The pandemic has been hard on mental health. What to do if you can't afford therapy
Therapy can be great. It also can be expensive.
The Affordable Care Act included a mandate for insurers to cover mental healthcare as an essential service. But consumers may discover a wide gulf between what's technically covered by their plan and what they can afford. If your plan has a high deductible, you might be stuck paying hundreds or even thousands of dollars out of pocket before coverage kicks in. Or you might not be able to find therapists in your area who accept your insurance. In some parts of the country, there aren't enough mental health professionals to treat people who need care. And depending on your cultural background, there might be a stigma around seeking traditional talk therapy.
"In a lot of circles and communities, especially communities of color and immigrants, you just don't share that you're getting help outside of home," said Curley Bonds, a physician and psychiatrist and the chief medical officer for the Los Angeles County Department of Mental Health.
Some of the stigma of therapy might come from not knowing what it is or who it's really for. The idea of "seeing a therapist" might conjure up a mental image of a decadent wealthy person lying on a couch complaining about their mother. Or a complete stranger in a dark room asking you to spill your darkest secrets and then slinging a handful of medication at you. But neither of those stereotypes reflects reality, said Katrina DeBonis, a psychiatrist and associate clinical professor at UCLA.
"A lot of people think of therapy as this indulgence as opposed to an effective treatment," she said. "They might think therapy is only for rich people. One part of it is realizing that's not true. And it can be in combination with medication or instead of medication."
Before you give up on the idea of therapy altogether, DeBonis recommended you make sure you have the details right on what your plan covers. Call the number on the back of your insurance card or visit your insurance website and find out what mental health coverage is offered. She said a number of plans contract with platforms for telehealth or other virtual therapies.
If that's not available, or if you'd rather pursue a different avenue of treatment, there are still lots of free and low-cost alternatives to traditional therapy.
If you need help right now
If you are currently experiencing a mental health crisis, there are free phone- and text-based ways to get help. The National Suicide Prevention Hotline is available at (800) 273-8255; it's also available for Spanish speakers at (888) 628-9454 and for deaf or hard of hearing people.
If you can't or don't want to talk on the phone, the Crisis Text Line has crisis counselors available via text (send "HOME" to 741741), WhatsApp and Facebook Messenger.
Free alternatives to therapy
Your workplace, school or place of worship: Check with your employer to find out if your job offers an Employee Assistance Program. These programs often cover several free sessions with a counselor.
If you're a student, inquire about a school counselor.
In both cases, sessions are subject to standard confidentiality constraints. In other words, the person you talk to won't go to your employer or family members and tell them what you talked about. DeBonis said to ask about those privacy limits so you go in fully informed of your rights.
Many churches, temples and other places of worship offer confidential support and counseling for free.
Warmlines: Hotlines are generally for people in a crisis. If you're not at crisis level but just need someone to talk to, L.A. and Orange counties offer "warmlines" where you can chat or vent about whatever's on your mind, including anxiety, substance abuse or loneliness. Beyond immediate assistance, the person you speak to can offer advice and referrals for further resources if you need them. The Los Angeles County warmline is available from 9 a.m. to 9 p.m. at (800) 854-7771 (option 2). The Orange County warmline is available 24 hours a day, seven days a week, at (714) 991-6412.
Local resources through 211: Calling 211 from anywhere in America will connect you to someone knowledgeable about your local resources for all sorts of things, including mental health, rent and mortgage assistance, transportation, child and elder care, and job training. 211 is available 24/7 in California. Call 211 and ask what your local government offers for mental health needs.
Support groups: Most places that offered in-person support groups pre-pandemic are still going the virtual route. The National Alliance on Mental Illness of Urban Los Angeles and associated chapters throughout L.A. (including San Fernando Valley, Glendale, San Gabriel Valley, Pomona Valley, South Bay and Greater L.A. County) offer weekly peer support groups over Zoom led by trained facilitators for people living with mental illness or their family members. Self-Help and Recovery Exchange has a regularly updated calendar of volunteer-run support groups, including ones that meet on Zoom or in person in Culver City and downtown Los Angeles. Group topics include substance abuse, addiction, grief and loss, anger management and a variety of mental health conditions.
Online peer support: L.A. County offers 24/7 peer support through the iPrevail platform for free. You must be physically in L.A. County to register for the free account. Other cities and counties also offer free or subsidized iPrevail support; if your area doesn't, it's $9.99 a month. 7 Cups offers free peer support 24/7 with an option to upgrade to a licensed therapist for $150 a month.
Social media peer support groups and forums: There are lots of places on Reddit and groups on Facebook where people share their issues and experiences and seek support for a wide range of mental health issues. On Facebook, you can type in whatever issue you're dealing with and browse available groups. On Reddit, search for subreddits based on particular conditions or experiences, or start in more general places like r/findareddit, r/KindVoice and r/internetparents.
Because the people you're talking to aren't trained professionals, their expertise and your experience can vary, Bonds said: "You just want to be careful of things that aren't managed by professional organizations. There may be varying levels of quality."
Pandemic-specific resources: The L.A. County Department of Mental Health has published information and resources geared toward people experiencing anxiety, panic, grief, stress, frustration, depression or other mental health issues as a result of the pandemic. The department also partnered with the UCLA Public Partnership for Wellbeing to offer a guide to resources specifically for front-line workers, county employees, and educational and care workers.
Meditation: "Have you tried meditating?" might come off as trite but, really, experts say you should try meditating. "Practicing mindfulness can be helpful," DeBonis said. "It's free and evidence-based for a lot of mental health conditions. Not everyone takes to it right away, but it's worth trying."
Guided meditations and developing mindfulness practices can be powerful tools to support mental health. Apps like Calm and Headspace offer free trials and then paid versions afterward. If you're in L.A. County, Headspace is still free. There are also free videos on YouTube, free meditations available through Spotify and a number of podcasts available in the many places where you can find podcasts.
Low-cost alternatives to therapy
Sliding-scale clinics: There might be therapists or clinics in your area that offer services at lower rates based on your ability to pay. Google "sliding scale therapy near me" to see what's available.
Graduate schools and teaching hospitals: If there's a college or teaching hospital in your area, it may offer therapy sessions at reduced rates with clinicians in training. Contact them and ask what they offer.
Therapy apps: Apps such as Talkspace and BetterHelp offer therapy over text, phone or video, usually for less than the average sticker price of in-person sessions. They charge a per-session, monthly or annual fee, often with upsells for additional sessions or services.
Other mental health apps: If you're looking for apps suited to a particular condition, issue or treatment type, you can browse more than 200 in One Mind PsyberGuide's database. You can specify that you're looking for apps geared toward things like "chronic pain," "dialectical behavior therapy," "PTSD," "borderline personality disorder," "productivity" and more. Click on an app name from the database to see the cost (some are free), credibility, user experience and research based on the treatment type used.
Books and workbooks: Bibliotherapy is its own sub-discipline of therapy. But you don't necessarily need a licensed bibliotherapist to find value from books or workbooks.
"You can make a lot of progress on your own if you're motivated and can access a book from the library or from Amazon," DeBonis said.
DeBonis and Bonds offered some recommendations. Both mentioned "Wherever You Go, There You Are" by Jon Kabat-Zinn and David Burns' "The Feeling Good Handbook," which DeBonis said take a similar approach to cognitive behavioral therapy. Bonds said "The Courage to Heal" by Ellen Bass was good for people with trauma. He also recommended "Overcoming Depression" by Lawrence Shapiro and the anthology "Black and Buddhist: What Buddhism Can Teach Us" edited by Cheryl Giles and Pamela Ayo Etunde.
Updates:
3:17 p.m. Oct. 25, 2021: This story has been updated with the website, phone number and hours for the L.A. County Department of Mental Health warmline.
5:48 p.m. Sept. 29, 2021: This story has been updated with more information about L.A. County chapters of the National Alliance on Mental Illness.
For the record:
10:56 a.m. Sept. 24, 2021: A previous version of this post misspelled Jon Kabat-Zinn’s name as John Cabot Zin.
This story originally appeared in Los Angeles Times.
