Can’t afford therapy? Consider group therapy, telecounseling and other alternatives.
Susan Johnston Taylor | U.S. News & World Report
When you’re in an emotional crisis, the last thing you need is to worry about a bill from a therapist or counselor.
The good news is that seeking help for mental health issues isn’t as taboo as it once was. Still, economic barriers remain. In fact, 45.7 percent of Americans with an unmet need for mental health services cited cost as a top reason for not receiving treatment, according to a 2011 report from the Kaiser Commission on Medicaid and the Uninsured.
“A lot of [providers] don’t take insurance, and the ones that do are pretty backed up, so it’s going to be a couple months’ wait to get in to see somebody,” says Mike Frazier, a psychiatrist who’s finishing up his residency at UC Irvine in Orange County, California.
For this reason, we’ve pinpointed several affordable options for accessing mental health care services, just in time for Mental Health Month.
Community resources. First, tap into local resources for free or discounted counseling. For instance, survivors of sexual assault, domestic abuse or other circumstances often have access to free counseling at local community centers. “I have previously worked for a rape crisis center, and my counseling services were covered 100 percent for anyone who had been through a sexual assault of any kind, male or female,” says Stephanie Adams, a Fort Worth, Texas-based counselor and business coach for counselors. “There are services funded by donations that cover counseling for the military and many more,” she adds. To find a free or low-cost center near you, check out resources like Rainn.org, a national antisexual assault organization, or NAMI.org, which lists mental health resources for teens, young adults, the LGBT community and other groups.
Seek out therapists or counselors in training. If you live near a college that offers marriage and family therapist or master’s of social work degrees, you may be able to see a trainee at a reduced rate. But keep in mind that your therapist will be supervised by someone more experienced. “You may or may not meet this person [supervising the trainee], but your therapist will be talking to them about your case,” Frazier says. “This means that in a sense you will have two sets of eyes on you, which can translate to better care for you,” he adds.
However, there is one major downside. If you find someone you like, they’ll eventually graduate and leave the program. “You may only have a therapist for about a year before they graduate their program, though it is possible to work with someone longer term if their program is longer and if you catch them at the beginning of it,” Frazier says. Hopefully, by then, you will have made progress towards your goals.
Consider group therapy sessions. According to Frazier, group therapy sessions tend to “be [at a] lower cost and [have] actually been shown to be just as effective, and sometimes more effective, than one-on-one therapy.” Frazier recommends asking about group therapy at universities that offer a psychiatry program.
Oftentimes, group therapy brings together people with a shared concern, such as post-traumatic stress disorder or eating disorders, but a different type of session called process groups could help those who want to work more generally on how they interact with others. “Group counseling offers the unique benefit of hearing stories of other people’s struggles and triumphs in addition to the support of a therapist,” Adams says.
Find a therapist who works on a sliding scale. Some therapists offer services on a sliding scale based on income qualifications, so it never hurts to ask if this is an option. If you find a therapist you like, Adams also suggests asking if he will offer a rate reduction if you prepay for multiple sessions at once.
Some religious organizations also offer sliding-scale services or connect you to other therapists who do offer such services. “Every Jewish Family Service agency in the country provides mental health services to the community [whether you’re Jewish or not]. We accept all insurances, and provide sliding-scale fees to those individuals without mental health coverage. Our fees begin as low as $35 for private therapy,” says Ellen Finkelstein, director of marketing at Jewish Family Service of Bergen and North Hudson. Other religious groups, like the American Association of Christian Counselors, may also be able to provide a list of resources and clinics that operate on a sliding scale.
Employee assistance programs. EAPs began in the 1920s when employers realized it was more cost-effective to rehabilitate employees with alcohol or drug abuse issues rather than replace them. These programs have now expanded to cover a broader range of services, including assistance with childcare, work-life balance, legal and more general mental health issues, according to Bert Alicea, a licensed psychologist and vice president of EAP and Work/Life Services at Health Advocate, a national healthcare advocacy organization that works with employers to administer EAPs and other programs.
If your employer offers an EAP, you may be eligible for a certain number of in-person or telephone counseling sessions at no cost. “We know that there’s a lot of people out there who might be uninsured or can’t afford the out-of-pocket costs associated with assessing mental health services,” Alicea says. “Coming to the EAP doesn’t cost them anything but their time,” he adds. If you have mental health coverage, organizations like Health Advocate can find you a provider who accepts your insurance so you can continue beyond the sessions covered by the EAP. If you don’t have insurance or can’t afford the copays, they can also refer you to less expensive resources in your community.
Online or telephone counseling. Options for online and telephone counseling are growing, which is good news for those with childcare constraints and those living in areas with a shortage of mental health professionals. Keep in mind that just as rates for in-person therapy vary widely, rates for telecounseling can be all over the map. However, Brittany Sherwood, a Florida-based psychiatric mental health nurse practitioner who works with patients virtually, says there’s typically more price transparency with this option because patients seeking online counseling expect to see clear pricing information. Like some other providers, Sherwood offers services on a sliding scale. She also offers a discount to college students who may not be able to see a counselor at school due to scheduling constraints.
Some states require insurance providers to cover telecounseling services, but Frazier says the trend is moving towards more coverage for telemedicine. Sherwood says patients often have more success paying upfront and getting reimbursed rather than the provider billing the insurer separately. “If the patient decides to do a cash rate and I provide a bill, they are much more likely to get reimbursement in some manner from their insurance company,” she says. “Insurance companies tend to be more flexible when it’s coming from the patient and not the provider,” Sherwood adds.
Regardless of why you’re seeking professional help to optimize your mental health, the need for help should outweigh concerns about cost. “When you’re concerned about the high cost of mental health treatment, it’s important to remember that early intervention and treatment will end up costing much less in the long term,” Sherwood says.