What to Do When You Can’t Afford Therapy

Morrow

Kimberly Morrow, LCSW

Practical advice for obtaining quality mental healthcare when money is tight

Thanks to mental health parity, many more people have access to psychotherapy than in the past. But two great barriers to treatment remain. The first is shame, as the stigma of mental illness still prevents many from seeking professional help. The second is cost, because even when people have health insurance, the expense of co-pays and high deductibles can be too much when money is tight.

For some people, the predicament of needing mental health treatment, but not being able to afford it is doubly shameful, and so they never seek the care they need.

But I’m here to tell you there are ways to obtain high-quality therapy for little or no cost, and people should never let shame get in the way of wellness. Here are some tips for talking to mental health providers about cost concerns, as well as suggestions for ways you can get free or discounted care.

1. Know that it is OK to talk about cost.
First and foremost, understand that cost is not a taboo subject. Money is a reality for both providers and patients, and people should feel comfortable discussing their ability to pay with therapists.

If you have concerns about cost, be direct and honest with your provider. When you first call to make an appointment, say, “This is the insurance I have, do you take that insurance? If I can’t make my co-payment, then what do you do? What do you offer for people who don’t have resources to pay your fee?”

Granted, talking about your ability (or inability) to pay may not be your favorite topic; but it is far better to have the conversation than avoid seeking care. People must shift their thinking to recognize that long-term wellness outweighs the brief discomfort of a conversation about cost. It’s about leaning into that discomfort and believing, “I deserve this.”

2. If a therapist won’t work with you on cost, find one who will.
If you ask a therapist about reduced-cost care and get an unsatisfactory answer, don’t take that “no” for your final answer. Just because one therapist won’t work with you on cost doesn’t mean that’s how all mental health facilities function. Ask the therapist if he or she has any recommendations for where you could receive free or low-cost care. Very rarely will a therapist just turn someone away with no guidance or referral.

And if you get a rude response when you ask about cost, he or she is probably not a provider you want to work with anyway.

3. Tap community resources.
If you are having trouble affording traditional psychotherapy, there are some low-cost alternatives that might meet your needs. For example, I offer a free support group to OCD patients and a $15 therapy group for patients with anxiety. I don’t bill insurance and everyone who comes pays just $15. A lot of other therapists provide similar free or reduced-cost support and therapy groups, so be sure to ask.

If you live near a university, call the graduate psychology department and ask if they have a counseling center for people in the community. These centers are typically staffed by graduate students who are learning to provide therapy, and the care is usually excellent and free or very-low cost.

In every community, there are crisis care services (usually provided by the local health department) for people facing a mental health crisis. Specially-trained support staff will help you over the phone, and may even come to your home to help you through the crisis. Often, services include connecting people to affordable, appropriate care, and this can be a valuable resource for people who don’t know where to turn for assistance.

Finally, for people who are self-pay, some providers offer a sliding-fee scale. A sliding scale allows people to pay based on their personal income and what they can afford.

4. Explore what’s available through your employer.
Some people have an employee assistance plan (EAP) through their work. An EAP is an employer-paid benefit that is separate from your medical plan. It is designed to help employees through challenging situations. Typically, employees can access counseling through the EAP for no cost. As the EAP is designed to provide short-term assistance, there is usually a limit (ranging from three to eight) to the number of free counseling sessions.

If you are not sure if you have an EAP plan, call the 800 number of the back of your insurance card or call the HR department.

5. Seek quality care.
Free or low-cost care does not mean inferior care. Even if you don’t have the resources to pay for therapy, you deserve quality care. Don’t limit yourself to finding a therapist who can provide reduced-cost care; be sure you find a therapist who can provide the right care at free or reduced cost.

I encourage patients to interview potential therapists. Describe your symptoms and ask, “Do you feel like you can help me? How would you help me? What is the evidence-based treatment for my condition? Do you have training in this type of treatment? ” For further guidance, the Anxiety and Depression Association of American provides a comprehensive list of questions to ask when choosing a provider for yourself and for your child.

Most providers are willing to have a 10-minute conversation with you about this. If someone gets defensive about this sort of questioning, move on. You deserve to be treated with respect and have your questions answered. Even if it takes four phone calls to find the right therapist, it’s worth it. And you deserve it.

Questions

  • How have you approached the conversation with your provider around the costs of services?
  • What have been the challenges in starting that conversation?
  • What has been your experience in accessing affordable mental health care in your community?
  • If you are a mental health provider, what suggestions do you have for people seeking affordable mental health care? How do you approach these situations?

Facebook Comments

26 comments
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RachelleLemaitre

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Christina Butler
Christina Butler

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FinallyReady
FinallyReady

what do you do when you have insurance but it doesn't cover mental health until you hit the deductible and then they only pay 10%... I called around and all my local community health centers will only accept you if you have NO insurance or medicaid. And others I called charge $80+ a session.

I haven't found any one who goes on a sliding pay scale and even if they did they would look at my income and still think $80+ was acceptable but they don't see that we bought a house and are doing a complete renovation and are pretty tight with money at the time....


Amnicr
Amnicr

In same position. My therapy sessions were $9 per until my health insurance ticked over and restarted again. Now therapy will be $98 until I hit deductible. Which I won't be able to do for a while. In such a conundrum.

ashelykeneth
ashelykeneth

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NewNormal
NewNormal

I called a mental health care provider today and, with no isurance and little ability to pay, they gave me a number to get assessed for care over the phone. When all was said and done, she said that it sounded like I was doing alright, and that because that clinic was the closest to me, I should call them back.

I guess I am alright then, and do not have these services in my area.

jodivon
jodivon

No cash for co-pays and earn too much to qualify for any type of assistance. More than two hours by car from any type of community resources (closest major city & university) so it's 911 for primary behavioral health - YAY!  USA-USA-USA, so proud.  My interviews with counselors involve lots of sympathy but no results, most have limited time/appts for low income, and I'm either never low income enough or they're full. Inability to provide the basics for me and my family is one of the primary causes of anxiety and feeds my depression to no end. I suppose I could just not feed the kids.


And to the multiple posters reinforcing the 'check with your employer' matra, I do wish people luck. But in the last 30 years no business or organization I've ever worked for covered squat. Some were willing to match a donation to Red Cross or local public radio station, but even then only the really big national employers that worry about their reputations. This advice to someone who works for Wal-Mart or other similar lowest-common-denominator poverty employer is both laughable and dangerous. One is more likely to endanger their employment by asking. Speaking up marks onesself as both needy and self-admittedly revealing  that you're a member of a marginalized population. Those companies aren't even willing to pay enough to keep their employees off food stamps. 


Well intentioned article, but not even a band-aid in reality for everyone stuck in the middle. Crisis center might stop the suicide but real, effective *care* isn't available unless you're rich or utterly destitute. That bit left out in the middle is the increasingly desperate majority of the US population. AND we have easy access to guns, what could go wrong?

MichaelWB
MichaelWB

HaVery had anxiety /depression for 10 years now. On disability of $1700/month, pay around $200/mood drugs, and now have colitis, pay $585/tier 5. My best friend/companion will die before Christmas (my dog), and have lost 2 friends in past year. My brother has alhzeimers. Hard to drive, get white knuckled, sweat, feel like losing control. If it weren't for my kids, I'd gladly just give it up. Can't find a therapist to help, just shake their head and have no real advise, except your time is up....next!! I have about reached my breaking point.

Tee
Tee

After a 30-year professional career, I've just received my first Disability payment for Bipolar and PTSD. In order to be accepted for Disability, I had to be without income for 6 months. I live in a state that rejected the Medicare expansion as well as the ACA exchanges. Amazingly, my income from Disability for these medical conditions has caused me to lose Medicare and access to Medicaid because it's too much, and a tax credit for Obamacare because it is too little. I am a suicide attempt survivor who left an abusive marriage, lost my home to foreclosure, am declaring bankruptcy, and dealing with a host of other issues. If I cannot at least continue with my meds, I am going to fall into an even bigger pit. I'm terrified. Why have I spent so many years trying to get and stay well?

JanelleWinters
JanelleWinters

It is beyond difficult to struggle with the need to work with a therapist while feeling incapacitated because money is an issue. I know because I've been there; I've been there several times. I love your suggestion to reach out and communicate with therapists to see if there is an option available to you in your situation, because there usually is one. It may take a little sacrifice or creativity, but it is definitely worth it to receive the help you need! (Universities can be a great resource.) Sometimes we just need to hear someone tell us to lean into the discomfort and reach out for help, so thank you for addressing this! http://kptherapy.vpweb.com/Counseling-Services.html 

Michelle Gallo
Michelle Gallo

My husband and I are up against a wall, depression over the bills,family, and maybe loosing our house...I don't know where to turn, even tho we have insurance we don't have co-pay for the mental health with all the medical co-pays we barely make ends meet!

DoriB
DoriB

I'm in desperate need of help, and right now I communicate better by writing than by talking. I have no insurance, I can't afford to pay for therapy. A couple of years ago I tried to get therapy, but it was a disaster: 

 Almost three years ago, I was referred to a clinic. After calling this clinic several times a week for several weeks, someone finally returned my phone call. I managed to get an appointment with a psychiatrist three months after my initial phone call. The appointment I had was cancelled an hour and a half before I was supposed to be there. It then took me another month to get another appointment. I was evaluated by a therapist who assigned me to see a psychiatrist. The psychiatrist had only been in the country for six months and barely spoke English. She prescribed me some drugs, and assigned me to go to group therapy once a month with the original therapist I saw. Both she and the psychiatrist told me that I had to "dumb myself down" in the group therapy sessions because I was more highly educated and twice as smart as anyone else in the group. Yes, I was told not to be myself, to be other than myself to fit their standard of care. I was allowed to attend this clinic for the next eight months in which four of the therapy group sessions were cancelled and never rescheduled. After that, I was not allowed to attend anymore because I was only allowed to attend the clinic from the initial date of my referral, not the date of my first appointment. 

This was such a bad experience for me that I'm finding it extremely hard to trust any clinic ever again, but I need help, but I refuse to go back to this clinic. I don't know what to do. I'm falling apart, I'm breaking, I want help. Somebody, please, please help me.

fishera
fishera

@DoriB 

Dori:

your comments have me quite worried about you so I hope these suggestions will help.  Don't know where you live, but you can contact your local chapter of NAMI for referrals.  If they can't give you any, they should stop existing!  Also, if you are Bipolar, contact DBSA for listing of local support groups in your area.  There is no charge to attend these support group meetings and often, some folks who attend can give you names of therapists, etc.  Also contact the national chapter of DBSA in Chicago, or google them and let them give you some names of folks in your area for assistance.  DBSA has to do more then advocacy.

You said you have no insurance.  Do you qualify for Social Security disability?  I don't know your age, but if you do, you will need a doc to assist you in applying.  Suspect you have been employed at one time or another, so your SSDI amount will be rated based on your previous work history and salary.  Also, are there any teaching hospitals and/or teaching universities in your area wherein you can contact their dept. of psychiatry for help.  Usually, not having insurance should you live near one of these facilities should not be a problem.

Also, when you get it together, you should report this clinic to your state Dept. of Health for further investigation, especially if they are receiving Medicare/Medicaid reimbursements for treatment It is total unacceptable to me as a professional therapist how your appts. were handled; cancelled, etc. etc.  I know that the majority of mental health professionals have opted out of Medicare and probably Medicaid due to low reimbursement rates.  Suspect the psych doc you did see and the clinic you went to were involved in a behavioral health group. 


Finally, I hope when you receive this message that you will make some calls tomorrow, 9/8/15.  Also, do you have any kind of support system and/or friends you know and feel comfortable with who are already in therapy and/or could give you some referrals.  If you are feeling suicidal, please call 911 immediately.


a. fisher, MSW; LICSW

 

emilysmith47876
emilysmith47876

Thank you so much for the information about what I can do to help my marriage if I can't afford therapy. I like the tip to find a therapist who will work with me on cost. I didn't know that I could negotiate the terms of payment with the therapist. I will have to see what I can find. Thank you so much for this tip! 

http://www.giblinconsulting.com/?page_id=18 

qwyzl
qwyzl

why don't these "mental health" experts all get together, form a lobbying group and petition the government to provide high quality facilities for troubled people with no money to go to for the help they need?  and I also think a lot of these "professionals" push drugs on people who don't really need the drugs, treating insurance companies as though they were their overly generous rich uncle's pockets.


which is probably why they don't petition the government on behalf of those in need - they're a bunch of greedy parasites.  may be these "mental health" experts should take a few psychological tests them selves.  they can start with a test for "how much of a greedy, selfish psychopath am I, any how"?



No
No

Great if you're a Yank living in the USA but not much help to the rest of us.

guest
guest

I don't see how low cost therapy equals quality therapy. Health professionals didn't get into the health business to offer their services for low cost. It seems like the only option for someone who does not currently have a job or insurance is to call 9-1-1 and I will not do that if all I need is to just  talk to a therapist.

LaurenAdams
LaurenAdams

I really like your advice to explore what is available through your employer. It is interesting what a lot of companies would offer their employees if they would only just ask. However, some people seem to be hesitant to do that. They shouldn't be. Mental health is important, and most employers want to help you grow into a more stable individual. http://cbhai.org 

EbonyKleinman
EbonyKleinman

That's good to know that there are mental care facilities out there that could be willing to work on cost if you feel like you can't afford therapy. I think it should be something that's covered by every insurance company because it really is important for a lot of people's mental health. Sometimes you just need a third party to talk to that can give you advice. Other times, there are serious problems that need to be talked through and worked on. Finding the right therapist can take work, but it will be worth it in the end. http://www.toolsandskills.co/en/ 

johnmc1224
johnmc1224

This is very interesting to think about as someone who is possibly having a hard time with their mental health. Something that really stands out though is that there are some that are able to get psychotherapy since there is mental instability. That is at least what it sounds like for those who are in need of that kind of mental therapy. Thank you for sharing.


http://www.joymiller.com/what 

fishera
fishera

interesting article.  from what i have read from the comments and certainly understand, many mental health professionals who have been in the business of providing treatment are opting out of the ACA and sad to say, many clinics with sliding scale may not have as well trained professionals folks are seeking.  Local and State mental Health departments often have  a big turnover in staff due to salaries.  After all, we professional trained mental health providers want to be paid, and there is nothing wrong with that.  Abeba's story certainly rings true for me as a patient who has Medicare and as I have been working the "network" of folks to find a therapist or psych doc to provide meds, i think its safe to say that about 98% have opted out of medicare and there are fewer who will accept Medicaid due to reimbursement rates.  I don;'t believe its not going to get any better with ACA insurance companies or state run facilities and the $150 p/hour rate Abeba had to pay is about standard for private providers in her area.  However, private pay in many different cities/states, depending on location, hourly rates can run as high as $200+ dollars.


One suggestion to find a therapist or psych doc for meds is to reach out to your teaching hospitals and clinics with a good reputation.

jessthib28
jessthib28

This is a really great article. I work at a Crisis Line and when encouraging callers to seek therapy, too often callers discuss finances being the barrier that holds them back from seeking therapy. If they have and have had a bad experience, it's even more difficult at times to encourage them to seek another therapist and continue with their self-care. This article provides really great tips for us phone counselors in exploring avenues of approaching the topic with callers.

abeba
abeba

When my daughter needed a therapist when she was seriously depressed she had the state's health plan as insurance because she was not working. We found almost all private insurers would not take her insurance. The one place that did provided inadequate care, did not return emergency calls and had frequent turnover of staff. In fact, when she had a reaction to the medication they never called back despite repeated calls.


So her father and I (divorced but both involved) have been paying out of pocket a discount rate of $150 an hour. I took a second job and will not retire now but it was worth it. She worked with him two years ( he is both a psychiatrist and psychologist) and he has done wonders. I don't regret a penny because she is not depressed, working and even funny a lot these days. However, the cost has been difficult and resulted in major financial  sacrifice ( which I would make again and never speak of to her) t and I wonder why this kind of care is not there for those without a parent to sacrifice. 

GouriBanerjee
GouriBanerjee

Great step by step guide to paying for care. Saheli, Support and Friendship for South Asian Families, Burlington, Mass.

socmichael
socmichael

Hi Kimberly, excellent article.  I am a Client Advocate for a university counseling center and a huge part of what I do is find community resources for Clients who need more long term care or specialized care.  It is often frustrating to reach out to providers both in private and community and ask for a sliding scale for our Clients who are all students.  Most often they do not have insurance and are unable to pay for regular rates of 100+.  I am always asking, pleading, on the behalf of the Clients to ask for a lower rate.  Sometimes it works and others it doesn't,  At those times, it makes me question, why are we in this field.  Now, granted, we all have to eat and take care of our families and lives, but at some point, I believe we entered this field to help hurting people.  Somewhere along the road, I believe some of my colleagues have forgotten that.  


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