starting a mental health practice

Ten steps to starting a strong mental health practice

Posted in Before Starting

Starting a mental health practice is no small task. Where does one begin? What are the steps to starting a mental health practice? How does one build a good foundation? This post outlines ten steps that are certain to get you going in the right direction. But before we begin, let’s talk about how long it takes to get started.

A note on the time it takes to do things

This post suggests a six-month lead-time before the Launch Day. I am quite aware that for most, the lead-time turns out to be less. And for most, it works out just fine though perhaps bumpy at first.

In truth, when starting a mental health practice, many of the tasks I suggest are overlapping. They rarely happen in the linear fashion I have outlined here. I write this to help you think through the many details within an adequate timeframe. You will do it your way and that is as it should be. As a suggestion, I have turned this post into a Checklist. Click here.)

I have also written a different article called The ultimate guide to starting a new mental health practice. There I focus on a high-level overview of the main areas of focus rather than the detailed step-by-step approach I take here.

1. Envision what you want and start your research

Six months ahead

As with any endeavor, starting a mental health practice requires a plan. And that plan begins with a vision of what you want to create. The practice will be yours, so it needs to fit with who you are. In many ways, a new practice takes the shape of the owner. That is part of what makes it so fun.

No doubt you have been thinking about starting a practice for some time. And now you are getting more serious. Start by thinking about all the experiences you have had in other therapy settings. Some may have been as a client and some as a clinician.

Write out your ideas and dreams. What did you like about the other practices you know? How were things set up that was appealing? What would make you excited to come to work each day?

Further out

And let’s think a little further out, as well. If all goes as you hope, how are you going to handle the inevitable problem of having too many referrals? Will you want to hire another clinician to work next to you?

Answering these questions will bring into focus the future decisions you will make about space and the infrastructure you put in place. Of course, one cannot afford to lease a ten office space right away, but if you know that you eventually want ten clinicians, that may affect the building you first lease in. If possible, you will want a building with the option of expansion without a significant move. See more about your decisions about office space here.)

Meanwhile, as you are pondering these topics, it is time to start your research in several areas. More specifically, start looking into these areas:

  • develop a list of some web designers, brand experts, and other consultants you want to evaluate
  • begin to list a few attorneys and CPA names to interview
  • collect some demos of practice management software that will work with your computer (see Step 7 for some ideas).

I suggest you focus on these areas early because they can be easily fit around other tasks. These tasks are just a matter of putting in the time to do internet searches and talking with other practice owners in your area. Collecting names and resources will help you later. Therefore, start early and chip away at it.

2. Decide on a practice name, tagline, and domain name

Five months ahead

Your practice name and your tagline begin defining your brand. For most, picking a name is also about finding a URL for the domain name used for your website and email. You can look up various options you are considering for your domain name here. GoDaddy is the largest company for registering domain names. Furthermore, they have tutorials and advice about building websites here.

Register your domain name as soon as you can since you will use it for many other things. And while you are selecting a domain name, pick a business email address as well. You could use your personal email for the next steps, but it is better to separate your business stuff from your personal stuff. It makes it all easier to keep straight and is more professional.

But what is a brand?

Meanwhile, let’s think about the less technical parts of creating a brand, First off, what is your brand? Here is one favorite definition:

Your “brand” is what your prospect thinks of when he or she hears your brand name. It’s everything the public thinks it knows about your name brand offering—both factual…and emotional….  Your brand exists only in someone’s mind.

Jerry McLaughlin. (2011). “What is a Brand, Anyway?” Forbes Magazine

I like this definition because it points to how much a brand is more than just a logo or your company letterhead. It is everything that goes into creating an impression of your company. (See more on branding in these posts: Branding: A name, some services, and how a dream become real and Growing pains: Outgrowing your brand.

The first impression begins with the name of your company. And not far behind is the tagline you use to say a little more. For us, we used a few tags. Words like “Growth. Healing. Hope.” Then we put our mission on the homepage of our webpage,

  • Provide Quality therapeutic care
  • Long-term commitment to serve our communities
  • Assist clients in a faith-sensitive manner

These taglines offer an impression of our organization. They begin to shape the perception of what people are going to experience.

3. Get a phone number, answering service, and liability insurance

Five months ahead

At about this same time, we should be securing a phone number with voicemail attached. Many start-ups use a Virtual Receptionist to handle calls. These come in two varieties. Some are services that have an actual person who answers the phone while you are busy. Others use electronic voice messages set up with different messages at different times of the day.

Don’t forget HIPAA

Of course, mental health professionals have some unique HIPAA requirements to consider. Companies like All Call Technologies and Phone.com have developed packages that are tailored to the mental health field. Importantly, they allow you to transfer your phone number to a landline if needed. You may not think you will ever need a landline, but if you grow to hire support staff, they will need a landline and, eventually, a phone system.

If you do not have malpractice insurance, you will want to purchase it. All the trade associations endorse providers of liability insurance. These rates and coverages are pretty standard and give you some confidence in the coverage. For example, here are the plans for APANASWACA, and AAMFT. One of these should do. You do not have to be a member to purchase these policies though you will get a discount though if you are a member. 

Five months ahead

There are several legal aspects of starting a business. It is best to meet with an attorney and a Certified Public Accountant (CPA) to help you sort this area out. Some things you can do. Nevertheless, there are some things that only professionals should do. After all, you are interfacing with state and federal bureaucracies.

Not long into this process, you will need an Employer Identification Number (EIN). You can apply to the IRS here. And you will need to get a National Provider Identifier (NPI) number for each provider/clinician. You may already have this, but you will want to update it if you do. Here is a website to apply for an NPI number. Here is the government website for creating or update an existing NPI number. You will need these numbers for upcoming steps in starting a mental health practice.

This is probably the time to start your business checking account even if you do not have an address yet. Just don’t print checks until you have the address. Having a separate account simplifies record keeping. You will be writing a few checks and you want to count every expense. It is all a business expense and which are tax-deductible.

Join insurance panels or not?

You may wonder about which insurance panels to join, which to avoid, or whether to join any. This choice is about where you are practicing and the needs of your constituencies. I have written some of my thoughts on this issue here: Why join insurance panels

If you are joining insurance panels, start as early as you can. Insurance companies are notoriously slow in making these decisions. You want the insurance payments to begin when you open your doors. Also read: Getting on Insurance Panels: Preparing for the process from the American Counseling Association.

5. Find space & decide on start date

Three to five months ahead

Location, location, location. In other words, your neighborhood has a significant impact on your mental health practice. Where your practice resides will have many consequences. And your office building makes a statement about your practice as well. Your office space is part of your brand. Furthermore, the office building may impact how easy it will be to expand and grow.

Over my 40 years of practice, I have had offices in 5 different communities. Each community was different. And that is to say that each community influenced the type of clients that came in. Your choices are mostly a matter of personal taste. Some owners want to be in upscale well-resourced communities. Others prefer communities with limited mental health resources. I have written about some of these decisions in these posts: Finding your community: The location and space and Rent, lease, or purchase psychotherapy office space.

You will, of course, be limited by what offices are available in your area in the timeframe you are considering. In my experience, rarely does the timing work precisely as you might wish. It is best to maintain some degree of flexibility in the timing of things. You want to be in the right location for you. Sometimes that means waiting until the space you want is available.

6. Develop your brand, build your website, Psychology Today profile, and social media

Three months ahead

Now is the time to start building on your name and tagline. You are going to need a logo or image that will be associated with your practice.

Some therapists have an artistic side. If this is your gift, this is the place to let it shine. For the rest of us, it may be time to hire a designer/brand consultant.

Starting a mental health practice will require building a website. And website development is both a technical and artistic process. If you have an eagerness to learn about websites, you can build it yourself. If that interests you, look at these options. Many, if not all, have free domain names and email attached to their site:

You will want to pick a template. These sites have thousands to pick from. They offer a tutorial and can help you if you get into trouble. Some of them will also have a designer to help if you have a need.

And if you do not enjoy technology or design

If you are not interested in technology or design, consider hiring a website developer. Remember that they are also helping you shape your brand. Here are some companies that advertise that they build websites for therapists:

Certainly, this will be a several thousand dollar investment whether you pay by the month or as a flat fee. Finding the right way that fits you is important.

Finding a custom website designer

Personally, I hired a local website developer, designer, and branding consultant. At times, this choice was expensive, but I liked working with someone with branding experience. I had no experience in these areas nor was I particularly interesting in learning about it. I just needed it to work.

So how do you find a website developer? Start by looking at the websites of practices in your area. See which websites you like. Look at the footer of the Home page and usually, you will see the designer’s company name.

And if you are looking for a bit more out-of-the-box website designs, be inspired by this set posted by Emily, who describes herself as a “licensed mental health counselor, business coach, and website designer.” See Therapy Website Examples to Inspire Your New Design.

Whatever method you choose, I strongly encourage you to find others you trust to give you feedback about the results of your efforts. They need not be a therapist. But certainly, fresh eyes are needed. Kick it around and see how it wears for a bit.

Beyond website development

Most start-up therapists should create a Psychology Today profile. You can sign up here. The cost is only $29.95 per month. Importantly, when potential clients search for a therapist, Psychology Today listings are at the top. I know of many who find that when starting, it is the single best referral source.

Of course, eventually, you will want to broaden your referral base from Psychology Today. I have written about how to do that with these posts: A community-based marketing method: Community-Connection Plans and then Growing pains: Outgrowing your branding.

In some communities, a strong social media campaign is essential to carving out a sustainable niche for yourself. But the social media approach is a long-term strategy for those who enjoy creating content. I write about some of the pros and cons here: Social media marketing: Good or bad? Yet in most locations, word of mouth is still the best way to create a stable referral base. I have written about how to build that stability in this post: The five best marketing favorites that are not a big stretch.

7. Get your billing and records software/service and clinical forms started

Two months ahead

These days, everyone should use billing and scheduling software to organize many functions of a practice. One of the first questions is not deciding which one. Instead, you need to determine if you want a server-based system or a cloud-based system.

Server-based systems have the software reside on a computer that you own and manage. You will get notified by the software vendor when an update is needed. You download it, install it, and you are back in business. Your practice data is owned and managed by you. Your data does not reside on the internet but on your computer.

The other alternative is a cloud-based system. The data, software, updates, etc. all happen on a server that you do not own, i.e., in the cloud. Someone else is managing it, and most importantly, protecting it from bad people.

As time has gone on, more people are trusting their data to the cloud. But we should not forget that the cloud is a company or series of companies who support and maintain the data. You access your data via the internet, and it does not reside on any of your computers.

There are upside and downsides to both types of systems. Here is a blog listing the pros and cons. It is from a company that offers a hybrid option, which is probably too expensive for us. Yet, the blog seems to evaluate the pros and cons fairly.

Some practice management systems

Below I have listed some practice management systems of each type. Most will offer you a free 30-day trial. If you are trying a couple out, then be sure to give yourself the time to play with them. It takes a while to evaluate a system. And they are all quite different in format.

Server-based practice management systems:
  • ShrinkRapt — $35 per month–Mac or PC versions
  • MacPractice – Mac-version medical database, durable and expensive
Cloud-based practice management systems (you only need the internet and a browser on any computer):

You can see from this sample that there are many more cloud-based options than server-based. In my experience, smaller practices tend to start with cloud-based options. As they get larger and the monthly costs add up, they may move to server-based options. And even though server-based options have more start-up costs, they become more cost-effective as you get to a certain size.

One more point. All practice owners eventually become discontent with whatever option they select. In my case, I went through three vendors before settling on MacPractice, an expensive but durable option. Even that option was not perfect, but it allowed unlimited growth for us. Yet we still had bugs to contend with. It seems to go with the territory no matter which option you choose.

And practice forms

In addition to practice management software, you will want to develop your practice forms. What these look like can be tailored to what you need for your software and your tastes. Our intake forms had several pages:

  • name, address, phone, insurance info sheet
  • symptom checklist
  • policies about psychotherapy
  • consent to treat form
  • private notice
  • release form for contacting referral people and primary care MD

In addition to the forms, at a minimum, you will need to organize your data collection, scheduling, and rescheduling processes for intakes and continuing clients. Paper and pencil will work in the beginning but you will want to get all your information into a database pretty early on.

8. Make your announcement & start marketing

One to two months ahead

Your start date is likely dictated by when your space will be available. But get it settled so you can make as big a splash as you can with the start date. Your opening launch is your first chance to call attention to your new location. Make the most of it.

Send notices to everyone in your email list, both personal and professional. One never knows who may know somebody who is in your area. Use MailChimp to develop an e-newsletter to make the announcement. MailChimp walks you through the process of building what they call a “campaign” and it will keep track of responses for you.

And now it is time to furnish your office. This is a chance to set it up the way you would like. No need to be too extravagant. You want your office to send the right message–comfortable, professional, but not so opulent so as to put people off. You can, of course, add bits and pieces as time goes on. For now, you need the basics for the waiting room and office. (See Reflections on therapy office design for some of my thoughts on office spaces.)

9. Open your office

Launch Day

After all the work you have put in to start your mental health practice, Opening Day itself can seem anticlimactic. What? Is nobody dropping balloons from the sky? Where is the brass band?

Yet if you have done things correctly, you should be running pretty smoothly. And that is a nice reward, though not so impressive. Fortunately, in the beginning, you will have time to catch up on the details that you may have glossed over. That is perfectly normal. You will be working on and improving all these tasks for the rest of your practice’s existence. It doesn’t have to be perfect. Just good enough to get things rolling.

10. Begin doing the Daily Activities

Every day after the Launch

I have written extensively about the five tasks that every practice must master to stay in business. For example, we all have to schedule our clients, deliver a service (for us that is psychotherapy), bill both clients and insurance companies for that service, collect for that service, and then continually market our service to our communities. I have called these activities our “Daily business demands.” See the first of this series at Daily business demand #1: Scheduling, etc. 

Enjoying the adventure of starting a mental health practice

Starting a mental health practice provides many joys and satisfactions. We are blessed to have meaningful work to do, and doing it in your own practice adds another purposeful dimension.

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