I Can’t Afford Mental Health Care: How to Find Good Care That Fits in Your Budget

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May is mental health month. In that spirit, I reached out to my own counselor to ask about resources for when you can’t afford mental health care.

One of the most tragic facets of life in America is the healthcare system. That system breaks down even further when mental health is addressed. In many places, especially rural areas, mental health care is nearly non-existent, stigmatized, or just unaffordable. When you can’t afford mental health care, what can you do?

Even for people with health insurance, mental health coverage may not be great. When the co-pay is too high to fit in the budget, it’s easy to ignore the need for help. Other common justifications for not seeking help include lack of time, the need for childcare, and a denial of the true need. Mental health care is self-care.

Fortunately, there are multiple ways to get the affordable mental health care needed. The trick is knowing where to look. 

Free nationwide mental health resources

First and foremost, if you need mental health care, seek it out. There is no shame in getting treatment for a medical condition, including depression, anxiety, and more. Counseling, medication, and other treatments save lives and improve lives. 

If you are contemplating suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text “LISTEN” to 741741. The service is available 24 hours a day, for anyone in crisis. 

MentalHealth.gov lists other resources when you can’t afford mental health care, as well as assistance for those with health insurance. 

Mental Health America offers a wide variety of mental health screening tests online. These tests can be a starting point for admitting there is something larger going on in your life. The website also provides suggestions for self-help and assistance in finding a provider. 

Dial *211 to connect to the United Way and gain access to local resources. Dialing this number should put you in touch with a 24-hour crisis answering service through your local help center. These services extend beyond mental health care. You can also receive assistance with paying your bills or COVID relief. 

Domestic violence also greatly impacts mental health, as well as physical well-being. If you are being abused, physically, mentally, emotionally, or financially, please reach out to the National Domestic Violence Hotline at 1-800-799-SAFE (7233). There is also a live chat feature on the website if you feel sure your internet usage is not being monitored. 

Montana mental health care resources

In the Gallatin Valley, your best resource is the Help Center, which can be reached at 406-586-3333. The Help Center serves as a 24-hour crisis line and the answering service for all the local therapists who are on call. Thrive is another local option for finding resources to help in stressful situations, beyond mental health alone. 

The Help Center can also connect you to the Hope House, a crisis facility in Bozeman. Hope House had an open-door program pre-COVID. Anyone needing treatment could drop in during a rough time and see a therapist without an appointment.  I don’t know if the program is currently active.

Another great local resource is Community Health Partners. The Belgrade, MT office has a community resource coordinator who can put you in touch with the local resources you need. This free service can even assist with applying for Medicaid or Social Security benefits. 

For those in western Montana, contact the Western Montana Mental Health Center, based in Missoula. I recommend dialing *211 to reach your local crisis center easily, no matter where you live. 

Sliding fee clinics help when you can’t afford mental health care

Mental health agencies often offer a sliding fee payment scale. The amount you pay for mental health care is pro-rated based on your income. To find such a provider near you, just google “mental health sliding fee near me” or something similar. 

You can also enter your location information to search the Free/Low-Cost/Sliding Scale Mental Health Clinics database from NeedyMeds. I was able to find a list of local providers that I know offer a sliding fee scale, so it seems to be pretty accurate. 

A nice benefit of using a mental health clinic for treatment is medication. A therapist or counselor cannot prescribe medication, but a medical doctor can. Mental health clinics often have a psychiatrist, an MD, on-staff. That means you can receive counseling and any necessary prescriptions from the same place. This is especially helpful for those with diagnoses that are harder for a general practitioner to treat with medication. 

Check universities for therapists-in-training

If you’re lucky enough to live near a university that has a psychology or counseling program, you may be able to receive mental health care at the university clinic. These clinics are staffed by therapists-in-training under the supervision of a licensed professional. Since you are seen by a trainee, the sessions may be free, low-cost, or on a sliding scale, so they’re a great option for those who can’t afford other mental health care options. 

It’s important to know that these sessions are often videotaped, with the supervisor watching the video feed in another room. You should also verify if the supervisor is on-site, for safety’s sake. 

University clinics usually don’t allow you to choose who you see initially but will work to match you to a suitable trainee. Once a relationship has been established, you should be able to see the same person after.

This type of clinic will often treat children, teens, families, and couples, as well as individual adults. Look for a program that has a supervisor with a play therapy credential if that is what you’re looking for for your child. Look for “RPT-S” after the counselor’s name (Registered Play Therapy – Supervisor). 

How to find other local options when you can’t afford mental health care

When you don’t have health insurance, ask your mental health provider if they offer a self-pay discount. Providers often give a discount when they don’t have to go through the insurance claims process.

Even with insurance, you can always ask if a prompt-pay discount is offered. I’ve seen this more with larger providers, like a hospital system, but it doesn’t hurt to ask. 

To find a mental health provider during a time of crisis, call the local emergency room or the psychiatric unit of the hospital. The employees there should be able to direct you toward a qualified professional. 

For less time-sensitive treatment, ask your primary care provider for recommendations. A doctor who actually knows you may be able to refer you to a compatible mental health care professional. 

Virtual mental health care options

One positive side-effect of the coronavirus pandemic is the prevalence of telehealth, virtual medical care. Many health insurance companies will now cover telehealth appointments. Virtual appointments aren’t a great option when you can’t afford mental health care, but they are more convenient. 

Telehealth reduces some of the other barriers to accessing mental health care. Accessing care virtually eliminates the commute, reduces the need for childcare, and makes the appointments more private.

Before beginning telehealth counseling, make sure your health insurance will cover this type of visit. Your therapist may do the legwork for you, but having that knowledge will prevent a surprise bill. 

Even without health insurance, there are many virtual mental health care options. The out-of-pocket cost will be higher than an insurance co-pay, but it’s a good option for busy people. Some also offer texting or messaging options, making counseling even more accessible, at more times.  

Virtual counseling providers

• Better Help (individual, couples & teen counseling)
• Faithful Counseling (Christian counseling)
• Teen Counseling
• ReGain (couples counseling)
• Pride Counseling (LGBTQ counseling)

This list from Top10 provides ratings, reviews, and more details about many different providers, including those listed above. 

Mental health & insurance concerns

Always check with your health insurance provider to ensure your appointments will be covered by your specific plan. Ask for a list of specific diagnoses, including diagnostic billing codes, to cover your bases. Share that information with your provider to make sure the billing is processed correctly. 

Children’s mental health coverage

Children’s mental health coverage can vary from coverage for adults, even under the same plan. There may be limits on the number of visits per insurance year. 

A child on Medicaid & diagnosed with a Specific Emotional Disturbance can qualify for additional visits. Private insurance policies may have a similar exception for SEDs, so make sure to inquire. 

Serious Emotional Disturbance sounds scary, but anxiety falls under the SED umbrella. This helps make counseling accessible to children less severely impacted as well. Other SEDs include bipolar disorder, conduct disorder, eating disorders, obsessive-compulsive disorder, and psychotic disorders (including schizophrenia). 

Most policies cover a wide range of conditions. As long as the child receives the proper diagnosis, mental health care should be covered by health insurance. If you’re concerned about your child’s behavior or coping skills, please, please seek help. 

Insurance is unlikely to cover an appointment between the child’s parent and the counselor, even if it’s an update on the child’s progress. The parent can instead ask to speak to the therapist at the beginning or end of the child’s regular session. When the regular session is covered, the parent’s portion will be too. 

Adult’s mental health coverage

Mental health coverage for adults will often cover depression, anxiety, and more severe diagnoses like schizophrenia and bipolar disorder. 

Another concern is couples counseling. Many health insurance policies won’t cover couples counseling, but they may cover family counseling… even if it’s for a family of just two. Ask your counselor or their billing department to help with getting approval if you are having trouble. 

Appealing insurance denials when you can’t afford mental health care

Health insurance policies lacking in mental health coverage will likely result in at least one claim denial, especially initially. Appealing insurance denials is a whole process, and that can be a lot to ask of someone with depression. I have a whole guide on appealing health insurance denials, but the main takeaway is to never give up.

I know how overwhelming that sounds. I’ve been in that spot. When you find yourself there, reach out. Ask a trusted friend or family member to help you. Inquire whether your health insurance company provides an advocacy resource.

How to find a compatible mental health care provider 

Start the search process by checking with your health insurance provider to get a list of in-network mental health professionals. I also recommend asking close friends or family for recommendations, if possible. 

Your doctors are another source of recommendations. General practitioners and obstetricians/gynecologists often have lists of counselors they refer patients to. Now, with the pandemic mental health crisis, I assume most medical professionals will have access to such a list. Asking someone who knows you may allow you to find a counselor who is a good option more quickly. 

It’s important to interview potential counselors to ensure a good fit. There are no dumb questions at this time. It’s more important to find someone you are comfortable opening up to.

Questions to ask yourself about a potential counselor

1. Will I feel more comfortable with a male or female?
2. Will I feel more comfortable with someone older, younger, or about my age?
3. Does this person make me feel safe & comfortable?
4. Is the space comfortable and welcoming? Is it sterile or intimidating?

Questions to ask a potential counselor

1. Have you dealt with my health insurance provider before?
2. Can you check with my insurance to make sure my appointments with you would be covered?
3. Do you have experience helping others with concerns like mine?
4. What is your therapy philosophy?
5. What methods do you use?
6. How would sessions with you look?

The first mental health provider you see may not be the best person to work with you. Keep trying until you find that perfect fit. A good therapist will conduct an initial meet & greet (possibly virtually now). This is a good chance to get a feel for the counselor, to see if you feel comfortable with them and their philosophies. 

Trust your gut and ask yourself if you feel safe with this person. If you have other options, don’t proceed with anyone who won’t meet or discuss their methods. Also, know that agencies may not allow a meet & greet or a lot of personality in their offices so it may be harder to get a feel for someone working in that environment. 

Why is mental health care so important?

When you know, you just know. I am constantly suggesting that friends and family members seek mental health treatment. Even for those who haven’t experienced major trauma or loss, counseling can make a huge difference in the quality of life. 

I have recently seen a push on social media to share more stories about mental health and the importance of treatment. I heartily support this effort. Mental health care is as necessary and normal as any other type of health care.

My story

I began my own journey with depression, anxiety, and counseling during my senior year of high school. At that point, I lived in a small, rural town with limited resources, so I never really “clicked” with the only counselor treating children. I did begin taking an antidepressant, which helped so much as I transitioned to college and living apart from my family.

When I was 21, I was diagnosed with Crohn’s disease.  I eventually had to give up my dream of becoming a CPA because I didn’t think I could complete the rigorous work requirement, even though I passed all of the academic and testing qualifications. Accepting a less stressful staff accountant position wasn’t even enough to keep me working full time. Luckily, my pregnancy with my older daughter somehow helped put my Crohn’s symptoms into remission, where they remain today. 

My daughter was diagnosed with spina bifida myelomeningocele and hydrocephalus at the 20-week ultrasound. She’s had multiple surgeries, hospitalizations, new diagnoses, and therapies since then. Our lives have changed dramatically from our original plan.

I quit my job & became a full-time caregiver to a child with many medical needs. I love her so much, but it’s a lot. We had another baby. My husband works nontraditional and variable schedules, meaning the management of our family life falls on me. 

Through all of these huge life stresses, I have been in counseling. Finding the right fit with a counselor gave me the skills I needed to cope with so many traumatic experiences. I can honestly say that my life would not be as happy and stable as it is today without affordable mental health care. 

I am a better wife, sister, and mom because of what I have learned in counseling. More importantly, I am a better me.