insurance rules and some flexibility around state-to-state participation. Some of that has gone back to pre-COVID rules, but for a time it opened services for a lot of folks, and far more people are using telehealth today than pre-COVID.
What about crisis response and community programs?
We see a bigger emphasis on making sure mental health professionals are trained and working in teams. We have mobile crisis teams now that go out to people, not just police who may not have mental health training. Some areas have mental health agencies training specific police units. There are Assertive Community Treatment (ACT) teams wrapping people in services to keep them out of hospitals and jails. In places like Baltimore, there are programs for court-mandated mental health treatment designed to protect people and reduce unnecessary hospitalization or jail. It has caused a wider conversation.
Stigma is still there, but there is less than when I started, and more people are accessing services.
Insurance, payment, and system barriers
Where do people still fall through despite progress?
Insurance and the ability to pay are still gaps. Before the Affordable Care Act, I saw how many people could not access treatment. After, millions gained insurance, which was amazing. Barriers remain, though. Medicaid members have to reapply. If they do not know that, or if processing is slow, benefits can lapse. High deductibles are a problem. If you come to therapy weekly and have not met your deductible, it gets expensive. Some plans still cap visits, although that happens less now.
Reimbursement can also be a barrier. When insurers pay slowly or not at all, providers drop those payor sources. People with insurance then struggle to find someone who accepts it. Some entities try to keep services in-house, which creates long wait lists. Others refer out, but approvals can be slow and complicated. Licensing is another issue. The clinic I work in is in an area with many people who use Medicaid. We applied for our Medicaid license earlier this year and are still in that process. Until that is finalized, people who rely on Medicaid cannot schedule here.
How do real-time stressors affect care?
In the DMV area, we have many federal employees. During a government shutdown, some are not getting paid. People have to choose rent and groceries over therapy at a time when stress is rising. That tradeoff delays care when it is needed most.
How social workers bridge the gaps
When the system does not work as it should, how do you help people keep momentum?
Social workers are not only trained as therapists. We are trained in advocacy and case management. A core idea for me is helping people help themselves. It is not my job to fix everything; instead, I guide people on what I can do and what they can do. Inside our clinics, that includes advocacy for things like financial hardship applications. I also help people learn how to advocate for themselves, understand their benefits, and know what to ask before a bill shows up.
Social workers are also networkers. Through current work, past roles, and community connections, we know where the resources are or how to find them. Recently, a patient came in with an adult grandchild who was in a mental health crisis. The grandchild had been through a couple of different settings and kept getting released. Because of my background, I knew exactly where to send them and what they needed to do to get a full evaluation. They were not my patient, but that connection moved them toward the care they needed.
How do therapy skills help during hard seasons?
Therapy is not only “I am depressed, give me a pill.” We teach skills for dealing with depression, managing emotions, and handling difficult situations. Those skills translate when life gets hard. People can use them to take the next step, find resources, and keep from getting stuck.
What equity looks like in practice
How do you define equity, and what does it take to get there?
Equity is not everyone getting the same thing. It is people getting what they need. Access is part of equity. Affordability is part of it. Even people with employer insurance can struggle because coverage is pricey.
Quality matters, too. We stay current with research, invest in staff education, and provide strong supervision. Cultural sensitivity is also essential. Our clinics serve diverse populations, including many immigrants. We pay attention to who we hire across clinics, leadership, and supervisors. We want teams that reflect the communities we serve. When we do not have a language match, we use language services and maintain a live list of staff languages so our teams know who can help. Equity is not one change. It is many coordinated pieces that add up.
How do local differences shape services in the DMV?
I work near DC, Annapolis, and Baltimore, and we also serve more rural parts of Maryland and Virginia. Needs look different from Bowie, to Columbia, to Annapolis, to places farther out. As we spread out, we keep asking what access looks like in each place and we adjust so people can actually use services. Sometimes it is the difference between a dense metro area and a rural community. Sometimes it is simply whether a person can get across town.
What keeps Laura hopeful
What sustains your motivation for this work?
I look for the helpers. Media makes it feel like the world is always getting worse, but I try to remember the broader picture.
I believe most people are doing the best they can with what they have.
If I practice empathy and look from someone else’s perspective, I can understand how they ended up where they are, how choices were limited, and I can have compassion for that.
I also supervise new social workers, counselors, and prescribers. They come in excited with great ideas, and I like helping them grow into strong clinicians. On a personal note, my kids are old enough to ask what I do. One described me as a “feelings helper.” That still makes me smile and reminds me why this matters.
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