Right now, Americans are living through one of the most stressful times in our history. As of April 2020, the COVID-19 pandemic has sickened hundreds of thousands of Americans, killed thousands, and left millions essentially confined to their homes in an attempt to slow the spread of the virus. Many people are struggling to do their jobs from home, while many more are unable to work at all and are struggling to pay their bills with no income.
Between the fear of the virus itself, the social isolation, and the financial stress, the whole situation has been a massive threat to our collective mental health.
According to >Mental Health America (MHA), the pandemic has already led to a significant uptick in symptoms of clinical anxiety. On top of that, it’s made it harder for the one in five Americans who already have mental health conditions to receive the treatment they need. Social distancing requirements naturally make it more difficult to find a therapist and get to appointments. And for many Americans, there’s another, equally big problem: paying for treatment.
Nearly 12% of American adults with mental illness don’t have health insurance, according to MHA. Even if you have insurance, it’s not always easy to find a therapist who accepts your particular plan. On top of that, many plans don’t kick in until you’ve met a high deductible. That can mean paying hundreds or even thousands of dollars out of your own pocket.
If you’re in this position, don’t despair. There are many places to find the mental health care you need without racking up bills that will only add to your stress.
Check Your Health Plan
First of all, if you have health insurance, check to see what it actually covers. The Affordable Care Act (ACA), better known as Obamacare, requires any health plan approved under it to offer essential benefits, such as care for mental health and substance abuse disorders. By law, these plans must cover mental health care at the same level as other forms of care, with similar copays and no limits on the number of covered visits. However, plans can require proof that care is medically necessary after a certain number of visits – say, 10 or 20 per year.
However, there are still some plans that aren’t subject to ACA rules. Plans that were already in place when the ACA became law in 2008 and have not significantly changed since then are grandfathered. They can continue to offer limited coverage for mental health. According to MHA, about 8% of all teens in the U.S. have private health insurance that does not cover mental or emotional problems.
Even if you have an ACA-approved health plan, that doesn’t mean you’ll be able to get covered care from any therapist you want. Just like doctors, therapists can choose which plans to accept. According to the American Psychological Association (APA), insurance companies may be to blame. Many haven’t increased their payment rates for psychologists for 10 or even 20 years, and some have even cut their rates. As a result, few mental health professionals choose to take part in these plans.
To find a therapist who participates in your plan, start by visiting your health plan provider’s website. Most health plans have an online directory of professionals that accept their insurance. Some sites allow you to confine your search to providers who are accepting new patients. However, these websites aren’t always up to date. So confirm the therapist accepts your insurance when you schedule your first appointment.
Finding providers can be especially difficult if you’re on Medicaid. Medicaid provides mental health care at no cost. However, many mental health professionals don’t accept Medicaid. Those who do typically work at clinics or community mental health centers, including training facilities associated with universities. To find a therapist who takes Medicaid, visit the site for your state’s Medicaid program or consult the provider directory via Psychology Today.
If you can’t find a mental health provider in your area who accepts your health plan, consider a provider in another area who can treat you remotely. Through telepsychiatry, you can meet with a therapist virtually through phone, text, online chat, or video chat. During the COVID-19 outbreak, telepsychiatry is providing a lifeline for many patients who can no longer meet with their therapists in person, according to The Cut.
Medicaid covers telepsychiatry in 48 states, and 32 states require private insurance to cover it, according to the American Psychiatric Association. The only catch is that the therapist has to be licensed in your state.
Getting Care Without Insurance
If you don’t have insurance or you have one of the few insurance plans that doesn’t provide adequate coverage for mental health, there are ways to find care at a price you can handle. One place you should not look, except in a real crisis, is the hospital emergency room. Emergency departments must provide care regardless of your ability to pay. But they aren’t equipped to provide the kind of long-term care needed for most mental conditions. And even for the limited, short-term care they can provide, they charge astronomical prices.
There are better places to look for affordable mental health care.
Some mental health problems are true emergencies. For example, if you’re thinking about suicide or if you’ve been a victim of a sexual assault or domestic violence, you need help right away. In this situation, your best bet is to call a crisis hotline. They’re staffed with professionals and trained volunteers who can provide immediate help, 24 hours a day, at no cost.
There are several different hotlines that can help with different types of mental health problems. They include:
- National Suicide Prevention Lifeline. If you or someone you know is in distress – whether they’re considering suicide or not – the National Suicide Prevention Lifeline can help. By calling 800-273-TALK (8255), you can reach trained crisis workers at any hour of the day or night. They make sure you feel safe and help connect you with mental health services in your area. All calls are free and confidential.
- Crisis Text Line. The Crisis Text Line helps people dealing with any type of emotional crisis. Text HOME to 741741 (or 686868 in Canada) at any time, and you’ll receive a message from a trained volunteer crisis counselor, usually within a few minutes. As you text back and forth, the counselor will listen to your problem, ask questions, empathize, and help you move from “a hot moment to a cool calm.”
- National Domestic Violence Hotline. If a spouse, partner, or family member has physically harmed you, call the National Domestic Violence Hotline at 800-799-SAFE (7233). It’s staffed with trained experts who can help you escape a dangerous situation. Even if you haven’t personally experienced domestic violence, you can call this number to get resources and information or to ask questions about a relationship that might be unhealthy.
- National Sexual Assault Hotline. The National Sexual Assault Hotline is a free, confidential service that connects survivors of sexual assault with sexual assault service providers in their area. They can help victims talk through what happened, learn about the laws in their community, get information about medical concerns, and connect with local resources such as health facilities. You can call 800-656-HOPE (4673) at any time or use the online hotline for support via chat.
Hotlines can provide one-time help in a crisis, but for most mental problems, that’s not enough. You need to follow up on this emergency intervention with ongoing support. For many types of mental problems, you can get this from a support group.
Support groups connect people who have the same problem or have had the same experience. Members can talk through their experiences with others who understand what they’re going through. They can provide sympathy and support to each other and offer advice about what’s been helpful for them. Some support groups are free to attend, while others charge a small fee.
Support groups can work in different ways. Open-ended support groups simply gather people together to share their stories in a free-form way. Structured support groups, by contrast, typically have a professional or a trained volunteer lead each session. The leader guides group members through a different lesson each week to teach them skills, such as mindfulness meditation, for coping with their problems.
There are many support groups to deal with different types of problems, including substance abuse, shopping addiction, eating disorders, trauma, grief, and postpartum depression. Some well-known examples include Alcoholics Anonymous (AA), Gamblers Anonymous, and the National Eating Disorders Association (NEDA).
There are several ways to find support groups in your area to help with specific types of problems. There’s a lengthy list of groups on the MHA website and a searchable directory on Anxiety and Depression Association of America. You can also call the National Alliance on Mental Illness (NAMI) HelpLine at 800-950-NAMI (6264) or email email@example.com.
Since you’re going to be spending a lot of time with your chosen support group, it’s important to find one that fits your needs. One way to evaluate a group is to talk to the group leader before you join. Ask questions about the structure of the group and how members interact with each other. Alternatively, you can just try attending meetings of different groups until you find one that feels like a good fit.
One difficulty of finding a support group at present is that many groups have been forced to shut down their in-person meetings on account of the COVID-19 pandemic. However, some groups have found ways around this problem. For instance, TMZ reports that many AA chapters are using Zoom to stay connected, and NEDA has developed a list of virtual support groups to help its members. If you can’t meet with a support group in your area, check the group’s website to see if it has similar virtual resources available.
Affordable Private Therapists
While support groups can help with many mental and emotional problems, some people require ongoing professional help. Unfortunately, without insurance, the cost of professional therapy is out of reach for many Americans.
According to the professional directory Thervo, the national average cost of a single session with a therapist is $90. In cities like New York or Los Angeles, the typical price per hour can be as high as $250. If you need regular weekly sessions for several months, your out-of-pocket cost could easily run into the thousands.
To help with this problem, many therapists offer their services on a sliding scale based on income. That is, they adjust their hourly rate based on what patients can afford to pay. Some therapists even provide services pro bono (at no cost) to the neediest patients.
There are several ways to find a therapist who charges affordable fees. The therapist directory at GoodTherapy allows you to search for therapists in your area who offer a sliding scale. The site can also connect you with telehealth therapists.
Another place to try is the Open Path Psychotherapy Collective, a nonprofit that helps middle- and lower-income people find affordable mental health care. You must pay a one-time fee to join Open Path, but it gives you access to reduced rates for all the therapists in the collective – as low as one-third of the average cost you’d pay per session without it. Many of Open Path’s therapists are offering online sessions during the COVID crisis.
You can also try asking a specific therapist whether they’re willing to work with your budget. Therapists who offer sliding-scale fees don’t always advertise this fact, but two therapists interviewed by NBC News say they generally ask patients what they can afford and try to come up with a price they can handle.
Another way to get professional therapy at a discounted rate is to work with a therapist who’s still in training. In this situation, you meet with both a fully qualified therapist and a trainee who’s learning the job. You can receive the care you need at a reduced cost – or even at no cost – while also helping a new therapist learn how to work with patients over the long term.
If there’s a teaching hospital in your area, you can probably receive treatment on a sliding scale through its department of psychiatry or outpatient psychology program. To find out if hospitals in your area offer this service, contact each hospital’s department of psychiatry. If you can’t find that department in the hospital’s directory, try looking under “mental and behavioral health.”
Some therapists get their training through independent psychoanalytic societies and institutes. There’s a list of these institutes on the website of the American Psychoanalytic Association (APsaA). Psychotherapist Dr. Fran Walfishtold NBC News these institutes can often provide free care in exchange for a commitment to meet with a specific therapist three to five times a week over a period of a year or two. APsaA is urging all its members to offer remote sessions for patients during the COVID outbreak.
School & Workplace Programs
If you are a college student and your campus is not currently closed, you can probably receive free treatment through your school’s student health center. Most universities have a psychologist or counselor on their staff who provides counseling sessions to students at no charge. If you still need treatment after you graduate, your school’s counselor can help you find a therapist to work with.
If you’ve already left school and moved into the workforce, check to see if your employer offers an Employee Assistance Program (EAP). These workplace programs provide free short-term counseling to employees dealing with problems that could affect their job performance. For instance, they can help workers with job-related stress or who are grieving over the death of a spouse, going through a divorce, or struggling with substance abuse.
Most EAPs can’t provide ongoing treatment for serious mental disorders. However, they can assess your mental health and refer you to a therapist if you need one. To find out if your workplace has an EAP and if it’s still active during the COVID pandemic, contact the human resources department.
Community Mental Health Clinics
If you don’t have access to free counseling through your school or workplace, try looking for a community mental health clinic in your area. These government-funded facilities provide mental health care at steeply discounted rates or even free. Many of them remain open during the COVID crisis, although they may encourage patients to choose online sessions if they can.
Community mental health clinics offer a variety of mental health services. They can provide individual or family counseling, medication, and counseling for substance abuse. They’re staffed with psychiatrists and psychologists who are qualified to treat serious mental health disorders such as anxiety, depression, and schizophrenia. Many of them also keep costs down by employing student psychologists, counselors, and social workers who work under the supervision of licensed professionals.
There are several ways to find a community mental health clinic in your area. You can:
- Ask your primary care physician
- Call the NAMI HelpLine
- Contact your state’s department of public health or community health
- Use the locator map from the Substance Abuse and Mental Health Services Administration
If you’re having trouble finding an affordable therapist in your area, consider meeting with one online through a therapy app. These apps let you connect with your therapist from your home, workplace, or anywhere else that’s convenient. This is a useful feature for busy professionals, stay-at-home parents, students, and anyone who doesn’t have reliable transportation.
According to the APA, telepsychology – talking with a therapist via phone, text, or video chat – can be just as effective as face-to-face care. However, it’s not ideal for everyone. People struggling with addiction or a serious mental illness probably need more hands-on treatment than they can get over the Internet.
It’s also important to make sure the therapy app you’re using is trustworthy. The APA says nearly a dozen online therapy companies have sprung up over the past several years, and they don’t all have equally strict standards. Many of them aren’t run by psychologists, and the platforms themselves don’t always follow the legal and ethical codes required for health care providers. For instance, they may not follow the medical profession’s strict standards for patient privacy and informed consent.
Therapy apps can charge by the session, by the week, or by the month. Prices can be as low as $150 per month or as high as $100 per session. Certain insurance places cover some therapy apps, so you can receive reimbursement just as if you were seeing a live therapist.
Popular therapy apps and online platforms include:
- 7 Cups. This platform is part online therapy and part support group. You can connect with a professional therapist for a monthly fee or chat with trained volunteer listeners through a free, anonymous, 24/7 live chat. The service also offers daily self-help activities you can complete on your own.
- American Well. This telemedicine service connects patients with all types of medical professionals, including therapists. You meet with your therapist by video conference and pay a flat fee for each session. Many insurance plans cover American Well visits.
- BetterHelp. This is the largest online counseling platform worldwide. All its counselors are accredited psychologists, marriage and family therapists, clinical social workers, or licensed professional counselors. Once the service matches you with a counselor, you can communicate with that person through secure messages, phone, live chat, or video conferencing. You pay for the service by the week.
- Breakthrough. This service is part of MDLive, the nation’s largest telehealth network. It employs 1,000 licensed and screened therapists and psychiatrists, with people licensed in every state. Patients meet with therapists by mobile app, video, or phone and pay by the session. Some insurance plans provide coverage for Breakthrough therapy sessions.
- Talkspace. On Talkspace, there are more than 5,000 licensed, screened therapists with a variety of specialties. You can message your therapist at any time from any device and receive daily responses. The service charges by the month, with varying rates for individuals, couples, and teens.
Not every mental health problem requires therapy. If you’re dealing with a minor issue like irritability or job-related stress, there are things you can do to improve your mental health on your own. Getting regular exercise, adjusting your sleep habits, and spending time with a pet can all boost your mood without therapy or medication.
However, these self-help measures aren’t a substitute for professional care. If you have symptoms of a serious mental illness – such as sleeplessness, loss of appetite, panic attacks, or thoughts of self-harm – don’t try to deal with the problem on your own. Help is out there, even with a limited budget.
Here are some other ways to get health care without insurance.
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