The pandemic has taken a toll on mental health over the past year. Help is needed now more than ever, and the demand for mental health services isn’t decreasing anytime soon.
Maybe you’re one of the nearly 1 in 5 adults in the U.S. who has been living with a mental health disorder and the feelings you’re struggling with now aren’t new; or maybe this is the first time you’re experiencing anxiety or stress at this volume. Either way, the first step is clear: Ask for help.
But it’s not always that easy. “First of all, we have a supply-demand mismatch,” says Dr. Ken Duckworth, chief medical officer for National Alliance on Mental Illness. “Obviously a big wave of the pandemic has been the awareness that people are struggling with isolation, job loss, grief, racial trauma — more people are seeking help.”
Demand has increased for mental health services. Yet the supply is unchanged, he says. “More people are looking for help, but there’s still only so many seats on an airplane.” Beyond that, “There’s a private pay market, it takes seats off of our plane. These are the first class seats,” Duckworth says.
Even the Insured Are Often Underinsured
About 68% of Americans are covered under private health insurance. Even so, many are still underinsured, meaning services aren’t affordable — even after filing a claim through insurance.
Plus, it’s often tricky to figure out what behavioral health services are covered and when. Duckworth emphasizes that it’s important to understand your health plan and reach out to representatives of your plan who can help you: “You’re paying for it,” he says. “You have to make them help you find somebody,” even if that involves pushing on them.
Many Americans who don’t have private health insurance qualify for federal health insurance programs, like Medicaid or CHIP. But that still leaves 30 million Americans that are completely uninsured. With the average fee for a single therapy session averaging between $100 and $200, finding help may feel inaccessible. So, what are your options?
Where to Get Help on a Budget
The traditional therapy model may seem out of reach, but that’s not your only way to get help when you need it. Here are accessible alternatives — free of charge.
— Peer support.
— Group therapy.
— Emergency care.
— Community resources.
— Employee assistance programs.
“You have to bring new players onto the field,” says Duckworth. “This is an interesting area for peer specialists, peer navigators, peer coaches — so these are people with lived experience.”
They’re not therapists, he emphasizes, but support from a peer can extend the reach of some practitioners. There’s more support, learning and education that’s happening outside of the clinician space. Peers can help a lot of people, but “you don’t want them doing an assessment and giving diagnoses.”
There are many cases where peer support can be a good fit. For example, say “a person with bipolar disorder has figured out how to manage (their symptoms),” Duckworth says. When a person with new onset of bipolar disorder is seeking support, what they could benefit from is “access to this person who actually has made mistakes, has learned from them and wants to be of service to other people.”
Duckworth points to addiction as another example where there’s a clear success model of peer support, like Alcoholics Anonymous and Narcotics Anonymous, often in a group setting.
“Group therapy can be really helpful either by itself or in addition to having one-on-one sessions, depending on what kind of issues you might be working on,” says Dr. Jared L. Skillings, a psychologist and the chief of professional practice for the American Psychological Association.
“Group therapy has a lot of scientific evidence behind it showing that it can be helpful for a whole range of different kinds of conditions,” he adds.
Support in a group setting can be a good fit in several cases. “If people are open to that and willing to talk about what their issues are and what they’re struggling with in an open kind of format with other people, and they’re the kind of person who likes listening to other stories and learning lessons from other people,” says Skillings, then they’re likely a strong candidate for group therapy.
He adds that the people who seem to really get the most out of it are “people who are a little more talkative and outgoing and extroverted.” On the other hand, “some of the more quiet, shy, introverted people” often prefer one-on-one support.
Therapy in a group setting may not always be a good option. That may include:
— Someone who’s violent. “If you have someone who is really homicidal and threatening other people and really has some problems with violence,” Skillings says, then putting them in a group with other people would be challenging.
— Someone who says harmful things. For example, Skillings says if someone were to make sexist or racist comments in a group therapy session, “it’s so deeply offensive that it ruins the whole environment.”
— Certain mental health conditions. “Some people’s mental health conditions are serious enough that that’s not going to work either,” he says. For example, in a case of very serious bipolar disorder, where someone’s mood is fluctuating and it’s hard to control how you’re feeling from minute-to-minute, “that’s probably not the right kind of treatment mode you need.”
— A crisis situation. If someone is in a crisis situation where they are a potential harm to themselves or others, they should seek emergency care.
Some situations require immediate attention. “If you’re having some very serious functional problems in your life, if your relationships are falling apart or other really serious problems,” Skillings says, then you should be seeking emergency care.
He emphasizes that someone who is truly in a crisis — meaning they’re suicidal or potentially homicidal — should go to urgent are or the emergency department. “If you’re uninsured, hospitals are required to provide some care,” Duckworth adds.
Calling a helpline may not be a long-term solution, but they’re often resources that can help you work through a challenging situation or provide support in a pinch. Here are just a few options:
— NAMI HelpLine. NAMI volunteers work to “answer questions, offer support and provide practical next steps,” according to NAMI’s website. You can reach the free HelpLine at 800-950-NAMI (6264) from Monday through Friday, 10 a.m. to 8 p.m. Eastern Time.
— Crisis Text Line. Text HOME to 741741 anytime in the U.S. You’ll be connected with a trained crisis counselor for free support 24/7.
— National Suicide Prevention Lifeline. If you or someone you know is in a crisis, call 800-273-TALK (8255) for 24/7 access to a trained crisis counselor.
There are also several helplines available specific to whatever your individual situation may be — domestic violence, sexual assault or substance abuse, for example — that can be found through a quick online search.
Local resources vary largely by county and state, but in many areas, public mental health services are offered through community mental health centers or free clinics.
“Centers are operated by local governments to meet the needs of people whose mental health condition seriously impacts their daily functioning,” according to NAMI. “Some of the services a person might receive from a community or county mental health center include outpatient services, medication management, case management services and intensive community treatment services.”
Duckworth adds that “many mental health community centers accept Medicaid.” And for those who are uninsured, community centers can typically help get you on a Medicaid plan if you’re eligible, he says.
Employee Assistance Programs
An EAP is a “voluntary, work-based program that offers free and confidential assessments, short-term counseling, referrals and follow-up services to employees who have personal and/or work-related problems,” according to the U.S. Office of Personnel Management. These programs are offered at no cost to employees.
Most companies offer EAPs, so check with your employer to see what resources are available to you at no cost.
Other Low-cost Therapy Options
Sessions at $100 to $200? That’s not always the case. You can advocate for therapy sessions at a lower cost, plus newer alternatives are adding more flexible and affordable options to the playing field.
— Sliding scale therapy.
— Virtual therapy.
— Online subscription services.
Sliding Scale Therapy
“A lot of companies and individual private practices especially will have a sliding scale,” says Skillings. “And what that means is that the fee is based on someone’s ability to pay.”
Depending on the place, that could mean your taxable income or in some cases they’ll ask about your disposable income. For example, “you may make $50,000 a year, but you live in the middle of New York City, and you’re spending $40,000 of that on rent,” says Skillings, meaning you don’t have very much money to actually spend.
Many places have a sliding scale to help people out as they’re able. It won’t be free, he says, but it’s “absolutely something (that) someone who is struggling financially should ask about.”
Telehealth has seen a boom in access to care. Phone sessions are very good for equity, adds Skillings, because not everyone has the internet or space to take an online appointment.
Most people find telehealth a helpful resource, as it can cut costs on traveling to and from an office and fit into a busy schedule as needed. However, Duckworth says it may not be a good fit for all individuals, including:
— People with developmental disabilities.
— Some with a language problem.
— People who are paranoid about technology.
However, Skillings cautions against something new that’s been popping up: anonymous texting therapy, meaning the therapist doesn’t know who the patient is.
“The reason why is twofold: One, is because the therapist is never going to know who you are. And if somebody is really, really in trouble, like very out of sorts, or suicidal, or homicidal,” it’s the therapist’s job to try to help the person control how they’re feeling and get them into a safer spot.
Second, says Skillings, having the patient say who they are is also “better for the patient” because then the patient is admitting who they are and saying ‘I need to work on this.’ “And just that step of being honest with yourself — that it’s me who is doing this, I’m being straightforward about it — that itself can be healing.”
Online Subscription Services
Online alternatives to the traditional in-office therapy model have popped up in recent years, such as Talkspace or BetterHelp. These services typically offer subscription plans, ranging anywhere from one to four or more sessions per month, often including online messaging or texting options.
“They represent these kind of alternative pathways as people try to recognize that we actually have a problem with supply-demand mismatch,” Duckworth says. “People are trying to add supply.”
Use Your Support System
“The most important thing is to talk to someone else that you are having that kind of trouble. That can be frankly anybody who you think is a pretty stable, helpful, supportive, caring person,” Skillings says. And if you’re feeling so overwhelmed, like you’re on the edge of falling apart, “have someone help you think through it.”
“When you’re that upset, when you’re really just on the edge of totally falling apart, it’s often hard to make good logical choices,” he says. “So you might want to have someone who you trust help you think through what should you do next: ‘Who can we call? Where can we go?'”
And to take it a step further, Skillings offers action steps for someone who’s helping a loved one: “I have frequently encouraged other family members and supportive people to go with someone to an appointment who’s in that spot.” He says the most important thing is just to be there and to be a support.
“Say ‘What can I do to help?’ ‘I don’t know what to do,’ the person might say, or ‘I’m just out of sorts.’ Then probably the next step is to try to get them to somebody who would know. Take them to urgent care, take them to their primary care doctor, go find somebody who has some expertise. Or call the crisis line.”
If you’re the supportive person or the caregiver in that situation, “You can’t go far as to order people around or boss them around,” he says. “But I do think it’s OK for you to push it. And for you to say to them, ‘Look, you really are upset. This really has me worried. Let’s both go — we’re going to go to the doctor today and get it checked out.'”
Finding an option that suits your needs can be daunting, and exhausting. But don’t give up. “It takes persistence. I’m sorry to say that,” says Duckworth. “People who are facing some of the hardest challenges are left with the worst obstacle course in American health care.”
“Remember, the system was broken before you began to look at it. It has no commentary on your suitability for care,” Duckworth emphasizes. “There’s no easy way to navigate a chaotic and fragmented system. Be gentle with yourself, be persistent — this is not a commentary on your worthiness for care.”
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