According to the National Alliance on Mental Illness (NAMI), roughly one in five adults in the United States experiences some form of mental illness.
Earlier this month, LifeStance Health, one of the largest providers of virtual and in-person outpatient mental health care services in the U.S., released the results of a new survey of 1,085 U.S. adults that explored a range of issues related to mental health, including Americans' mental health, access to mental health support, and the ranking of therapy in overall household finances.
70% of survey respondents said they have experienced stress, worry, anxiety or depression. Of those with current mental health issues, 64% have previously sought therapy. More than half (54%) rank therapy or similar mental health services as their top discretionary spending priority.
If given the choice, half (50%) would choose a year of free therapy sessions over opportunities such as Taylor Swift concert tickets, Super Bowl tickets or an all-expense paid luxury cruise.
65% of respondents said they would not be able to get therapy if their health insurance did not cover it. But reflecting the fact that having health insurance does not always mean you can get the mental health care you need, 66% of respondents were able to find a therapist who accepted their insurance and was available for an appointment, while 27% were not.
If you’re struggling to fit medical expenses into your budget, you’re not alone.
Getty
Why therapy is hard
Joy Liu is a certified financial trainer at Wilmington, North Carolina-based Financial Gym. “Many people live payday to payday, so fitting big expenses into a budget can be hard.” She adds that for people who already have mental illness, if their executive function is affected by their symptoms, “it can be hard to prioritize accordingly,” and says the process of finding a therapist, let alone one that's covered by insurance, can be overwhelming. “Unfortunately, there are a lot of hurdles to jump through.” The online search, finding out if a referral is needed, calling or emailing, following up… it can be a frustrating process.
The cost of treatment can also be a barrier for many, and the cost varies depending on factors such as where the therapist is located, the amount and type of the therapist's training, the length of the session, and the therapist's area of expertise. Sessions can cost anywhere from $65 to $250 or more per hour. Insurance copayments vary, but average between $20 and $50.
“Therapy can be incredibly expensive, and I know many fellow therapists who can't even afford to see their own therapist. Even if you're lucky enough to find a therapist who accepts insurance and is accepting new clients, it may be months before you can see that therapist,” says Los Angeles-based therapist Theodora Blanchfield, AMFT.
Blanchfield recommends finding an out-of-network therapist who will provide you with a superbill so you can apply for partial reimbursement with your insurance. “What clients looking for therapy don't know is that many therapists don't take insurance because their reimbursement rates are incredibly low and it takes a ton of time and effort on top of your regular sessions. By not taking insurance, we can take on more clients and help more people.”
How to create and stick to a budget that includes therapy
“The first step is to understand the difference between a fixed and variable cost budget,” Liu says. Fixed costs are things like rent or mortgage payments, car payments, and utility bills. Variable costs fluctuate.
Once you're clear on what that is in your life, “you can start to compartmentalize and work at it. Once all your fixed expenses are factored into your income, you'll know how much is left for variable expenses and how much you can save,” Liu explains. Knowing what you need to budget for in each category can help you figure out what's available for therapy and what trade-offs you need to make to fit more comfortably within your budget.
Of course, making a budget and sticking to it are two different things. To develop healthy money habits, Liu recommends automating as much as possible. “In addition to separating fixed and variable expenses, one of the things we recommend to our clients is to commit to a savings goal or whatever is important to you, so you have as much clarity as possible about how much you have left for variable expenses.”
That might be having your paycheck automatically split into several accounts (for example, a checking and savings account, or if you're married, a joint account plus an individual and savings account). With so many ways to pay (cash, credit cards, debit cards, payment apps, etc.), Liu recommends separating what you use to pay for fixed and variable expenses to help you keep track of your available money. She recommends using a system that works for you to track your spending as closely as possible. “For example, you might have one account that you use to pay for all your fixed purchases and another account for variable expenses,” she says.
There are many mental health resources available at a variety of price points.
Getty
Reduced medical costs
In addition to researching online therapy platforms, which are becoming increasingly popular due to their accessibility in terms of cost and time, Blanchfield recommends some low-cost therapy resources for those who can't access in-network care and lack out-of-network coverage: “Open Path Therapy Collective is a great place to find low-cost therapy, as it is a nationwide collective where member therapists offer sessions to clients for $40-70 per session. Additionally, you can find out if your local university has a counseling center where therapists in training can see clients for a low fee. Another option is to look for associate degree or pre-licensure therapists in your area; their fees are often lower than fully licensed therapists.”
She adds: “If you're part of a marginalized group, organizations like the Loveland Foundation and the Lotus Therapy Fund offer scholarships. Finally, if you find a therapist you like but can't afford the quoted fee, it's always worth asking if they have sliding-scale slots or if you know someone who does.”
She also suggests trying group therapy. “One thing I often say about therapy is that it's a microcosm of the 'real world' outside the therapy room. That means that if you're not comfortable voicing your opinion to your therapist, you're likely not comfortable voicing your opinion in other areas of your life either. For this reason, I think group therapy can be a great, low-cost therapy option if you're not going to therapy to process a specific issue or trauma. In group therapy, you often discuss the dynamics that are emerging in real time in the room with other people, not just your therapist. You end up learning more than you expected about yourself and how you operate in the world, and how to feel more comfortable doing so.”
Liu adds that sometimes treatment is absolutely medically necessary, but funds simply aren't available: “When it comes to health, including mental health, sometimes it doesn't matter whether you have money or not. If you're making a conscious choice and you know that nothing will work until your mental health improves, then it's okay to put money on the back burner for now. There are many ways to measure your decisions, money is just one of them.”
If so, she recommends making a plan to pay off any debt you may incur to cover mental health care and seeking resources such as financial assistance from your community, church or charity.
Getting the most out of your treatment
Once you've found the right way to make therapy a part of your daily life, you need to make sure you're getting the most out of the time, energy, and money you invest.
“One of the best ways to get the most out of a therapy experience is to journal immediately after,” says Blanchfield. “What did the session feel like for you? Did you feel like you had a weight lifted off your shoulders? Or did you feel really overwhelmed and exhausted? What do you want to take away from it and incorporate into your life? How do you go about doing that? This could be either a new way of thinking about something or trying a new coping skill, like a thought log, in which you write down as many of your negative automatic thoughts as you can.”
Just as important as actually writing your notes is coming back to them later in the week and reflecting on what you've written, she adds.
If financial reasons don't allow you to seek treatment, there are still ways to prioritize your mental health.
Getty
Prioritize your mental health
Therapy is an essential tool in managing your mental health, but financial barriers can often feel overwhelming. But with careful budgeting, exploring low-cost options, and making small changes to your spending habits, you can incorporate therapy into your daily life. Finding a sliding-scale therapist, using online mental health platforms, and leveraging community resources are some ways to get the care you need. Remember, investing in your mental health is one of the most important commitments you can make to yourself. By prioritizing your mental health, you'll ensure your long-term health and resilience while taking care of your mind.
