More than a dozen therapists are no longer partnering with the LGBTQ advocacy group Encircle — and they say the fissure has left them scrambling to pay for care for about 200 young clients who previously were subsidized by the prominent and fast-growing Provo nonprofit.
Administrators at Encircle say they are setting up new counseling services for the teens and young adults who come to the group’s centers in Provo and Salt Lake City for support, camaraderie and suicide prevention services. They say the move will protect Encircle’s nonprofit status and allow the group to provide uniform care as it plans to open more centers in the state.
But the therapists who previously contracted with the group say the transition could disrupt treatment for vulnerable clients, some of whom are in life-threatening distress.
“We deal with a high degree of suicidality,” said Lisa Hansen, clinical director of the therapy group Flourish, which previously provided Encircle’s mental health services. “Clients who experience that are reluctant to be vulnerable with a new therapist until they understand that the therapist is connected with them and understands their stressors, triggers and coping skills. That takes time.”
Flourish therapists have been providing care at Encircle since it opened in 2017. As of April, 13 therapists were conducting about 400 hours of therapy per month for Encircle’s clients, Hansen said, with Encircle paying $26 per session.
But Flourish is a for-profit company — though it began seeking nonprofit status earlier this year. Encircle CEO Stephenie Larsen said attorneys advised Encircle to directly hire its therapists, rather than outsourcing therapy services.
"They said there are really big red flags when a nonprofit is paying a for-profit entity who gets all of their clients through us, exclusively," Larsen said. "There can be the appearance of using the nonprofit to enrich the for-profit."
In-house therapy would also allow Encircle to set up a consistent practice as it adds centers in other parts of the state, Larsen said. The group recently opened a house in Salt Lake City and plans to open a house in St. George by the end of this year, Larsen said. Encircle also is exploring a rural outreach center, based in Logan, to provide “teletherapy” to clients statewide, Larsen said.
To set that up, the group has enlisted Jared Klundt, who was a clinical professor at Brigham Young University before he became Encircle’s clinical director on the first of this month. At BYU, his research focused on the relationship between religiosity and mental health for sexual minorities.
“He’s really an expert in the field,” Larsen said. “We’re extremely thrilled; he’s passionate about this. He wanted to really build a group where we can have the best LGBQ therapists out there."
Klundt said he plans to track outcomes among new clients to “eventually build the best program in the state for LGBT folks.”
A split in patient care
But Encircle now has a fraction of the clients — and therapists — that it did a month ago.
Larsen said she initially offered to employ the Flourish therapists directly and appoint Hansen as Encircle's clinical director.
But what Encircle saw as a job offer, the therapists saw as an ultimatum: Become our employees or your clients will lose their funding for your care.
All but one of the therapists refused — primarily, Hansen said, because it seemed to them that Encircle was willing to use its clients as bargaining chips.
“It was important to the therapists to feel that vulnerable client care was the top priority,” Hansen said. “Encircle is very good at saying that, but it was not apparent that that was what was happening. Ultimately, 200 clients had their therapy terminated with no plan other than, ‘Encircle Therapy will eventually have therapists.’”
About 95% of the clients at Encircle have said they will continue their care with their Flourish therapists, at other sites and without Encircle’s subsidy, Hansen said.
Three full-time therapists were planning to join Klundt at the new Encircle Therapy as it launched this week, Klundt said.
While continuity of care is a concern, Klundt said, "it sounds like [Flourish] has a place; it sounds like they’re going to continue to see clients.
"With therapists, the patient follows the therapist, not the organization," Klundt said. "So we'll continue to provide care for anyone that needs it, and the Flourish therapists will be responsible for the care of their patients."
A toll on patients
But the loss of Encircle’s subsidy for those clients has led to a flurry of fundraising as Flourish seeks nonprofit status. Encircle’s clients were contributing on average $20 to the $46 cost of their therapy sessions. Hansen, disagreeing with the assertions by Encircle, said attorneys she consulted said the cost is so far below the typical charge for therapy in Utah County that its contract with Flourish did not imperil Encircle’s not-for-profit status.
Encircle administrators had hoped to start submitting claims to patients’ insurance plans — another reason it was bringing therapy in-house, Larsen said. But Hansen said a survey of the 200 clients showed about 80% of them had no insurance, and most of those who did either had no mental health coverage or high deductibles for it.
“Our clients tend to be unemployed, tend to be students, tend to be people who do not want their parents to know they’re getting therapy at an LGBTQ place,” Hansen said. “Five or six of the clients are living in cars.”
Finding new providers and modifying payment arrangements can be arduous for people who are suffering from mental illness, said one Flourish client who recently was hospitalized. The Salt Lake Tribune agreed to not publish her name to protect her medical privacy.
"In general, when you’re getting mental health care, consistency is key," said the client, who since January has received care from a psychiatric nurse practitioner with Flourish. Finding a new provider, she said, "can take months."
“I’m just not mentally well enough to go out and deal with the whole insurance thing, finding new people,” she said. “If I were to get dropped [from Flourish], I don’t think I would bother; I would just give up and go off my meds.”
The departure of most of Encircle’s therapy recipients comes as Encircle has enjoyed rising visibility and support in Utah County and statewide. It has received national media attention for its efforts to bridge gaps between LGBTQ youth and the conservative Mormon culture in Utah County. About 85% of the population belongs to The Church of Jesus Christ of Latter-day Saints, which teaches that having same-sex attraction is not a sin, but acting on it is, and has waged political and legal campaigns against LGBTQ rights. Encircle also has been widely promoted by rock star and Latter-day Saint Dan Reynolds, whose annual “LoveLoud” concert raised funds for the group.
In May, the group received $30,000 from the Governor’s Suicide Prevention Fund. Its application for the grant, filed before the split with Flourish, states that “Encircle has a close partnership with Flourish Counseling, which provides/will provide therapeutic services in all three Encircle homes.”
But the application focused on Encircle’s many weekly activities and support groups, and does not list therapy costs when describing how the grant money will be used, noting: “We have donors that have pledged the majority of our operational costs for the next few years.”
While Encircle has succeeded in fundraising and making connections in Utah’s most conservative communities, the client whose care provider has left Encircle and will remain with Flourish said she worries the departure of its therapists will leave clients wary.
“It just looks chaotic,” she said.
Editor’s note: If you or people you know are at risk of self-harm, the National Suicide Prevention Lifeline provides 24-hour support at 1-800-273-8255.