The COVID-19 pandemic has been one of the most stressful times in our nation’s history. Between the fear of the virus itself, the social isolation, and the financial stress, the whole situation has caused a major uptick in anxiety. And social distancing has made it harder for the one in five Americans with mental health conditions to receive the treatment they need.
But 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 Mental Health America (MHA). Even with insurance, it’s not always easy to find a therapist who accepts your plan. On top of that, many plans don’t kick in until you’ve met a high deductible.
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, including mental health benefits.
By law, these plans must cover mental health treatment at the same level as other forms of care. That means 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.
Also, some plans aren’t subject to ACA rules. Plans that were 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 can 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, but many mental health professionals don’t accept it. Those who do typically work at clinics or community mental health centers. To find a therapist who takes Medicaid, visit the site for your state’s Medicaid program or consult the provider directory at Psychology Today.
If you can’t find a local mental health provider on your health plan, consider a provider in another area who can treat you remotely. 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’t meet with their therapists in person, according to The Cut.
Medicaid covers telepsychiatry in all 50 states. Moreover, 43 states (plus the District of Columbia) 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.
Therapy Without Insurance – How to Get Affordable Mental Health Care
If you don’t have insurance or your plan doesn’t provide adequate coverage for mental health, there are ways to find care at a price you can handle. However, 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 issues.
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.
The Lifeline’s workers listen to you, figure out how your problem is affecting you, and provide support. They can also 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. Just text HOME to 741741 (or CONNECT to 686868 in Canada) at any time. You’ll receive a message from a trained volunteer crisis counselor, usually within five minutes.
As you text back and forth, the counselor will help you sort through your feelings by actively listening to your problem, empathizing, and asking questions. The conversation ends when you and the counselor agree that you’ve reached a calm, safe state of mind.
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.
This line can help you even if you haven’t personally experienced domestic violence. You can call on behalf of a friend or family member or if you fear you might have abusive tendencies yourself. Staffers can provide resources and information or answer your 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 you to:
- Talk through what happened
- Learn about the laws in your community
- Get information about medical concerns
- 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. The service is free, safe, and confidential.
Hotlines can provide one-time help in a crisis, but most mental health problems require ongoing support. For many types of 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.
There are three main types of support groups:
- Mutual Support Groups. These groups are gatherings of people who share a common problem, such as trauma, grief, domestic abuse, or mood disorders. A trained facilitator may help guide the discussion, but this person doesn’t give advice. Instead, members share their stories, discuss what’s working for them, and encourage each other.
- 12-Step Programs. These groups typically help people dealing with an addiction of some kind. There are groups for substance abuse, shopping addiction, and eating disorders. Some well-known examples include Alcoholics Anonymous (AA), Gamblers Anonymous, and the National Eating Disorders Association (NEDA).
- Group Therapy. These groups are led by professional therapists. They gather together people with the same mental health problem and treat them as a group. There’s often a fee for this type of treatment, although it may be covered by insurance.
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 from the Anxiety and Depression Association of America (ADAA). You can also call the National Alliance on Mental Illness (NAMI) HelpLine at 800-950-NAMI (6264) or email firstname.lastname@example.org.
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. You can evaluate a group by asking the group leader about its structure and how members interact with each other. Or you can just try attending meetings of different groups until you find one that feels like a good fit.
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. NEDA has also 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. The MHA and ADAA lists can also help you find online groups.
Affordable Private Therapists
While support groups can help with many mental and emotional problems, some people require ongoing professional help. But without insurance, the cost of professional therapy is out of reach for many Americans.
According to 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 low-cost therapist. 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. This nonprofit helps middle- and lower-income people find affordable mental health care. After paying a one-time fee of $59 to join, you gain access to reduced rates for all its therapists — between $30 and $60 per session. Many of Open Path’s therapists are offering online sessions during the COVID crisis.
You can also try asking a specific therapist whether they can work with your budget. Some therapists don’t advertise sliding-scale fees, but they’re willing to adjust their prices based on what patients can afford.
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 low cost — or even at no cost — while also helping a new therapist learn how to work with patients.
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). They can often provide free or low-cost care to people with limited means. 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 therapist 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 who are struggling with:
- Job-related stress
- Grief over the death of a family member
- 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 these companies aren’t run by psychologists. Also, 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 $108 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. All the counselors on this platform are accredited psychologists, marriage and family therapists, clinical social workers, or licensed professional counselors. You can communicate with them through secure messages, phone, live chat, or video conferencing. You pay for the service by the week.
- MDLive Behavioral Health. This telehealth network employs both licensed therapists and board-certified psychiatrists. Patients meet with therapists by video or phone and pay by the session. Several major insurance plans provide coverage for MDLive therapy sessions.
- Talkspace. Talkspace offers a variety of mental health treatment options, including online therapy, couples therapy, teen therapy, and psychiatry. The service charges by the month, with varying rates for different tiers of service. All plans allow you to message your therapist at any time from any device and receive daily responses. Higher tiers include either one or four live sessions per month.
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 mood on your own. Getting regular exercise, meditating, and spending time in nature can all lift your spirits 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.