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Nobody should have to go bankrupt for seeking help.
By Sarah Fielding — Written on Jul 16, 2019
When I was diagnosed with a panic disorder during my senior year of college, I was fortunate to have access to regular, affordable mental health services.
Weekly therapy and monthly psychiatry appointments were available for free at my school. As a student working part-time, there was no way I could have afforded to pay out-of-pocket for counseling had that not been the case.
In fact, few people in the United States can afford the costs associated with therapy and mental health care, and that's a big problem, especially considering how many people are uninsured or under-insured.
And access to mental health services in the U.S. is challenging not just because of the cost, but when you combine the effects of mental health stigma still held by far too many people, limited affordable resources and the high financial cost of regular mental health care treatment, an alarming cycle of oppression emerges.
How much does therapy cost?
According to U.S. Census Bureau's data collected as part of the Current Population Survey Annual Social and Economic Supplements (CPS ASEC), 28.5 million people (8.8 percent of the population) did not have health insurance at any point during 2017.
For non-elderly people, the uninsured rate is even higher.
And a report from the Henry J. Kaiser Family Foundation states that 12 percent of people ages 19-64 don't have insurance coverage at all.
The outlook is even more dire for people of color, as African Americans and Hispanics in the United States are uninsured at even higher rates — 11 percent and 19 percent, respectively, compared to 7 percent among both White and Asian populations.
Regardless of whether you have insurance, therapy and visits with a psychopharmacologist — psychiatrists and other physicians who prescribe and monitor psychiatric medications — are expensive.
An article in Healthline explains, "Having health insurance doesn’t guarantee that you won’t need to pay upfront for therapy. Plans with high deductibles won’t cover any medical costs until the deductible has been met. Until that time, you’ll need to pay out-of-pocket for your appointments.
Unlike a $10-$30 insurance co-pay, most therapists charge between $75-$150 per session. In [more] expensive cities, like San Francisco, Los Angeles, and New York, however, therapy can cost as much as $200 per session."
And many of the people we talked to for this article have seen fees that are even higher than that.
For Allie*, 18, who struggles with depression and stress management, managing her healthcare needs can be complicated, as she must rely on private insurance that only covers some of the cost.
When she began looking for help, a 45-minute appointment with a counselor cost her up to $260, which she sometimes needed multiple times a week. On top of that, her psychiatrist charged more than $300 for the a 15-minute visits necessary in order for her to be prescribed medication.
Both of these fees were expected to be paid by the patient, not covered by her insurance, resulting in extremely high out-of-pocket costs.
“It's an extremely unfortunate life to live with ‘invisible illnesses’ because not only is it what you pay, it's what you lose,” Allie told me. “I am in a commission business now, so if I am not at work, I am not making money."
In order to keep up with her mental health care, she has to miss work for appointments.
She explains that trial-runs to find the right medication required at least three visits, an hour away from her job. It got to the point where Allie had to discontinue therapy and go off her medication because she simply couldn’t afford it.
Why are mental health services so expensive?
When people are unable to get the help they need, everyone suffers.
Those with untreated or under-treated mental health issues are not able to function as their best selves due to being without the cast and support their mental health requires.
This can lead to poor performance at work, the need for increased days off from work (if you can even take them) and, ultimately, the need to settle for less than one could otherwise achieve in both their personal and professional lives.
“Adults with one or more serious mental illnesses, on average, die 25 years earlier than those without serious mental health conditions,” Constellation Behavioral Health reports. “The main causes of death are treatable or preventable physical health conditions. Unmanaged mental illness can lead to poor management of physical health, including missing doctor appointments, ignoring symptoms, and making bad lifestyle choices."
In turn, people who live with conditions like depression, anxiety and other mental health concerns are less likely to rise in the ranks at work or receive raises.
This creates a vicious cycle where people who come from poverty or underserved communities — for whom access to regular mental health services is severely limited — are faced with yet another challenge in ascending to positions of power.
According to the American Psychological Association, people living in poverty are "nearly 2.5 times more likely to have depression than those at or above the poverty level."
When one considers that women earn less on the dollar than men — especially minority women, "with Asian women earning 97% of what white men earn [and white women earning] 79% ... while black women earn 67% and Hispanic women earn 58%," according to Business Insider — the deeper, hidden costs of the inaccessibility of mental health care becomes more and more apparent.
This invisible barricade to professional success also means there are likely to be fewer people working in upper management who understand the mental health needs of their employees.
Instead, mental illness continues to be discussed in only whispers — a stigma to be avoided, rather than a recognized health issue to be dealt with based on compassion and efficiency, as most medical conditions related to physical health would be.
“The cost of mental health care is astronomical, and this is a topic that no one likes to talk about because there is so much shame involved,” says Laura*, whose 16-year-old daughter requires intensive mental health care.
“That also helps to keep the cost inflated and fewer preventative programs in place,” she explains.
Laura’s family has good insurance, but nonetheless, she has been forced to spend almost $100,000 out-of-pocket over the past few years to get her daughter the treatment she needs.
According to the U.S. Department of Health and Human Services' Office On Women’s Health, "More than 1 in 5 women in the United States experienced a mental health condition in the past year, such as depression or anxiety. Many mental health conditions, such as depression and bipolar disorder, affect more women than men or affect women in different ways from men."
That means at least 20 percent of women are at risk of increased suffering due to the lack of affordable mental health care.
Grace Suh, a Licensed Mental Health Counselor based in New York, has seen the impact this lack of necessary mental health care can have.
“You see it all the time in poor high-risk populations,” she told me.
She explains that this cycle may look very similar to the following example: “An undocumented individual who has childhood trauma, suffers from anxiety and depression, struggles to hold up a job and is ineligible for adequate insurance attempts suicide in hopelessness.”
Considering this patient is uninsured, the health care system must then absorb the costs of what she is unable to afford, raising the cost of healthcare for everyone.
“This may be the result of the high cost of mental health care system and failure to assist high-risk individuals in need.”
She continues, “Mental health care is not accessible for all human beings living in the United States. The reality is, you need to meet certain criteria, such as geographic accessibility, legal immigration status, certain types of insurance, and possessing a stable, paying job that allows you flexibility in your schedule to seek out and receive mental health services.”
As soon as I graduated from college, I found myself unable to see my psychologist, as I faced astronomical medical bills.
According to TalkSpace, visits to therapists in New York City, where I am based, cost an average of $200 to $300 per session.
Eventually, I was able to find a low-cost clinic that charged $40 a visit, which still felt like a lot, considering I was freshly graduated.
And given the limited number of affordable options available for the high number of people who need them, it took months to get an appointment at that clinic.
While I was mentally better than I was the year before, it was still a difficult adjustment to move from counseling once a week to receiving no mental health services at all for months.
Then there's the fact that, for some people, the need for mental health care comes at a time when they are already in a particularly vulnerable position: during maternity leave.
Jen Schwartz, 37, founded Motherhood-Understood, an online platform and community for moms affected by maternal mental health issues, after her own experience suffering from postpartum depression and anxiety.
Following her diagnosis, Schwartz began seeing a therapist weekly at $150 an hour and a psychiatrist bi-weekly at $110 an hour. Neither of these appointments were covered by her insurance.
“I go for check-ins about twice a year now with both those medical professionals at that same cost, [and they are still] not covered by insurance,” she told me.
On top of that, she takes two antidepressants, one of which she had to fight for her insurance to cover.
After four years, her insurance company recently notified her that they will no longer cover that second antidepressant. She is currently paying almost $300 out of pocket monthly while she’s waiting on her appeal.
Despite what one may expect, sometimes having access to health insurance via your employer can put you in an even worse position when it comes to accessing and paying for mental health services.
When Miriam*, 26, first began seeing a therapist two years ago, her visits were covered by Health First, Colorado’s Medicaid program, with a copay of $0.
“I wasn’t making much money at the time,” Miriam told me, “and my chief concern was making sure I was getting the medical attention I needed, as I was in a really bad place mentally after the death of my ex-boyfriend.”
Then she switched jobs and was covered by a high-deductible plan via a Third-Party Administrator (TPA), which is a firm hired by employers to ensure employee’s claims are paid correctly. With this plan, Miriam's employer paid for part of their employees' health care costs.
“Because I had a high deductible plan, I was expected to pay out-of-pocket for all expenses up until I hit my $4,000 limit. My therapist charged me, I believe, $70 per visit,” Miriam explains. “It wasn’t really a fee I could pass up, since it was for mental health care. Had I lagged in my appointments, I do believe other aspects of my life would have suffered.”
Cheryl*, 52, who has been on medication for about 20 years due to severe anxiety, panic attacks and OCD, echoes the fact that mental health treatment isn't something you can simply skip when times get tough financially.
“I spend $300 a month for the medication I take, plus the cost of weekly counseling sessions, which adds another $400 a month,” she explains. “It has gotten so expensive, but it's not something I can skip like Starbucks.”
Just like any other medical appointment, these services are incredibly necessary.
As a result, people may be forced to go into debt to ensure they’re able to stay healthy.
This shouldn’t surprise anyone, considering that, according to a report by CNBC, 66.5 percent of bankruptcies in the U.S. are tied to medical expenses, some of which, certainly, are for mental health services like therapy and medication.
What can be done to end this awful cycle and make mental health care accessible and affordable?
“This is a systemic issue, a health care issue, and a policy issue,” Suh says.
She insists that first, “health care specialists should be reimbursed at the equitable rate by insurance or government funding."
She also explains the importance of raising our voices to remind people that seeking mental health treatment is as normal and necessary as going to see your primary care doctor when you have the flu.
“It's important for individuals, including patients and specialists, to raise awareness that therapy is not a luxury for the affluent, but is necessary health care for all humans.”
In the meantime, for people who are seeking therapy, medication or other treatment for depression or other types of mental illness, but are worried about cost, there are options.
Suh recommends the following resources for finding lower-cost mental health care services and medications:
Call to find out low cost or no cost community mental health clinics at 1-800-950-NAMI (6264) or visit the U.S. Department of Health and Human Services website for more options.
Attending a support group is one of the most affordable solutions, as many are offered free or at low-cost by organizations like Alcoholics Anonymous (AA), the Anxiety and Depression Association of America (ADAA), Depression and Bipolar Support Alliance (DBSA) and Narcotics Anonymous (NA).
Explore whether or not you have an Employee Assistance Plan (EAP) through work. To find out if you are qualified, call the number back of your insurance card or contact your human resources (HR) department.
Find out if any local specialists offer have a "sliding scale" fee structure based on income qualifications.
Online, telephone and app-based counseling services like Talkspace allow you to speak with licensed mental health specialists, and can help you save time and money.
Group therapy tends to be offered at a lower cost and can be as effective as one-on-one therapy.
Find no-cost or low-cost training clinics at Association of Psychology Training Clinics.
Look for Prescription Assistance Programs (PAPs), which "help patients who lack health insurance or prescription drug coverage obtain the medications they need. These programs are typically offered by pharmaceutical companies to provide free or low cost prescription drugs to qualifying individuals." To find out more visit the Partnership for Prescription Assistance.
If you are a college or university student, take advantage of the counseling and other mental health services you are already paying for, as most are included in your tuition and fees.
Until we move past mental health stigma as a society, barriers to affordable treatment will remain.
Without more conversation and widespread acceptance, mental health care will continue to be treated as a luxury instead of the necessity it is.
When mental health services are affordable, everyone benefits and people live happier, healthier and more productive lives.
So, don’t stop talking about it.
The wall is breaking slowly and one day everyone will be able to let more light in.
*some names in this article may have been changed to protect subjects’ privacy.
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Sarah Fielding is a freelance writer based in New York and the co-founder of Empire Coven, a space for highlighting trailblazing women across New York. Her work has appeared in Bustle, INSIDER, Men’s Health, Healthline, Fashionista, and more. For more, follow her on Instagram and Twitter.