What to Do When You Can’t Afford Therapy

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?

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