Therapy is expensive. Here's what to do if you can't afford it.
Anyone uninsured (or underinsured) who has ever tried to find a therapist knows that it’s expensive as hell. The average talk therapy session costs between $75 and $100 and in more expensive places to live, that number can easily jump to $200 or $300.
It’s not only the cost of a session that stops people from getting care, though. Patients also get excluded from mental health treatment options due to limited provider options, long wait times, lack of awareness about treatment, and social stigma. On top of this, marginalized communities, including people of color and the LGBTQ+ community, face everyday social inequalities that can further isolate them from receiving proper care (which includes meds, talk therapy, or both).
The inaccessibility of care is more than inconvenient for people — it can be incredibly damaging, since severe mental illness can shave years off of a person’s life. I talked to two experts about how to find low-cost or free mental health care so you (or someone you love who is managing mental illness) can stay afloat, feel supported, and find the emotional tools to feel better sooner.
Research local sliding-scale options for talk therapy
Health insurance can feel kind of useless sometimes if it's behavioral health coverage you're looking for. Oftentimes, it’s not covered at all, but when it is covered, you often have a limited pool of options and the co-pays are high. If you’re looking for a therapist from a marginalized community you’re a part of, the options can be even slimmer. This is why it’s worth researching which therapists in your area can work the system with you.
“Many therapists offer what’s known as ‘sliding-scale’ payment,” explains Denice Cox, blogger and YouTube creator of Marbles Misplaced, a platform dedicated to helping people with mental illness live their best lives. (In many of her videos, Cox discusses what she’s learned while in Dialectical Behavioral Therapy [DBT], a program focused on mindfulness and social skills that traditionally incorporates group and individual therapy.) “This means you can come to a mutually agreeable price that is in your budget.”
Professionals sometimes will require some type of financial documentation (proving you actually warrant the assistance) to determine the cost of each session, but some practice the honor system. Additionally, some practices offer scholarship programs where the cost of a session is greatly reduced. In Philadelphia, Walnut Psychotherapy Center offers scholarships for low-income transgender people of color, dropping the cost per session from $75 to $30, reports WHHY. To start finding therapists in your area, you can begin searching on Psychology Today.
“You can also sometimes get free therapy through universities or research programs,” Cox adds. “Nothing can replace the benefit of working with a trained therapist who understands your unique needs.” Since there are many graduate students seeking practicum hours to complete their degrees, university behavioral health centers usually offer lower cost mental health services to their communities. (Note: Students almost always aren’t licensed yet, but are under the supervision of people who are.) Look into colleges in your area and contact their behavioral health departments for further information.
Seek out structured peer support
Niki Khanna is a San Francisco-based therapist who mainly works with queer, trans, intersex, and/or POC patients at low cost. Some of her patients have fallen back on community resources when they couldn’t afford to see a professional consistently.
“Uniquely, in the Bay area, there are some places that offer peer counseling support. [These are] folks who are not therapists, who haven’t gone through the same training, but have a certain type of training to offer peer support,” she explains. For instance, Khanna named LYRIC, a Bay Area organization dedicated to transgender youth, which offers a mentorship program to connect younger, transitional LGBTQ+ youth with LGBTQ+ adults to help guide them in their career and other interests.
Many community centers and locally-based nonprofits also offer mental health services, often in the form of a support group. (Khanna says they oftentimes are free or pay-what-you-can.) Some are more specific to getting through a life step, like grief- or divorce-centered groups. Others can be more focused on an identity, such as for sexual violence survivors or estranged adult children.
There is also the option of a warm line — an alternative to traditional hotlines in that they are peer-run to provide social support — where “folks can call and talk to other people who have also gone through their own mental health issues and have had some training.” They offer (free) non-urgent support for a more casual conversation, compared to a crisis hotline.
However, it’s helpful to know hotlines in case of emergency. The Crisis Textline is a 24-hour text messaging hotline service for those in the United States, United Kingdom and Canada. The Trans Lifeline is a voice line for transgender people in the United States and Canada. (Here is a list of suicide hotlines in other countries.) All lines practice confidentiality. While these lines are not replacements for professional help, they can be used for support when all other options have been exhausted.
Engage with a community around you
Managing mental illness such as depression or anxiety can be an isolating experience. This is why connecting with people who are dealing with similar hurdles is critical.
Khanna stresses the power of finding peers when you can’t meet with a therapist on-one-one. “We want comfort and support, [but] we often retreat in and don’t reach out to others because we feel like we’re too much. We don’t want to burden people." She says, however, that sometimes, we'd be really surprised what we can get from strangers who are on a similar journey as we are.
She recommends meditation centers, which usually offer a fellowship element. Some even offer affinity groups based on identity, such as for LGBTQ+ people or people of color. While the mindfulness that comes with practicing meditation can be useful, she says it’s more about the opportunity “to sit with others and be with other people who might have similar struggles.”
Khanna also identifies 12-step and other types of recovery programs as an option. “12-step might not be everyone’s jam, and might not be the specific thing you need, but it might be helpful to sit with another group of people, especially if you’re not feeling OK and don’t want to be alone,” she says “Often, they’re going to be welcoming and comforting in a way that maybe going to the mall or library might not be.”
Find people online who are vocal about managing their mental illness
It’s not always easy to find community groups, especially if you live in more rural areas. In that case, the internet — particularly social media, when used strategically — can come in handy. Many people create content revolving around their everyday experiences with mental health issues. While they may not have the professional credentials that a licensed therapist may have, their first-hand accounts of mental health can be relatable, helpful, and even educational.
“My mission when I started Marbles Misplaced was to share my story and offer support to others going through similar mental health struggles,” Cox says. “I'm not a therapist and I don't pretend to be, but I do share my personal experiences.” She adds that her hope is that people feel like they’re not alone when they watch her videos.
While Cox expressed that her content is not a replacement for in-person therapy, YouTube and Instagram have been tremendous resources for her. Some picks from YouTube are Leif Ostara, Ashante the Artist, Lisa Nichols, and Kati Morton. On Instagram, look out for the Trust Your Body Project, Decolonizing Our Healing, Lisa Olivera, and C-PTSD Survival Guide.
Mental health services can be difficult to come by, but they're out there. The above options often turn out to be a stepping stone to the next stage of well-deserved care. Even if the options covered in this list aren’t ideal, know that they can be used as supportive tools to get through your current situation.
If you're experiencing a mental health emergency and are at risk of endangering your life, please call the National Suicide Prevention Line at 800-273-TALK (8255).