Mental health support is needed now more than ever. Many Americans admit to rising stress levels associated with political and economic uncertainty. The demand for mental health services isn’t slowing down anytime soon, yet access to affordable therapy remains a challenge.
Maybe you’ve been managing a mental health disorder for years, and the feelings you’re struggling with aren’t new, or perhaps this is the first time you’ve experienced heightened 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. While more people are seeking mental health services, the number of available mental health providers has not increased.
“More people are looking for help, but there’s still only so many seats on an airplane,” Duckworth says. And beyond that, a private-pay market makes access even harder — reserving “first-class seats” for those who can afford to pay out of pocket or have better health insurance plans.
[Read: Grounding Techniques: Exercises for Anxiety and Panic Attacks]
Cost of Therapy
About 92% of Americans have some form of health insurance coverage — 65% in the U.S. are covered by private health insurance, while 36% rely on public programs. 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 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 for answers.
Many without private health insurance qualify for federal programs like Medicaid or CHIP. But that still leaves millions of Americans who are completely uninsured. With the average fee for a single therapy session averaging between $100 and $200, finding affordable mental health care can feel inaccessible and overwhelming. So, how do you get therapy when you can’t afford therapy?
[Read: How to Prepare for Your First Therapy Session.]
9 Options for Affordable Mental Health Support
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 — often free of charge.
— Peer support
— Group therapy
— Emergency care
— Helplines
— Community resources
— Employee assistance programs
— Sliding scale therapy
— Virtual therapy
— Online subscription services
Peer support
Peer specialists, navigators and coaches are people with lived experiences who want to help others in similar situations.
They’re not therapists, Duckworth emphasizes. They cannot complete a medical assessment or give a diagnosis.
However, support from a peer can extend the reach of some practitioners, with more support and education happening beyond the clinician space.
There are many cases where peer support can be a good fit. For example, Duckworth says that a person with a new onset of bipolar disorder is likely seeking support and might benefit from “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
Group therapy can be helpful on its own or in addition to one-on-one sessions, depending on what you might be working on.
“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 and issues,” says Jared L. Skillings, a board-certified psychologist.
Support in a group setting can be a good fit for many people.
“If people are willing to talk about their issues and what they’re struggling within an open kind of format with other people, and they’re the kind of person who likes interacting and learning lessons from others, then they’re likely a strong candidate for group therapy,” Skillings says.
He adds that people who seem to get the most out of it 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 someone is threatening other people or really has some problems with acting out angrily,” Skillings says, “then putting them in a group with other people would be a bad idea.”
— Someone who says harmful things. For example, Skillings says if someone regularly makes judgmental or intentionally hurtful comments in a group-therapy session, such as about someone’s age, race or personal values, “it can be so upsetting or offensive that it ruins the whole environment.”
— Certain mental health conditions. “Some people’s mental health conditions are complicated enough that group will not be helpful,” he says. “For example, someone whose thoughts are racing or so foggy or distracted that you cannot focus, or if it’s hard to control how you’re feeling or reacting minute-to-minute, group may not be the right kind of treatment you need.”
— A crisis situation. If someone is in a crisis situation and a potential harm to themselves or others, they should seek emergency care.
Emergency care
Some situations require immediate attention. “It is important to seek emergency care if you are thinking about ending your life, or thinking of harming yourself or someone else. The same goes if you know someone else who is talking about harming themselves or someone else — it is important to get them help,” Skillings emphasizes.
Call 911 or 988 — the new suicide hotline in the U.S. — or visit the emergency department, your local urgent care, any health care office or a trusted person in your family or community, he adds.
If you’re uninsured, hospitals must provide some level of stabilizing care. Under the Emergency Medical Treatment and Labor Act, or EMTALA, hospitals with emergency departments have to provide medical screening and stabilize a patient in an emergency, regardless of their ability to pay.
Helplines
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. A few available options include:
— 988 Suicide and Crisis Lifeline. If you or someone you know is in a crisis, call or text 988 or visit their website for 24/7 access to a trained crisis counselor. Previously known as the National Suicide Prevention Lifeline, the conversations are free and confidential.
— Crisis Text Line. Text HOME to 741741 anytime in the U.S. to be connected with a trained crisis counselor. This global nonprofit organization offers 24/7 free, confidential mental health support.
— 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 10 p.m. Eastern Time, or text “HelpLine” to 62640. You can also connect via chat on their website or by email.
There are also several helplines to address specific issues — domestic violence, sexual assault or substance abuse, for example — that can be found through a quick online search.
Community resources
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 in many areas.
“Centers are operated by local governments to meet the needs of people whose mental health condition seriously impacts their daily functioning,” according to NAMI. Available services may include:
— Outpatient services
— Medication management
— Case management services
— Help with substance use disorder
— Residential treatment services
Many mental health community centers also accept Medicaid, and for those who are uninsured, community centers might be able to help get you on a Medicaid plan if you’re eligible.
Employee assistance programs
An EAP is a workplace benefit that provides employees with free, confidential support services for personal and/or work-related problems. This can include assessments, short-term counseling, referrals and follow-up services, according to the U.S. Office of Personnel Management.
Most companies offer EAPs, so check with your employer to see what resources are available to you at no cost.
[Read: How Foods and Drinks Affect Our Mental Health]
Sliding-scale therapy
Many companies and individual private practices offer a sliding scale, meaning the fee is based on someone’s ability to pay.
Depending on the place, that could mean your taxable income or, in some cases, your disposable income — i.e., how much money you actually have to spend. Skillings notes that many people these days do not have much left over from their paycheck after paying for rent, food and living expenses.
Many places have a sliding scale to help people out as they’re able. It won’t be free, but it’s often more affordable and worth asking about if you’re struggling financially.
Virtual therapy
Telehealth has seen a boom in access to care. Phone sessions can be a good option for people without internet access or a private or safe 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 more easily fits into a busy schedule. 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.
“The reason why is threefold: One, is because if somebody is in a crisis, it’s the therapist’s job to try to help the person get them into a safer spot. You cannot do that if you don’t know who the person really is.”
Second, Skillings says, having the patient share their identity is also “better for the patient” because the patient acknowledges who they are and says, ‘I need to work on this.’ “Taking that step of being honest with yourself — it’s me who is doing this and reaching out — that itself can be healing.”
Lastly, he says that in the age of AI, if the therapist doesn’t verify the patient’s identity, it would be impossible to know if the text messages are coming from a real person.
Also, many people have voiced concerns that anonymous texting serves to further the unfair stigmatization of mental health problems.
Online subscription services
Online and digital alternatives to the traditional in-office therapy model have become quite popular in recent years, such as Talkspace, Teladoc Health 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.
“The pricing is transparent so that a patient knows how much it costs,” Skillings says.
[Read: What Is Cognitive Behavioral Therapy?]
Use Your Support System
Mental health care is for everyone — just like going to your primary care doctor for the flu, high blood pressure or an ear infection. “It is especially important to get a mental health check-up if you’re having serious problems functioning in your life — for example, you can barely get out of bed to do daily activities, if you cannot sleep for several days or if your relationships are falling apart,” Skillings says.
If you’re having trouble, it’s important to seek care and talk to someone.
“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,” Skillings says. “So you might want to have someone who you trust help you think through what you should do next: ‘Who can we call? Where can we go?'”
If you’re the supportive person in that situation, “you usually can’t go so far as to boss around or give orders to another adult,” he adds. “But I do think it’s OK for you to push it. And for you to say to them, ‘Look, you really are upset (or really not functioning very well). I am worried for you.”
If you are a parent, however, and it is your child or teenager who is having a serious mental health difficulty, you likely have more responsibilities and options to get them help.
For those helping a loved one, Skilling says you can suggest going to the appointment and getting it checked out together.
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,” Duckworth says. “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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Low-Cost Therapy Options for Every Budget originally appeared on usnews.com
Update 03/03/25: This story was previously published at an earlier date and has been updated with new information.
