SUMMARY: Paying for mental health care is difficult for many. Even for those who are insured, restrictions on mental health coverage require many Americans to pay quite a lot out of pocket. For the more than 30 million U.S. adults who do not receive the mental health services they need, 45 percent cite cost as a barrier to mental health care. According to a survey looking at treatment received between 2005 and 2009, a quarter of the 15.7 million Americans who received mental health care listed themselves as the main payer for the services, paying between $100 and $5,000. Yet for those who are persistent and direct about stating what they can pay, there are ways of finding more affordable treatment.
Second in our 6-part series on mental health
Millions of Americans experience anxiety, depression, bipolar disorder or other mental and behavior health ills; for them, mental health care is not optional.
Yet for the millions of Americans who have to pay out of pocket for mental health treatment, cost is a barrier to getting the service they need.
The math: The NIH states that 26% of the adult population of 240 million experience mental health problems. That means about 60 million U.S. adults experience problems, of whom 60%, or 36 million, do not receive treatment.
How much does psychotherapy cost?
While the fees therapists charge vary according to geographic location and levels of training, one standard session (45-55 minutes) of talk therapy generally runs between $80 and $120. In New York City seeing a psychotherapist runs higher (between $200 and $300), while on the lower end of the scale it is closer to $60. Multiply these rates by one session per week, and the costs can add up faster than patients are able to pay.
Here is a sampling of links to practitioners’ web sites and other resources with rates: Katherine Oram, Ph.D; a home-page link to the Psychology Today website, with a practitioner search tool; Dr. Neil Goldman on the Psychology Today site; Lisa Haberman’s rates page; and the rates page for Linda Beeler, a licensed clinical social worker.
Through the Affordable Care Act and Mental Health Parity Law, millions more Americans will be covered by insurance to seek mental health care. Yet plans with high deductibles and co-pays, consumers need to understand their care options. The question is, where do you start?
Which professionals provide mental health treatment?
A variety of mental health professionals have the training and qualifications to provide psychotherapy, including psychologists, clinical social workers, psychiatric nurses, and mental health counselors.
- Psychologist. A psychologist has a doctoral degree in psychology, which is the study of the mind and behaviors. After completing graduate school, a psychologist completes an internship that lasts two to three years and provides further training in treatment methods, psychological theory, and behavioral therapy. Licensed psychologists are qualified to do counseling and psychotherapy and provide treatment for mental disorders.
- Licensed Clinical Social Worker. A clinical social worker has at least a master’s degree in social work and training to be able to evaluate and treat mental illnesses.
- Licensed Mental Health Counselor. A psychological counselor is a mental health professional who has a master’s degree (MA) in psychology, counseling, or a related field. In order to be licensed, the professional counselor also needs two additional years’ experience working with a qualified mental health professional after graduate school.
- Psychiatric or Mental Health Nurse. Some nurses have special training to provide mental health services. They can evaluate patients for mental illness and provide psychotherapy.
The role of psychiatrists
Among mental health professionals, only psychiatrists are able to prescribe medication. Although psychotherapy was originally the purview of psychiatry, many psychiatrists today focus largely on medication management – a reality that is enforced by the financial disincentives created by insurance companies. Psychiatrists can earn much more for three 15-minute sessions of medication management than they can for one 45-minute session of talk therapy.
A solo practitioner near Princeton, N.J., Dr. Nancy Goldin has been practicing psychiatry for nearly 20 years, and she is a strong believer in the benefits of psychotherapy.
“I think talk therapy is alive and well, but psychiatrists are not doing it anymore,” says Goldin, who allows for longer appointment times – 30 minute sessions – so she can combine medication management with psychotherapy. “You need to have a relationship with these people.”
“We are a dying breed,” Goldin says of the psychiatrists who still engage in therapy. “Everything is driven by managed care and costs. Insurance companies don’t want to pay for a psychiatrist to talk to a person for 50 minutes. So they don’t reimburse for that. They reimburse for short periods of time.”
Psychiatrists who also provide psychotherapy may be a dying breed, but they can still be found. According to a 2010 study, while just 11 percent of psychiatrists provide talk therapy to all of their patients, almost 60 percent provide it to at least some of them. But for those who are paying out of pocket for therapy, seeing a psychiatrist is even more expensive that engaging a different service provider.
What you can do
The good news is, there are many approaches consumers can take to find affordable therapy. Here are five ways to negotiate a better rate:
1) Sliding scales. Almost all therapists offer sliding scales for patients who are paying out of pocket, and/or for people with limited resources. If you are already seeing a therapist or interviewing possible candidates, be sure to ask about discounted rates, which can be as much as 30% below the self-pay rate.
2) Request flexible scheduling. While many patients book weekly sessions with their therapists, those paying out of pocket may prefer to reduce costs by scheduling sessions on alternating weeks. In between sessions, many people engage in online support-type groups such as 7 Cups of Tea, through which users can connect with compassionate listeners for free. PsychCentral.com is also a go-to website that hosts many forums catering to a variety of audiences.
3) Be direct about stating what you can pay. Therapists often have pro bono slots in their practices, enabling them to see a percentage of their clients at no cost.
4) Inquire about a payment plan. Patients whose financial circumstances have changed drastically may consider asking about a payment plan rather than abandoning therapy altogether. Therapists may accept a plan to receive a portion of their fees at time of treatment, with the balance to follow.
5) Ask for a referral. Community mental health agencies offer therapy services at far more affordable rates. Local university clinics, where students in training provide low cost therapy, are another low cost option.
Next: 5 Reasons why people self-pay for therapy.
This is the second piece in our mental health series. The series, in its entirety, is outlined here.
- Overview of Mental Health Care in the U.S.
- Finding Affordable Psychotherapy
- Five Reasons Why People Self-Pay for Therapy
- Finding Affordable Psychiatric Medications
- Patient Assistance Programs
- Thinking Out of the Box for Therapy