two women in a therapy session

It is widely acknowledged that the United States is in a mental health crisis. Since the pandemic lockdown, demand for therapy and psychiatry has gone through the roof and only keeps growing with economic and political stresses.

There are not enough therapists to meet demand, and those who are practicing may be working full-out. No improvements in availability are expected soon. Therapists themselves are undergoing the same stresses as their clients — compounded by paltry reimbursements, clients in crisis and their inability to treat everybody who wants an appointment.

There’s a lot of burnout, leading some therapists to leave the field — just as people are experiencing factors like Long Covid’s effects on the body and the brain, isolation and the reordering of social life, lost job opportunities, economic challenges and the upheavals of the Trump administration.

Some people may find a therapist, but learn that she’s not in network and have to pay cash, full freight, which is out of reach for many.

What to do? We never give medical advice, but here are some thoughts.

Your local National Alliance on Mental Illness chapter may have a support group or suggestions via its helpline.

Open Path Psychotherapy Collective describes itself as “a nonprofit nationwide network of mental health professionals dedicated to providing in-office and online mental health care — at a steeply reduced rate — to clients in need.”

Psychology Today’s “find a therapist” function will show on a therapist’s profile if they have a sliding scale. The profiles also give information on specializations, insurances accepted, whether they are accepting new patients, and other useful information.

The Psychologist Locator on the website of the American Psychological Association and the National Register may also be useful, or your state psychological association may have names.

Seek out-of-network reimbursement. Your insurance plan might partially reimburse out-of-network providers.

Don’t give up if you hit a waitlist — keep checking back.

Many federally qualified health centers also offer mental health services. They are means-tested. F.Q.H.C.’s are safety-net providers, outpatient clinics that qualify for specific reimbursement systems under Medicare and Medicaid.  

Online options

There are any number of online options, but you should tread carefully. Betterhelp advertises widely, but has been accused of having some of its therapists use AI, though it denies that’s true. Betterhelp also settled a U.S. Federal Trade Commission case accusing it of disclosing consumer data it had promised to keep private.

There are many other online options: Talkspace, Brightside, Teladoc, Doctor on Demand, Therapyden, Thriveworks and Amwell, to name a few. Here’s a rundown of the various services — do your homework, because regulation of this space is apparently not robust. Cerebral was doing online prescribing of ADHD meds — not, strictly speaking, therapy — but its executives were accused of overprescribing and fraud.

Some options like 7 Cups offer “free online counseling,” but this should be approached with caution; many of the people who come to the phone are not trained therapists, but rather volunteer listeners. A recent investigation found a number of 7 Cups problems, “including the potential for manipulation of vulnerable youth by unqualified listeners and targeted abuse and harassment by trolls. Companion stories covered why online child exploitation is so hard to fight and why a contract between 7 Cups and the state of California was abruptly terminated,” The Association of Health Care Journalists reported.

Local resources, peer-to-peer

Many local resources exist: NYC Well is New York City’s free, confidential support, crisis intervention and information and referral service for people seeking help for mental health or substance use concerns. NYC Well advertises that it is available 24/7, 365 days a year, in 200 languages, at 888-NYC-WELL (888-692-9355) or by texting “WELL” to 65173. There may be something similar in your area; the National Alliance on Mental Illness (NAMI) helpline at 1-800-950-NAMI (6264), is a good resource.

Some specialized services exist, for example those focusing on substance use disorder, or cancer treatment, perhaps through an existing treatment program. If you’re in cancer treatment, then, ask if there are services that they may know of that are tailored to your concerns.

Related to the above, peer-to-peer health is the answer to a lot of questions — discussing your concerns with others who have the same issues. To find a peer-to-peer network, based on anything that ails you, go to this “Patient-led innovation” page from Susannah Fox, who’s a guru in peer-to-peer health matters at Rebel Health.

Online support groups can be a blessing and a curse. Hosted on places like Facebook and Reddit, they can offer advice and information that it’s hard to get elsewhere. But of course it’s not a good practice to rely unquestioningly on strangers on the internet for 1) ideas about mental health and treatment, or 2) protecting your privacy. Your internet history, as you know, is being bought and sold right now by any number of online entities.

For a thorough discussion of peer-to-peer health and online support groups, this New York Times article (gift link) is a pretty good rundown of the good, the bad and the ugly. The comments at the end may also be useful.

AI, telehealth

AI therapy chats are on the rise. This is a growing field, and while it may seem like it’s a good Bandaid, there’s ample evidence that AI chatbots do not deliver meaningful professional-level therapy with healing successes. A recent report about Generative AI found that therapy/companionship is the No. 1 use case for generative AI in 2025. The full report, from March 2025 by Marc Zao-Sanders, is here. It is true, though, that AI chatbots have been implicated in some tragic cases, like that of a Texas boy who committed suicide. This is not, strictly speaking, therapy, but rather a chatbot, which some people used to achieve some of the same goals of therapy: Connecting, reporting feelings, asking questions. There is a big difference between therapy and a chatbot.

Consider telehealth rather than in-person therapy. This is very common since the lockdown from the pandemic. Many insurance plans now cover virtual therapy, even for a therapist in another state.

Community mental health

Community mental health centers may be an option. These often offer sliding scale fees based on income and may accept various insurance plans.

University training clinics could help. Psychology departments at local universities often provide reduced-cost therapy with supervised graduate students.

Your Employee Assistance Program (EAP) might offer free counseling sessions. Not everyone wants their employer to know about their mental health struggles, but that’s what they are there for. They often offer several free counseling sessions.

Consider group therapy. It’s often more affordable and may be easier to find in-network.

Emergency services

There are a number of emergency services, designed for one-off or short-term help:

There are many local resources, for example in North Carolina, the NC Peer Warmline (855) PEERS-NC or (855) 733-7762 is staffed by certified peer support specialists 24/7, English only.

Your local National Alliance on Mental Illness (NAMI) chapter may have a local number. Looking for some other helpline? Try FindAHelpline. It lets you narrow down by nation, by issue and other factors.

As always, your doctor will say that exercise, good nutrition, good sleeping habits and a robust social life, plus meaningful work and community bonds, will bolster mental health. Try getting outside and exercising, even a walk with a friend.

Jeanne Pinder  is the founder and CEO of ClearHealthCosts. She worked at The New York Times for almost 25 years as a reporter, editor and human resources executive, then volunteered for a buyout and founded...