Mental Health on a Budget

Mental Health on a Budget

This post is part of a larger series hosted by Dr. Emily Roberts of Personal Finance for PhDs. Every day during the month of October, she's posting a video to her Facebook page with frugal tips for PhDs, and later this week, I'll be there talking about mental health on a budget. But I'm also writing up this post so that the informational is accessible in a variety of formats! 

Mental health care can be expensive, especially in the US. 

I have been extremely lucky to have some coverage for mental health care all my adult life, but even with insurance, mental health care can be expensive. From paying co-pays, to taking time out of work or away from other jobs, parking, medications, medication co-pays, and evaluations, even small $10 costs can add up. I've learned through my long, productive journey in mental health care a few ways to help alleviate some of that stress. 

Explore your university or college based options.

Many universities have some form of mental health care available to students, and much of the time, those benefits extend to the graduate student population. But, there are some things to keep in mind.

  • These sessions are often provided outside of mental health insurance coverage, and come without a co-pay (normally - obviously check with the intake staff.) 
  • There is often a limit to how many sessions you can have - at both schools where I did graduate work (UCLA and University of Michigan) there was a 10 session cap per academic year, but it did reset each year. These caps were not usually published on the website, but the intake staff was open about them when I asked. 
  • Because of that session cap, if your case is deemed complicated or "long term," you are likely to get referred to an outside practice. I have successfully asked for (and gotten) access to those sessions as a sort of "help me right now with this current issue" triage model, while taking time to research and explore other outside options. 
  • If you don't meet the requirements or aren't a good fit for individual counseling, many centers also run group sessions that can be a great fit. I have participated in two, one short term (10 week) group on "Reducing Dissertation Stress and Anxiety" and one on "Women in Graduate School" and although I had to get used to the dynamics of therapeutic work in a group setting, they were free, convenient to campus, and very supportive. These can be a great add-on or stop gap to let you "spread out" individual sessions (a technique I'll discuss below.) 
  • Because of the center's proximity to campus, and the wide clientele that they may serve, you are likely to run into students, or even faculty while in waiting rooms or near the center. Standard decorum is to not acknowledge unless previously agreed that it would be okay/the relationship felt safe to do so, and although I was often "spotted" by students, I was never made to feel uncomfortable about it. 

Different clinics can offer different payment structures. 

One of the major options for lower-cost mental health care is the sliding scale clinic. A google search of ["city" sliding scale mental health care] will often result in a list of places that take in patients regardless of insurance coverage. Sliding scale refers to a payment scheme where patients submit proof of income and pay for services based on that amount, starting with $0 and going up in proportion to income. 

Many clinics will give you information about the sliding scale before you come in, and you should be prepared to bring proof of income (tax returns normally work but this is something else that can be answered on the phone before you go.) Also, sliding scale clinics often have long waiting lists, so signing up as soon as you're interested might help you be seen more quickly. 

Many insurances are now offering long-distance mental health care, through apps or video sessions. It is worth calling to see if you are covered by any of these lower cost plans - the co-pays are often lower than in-person visits. 

Be up front about your budget concerns with your practitioner. 

Although this isn't a standard question on an intake form or in an introductory session, I've found that disclosing budget concerns upfront can be incredibly helpful. Some things my practitioners have worked with me on around budget:

  • Scheduling sessions thoughtfully, or on-demand. Many therapy practices meet regularly (once a week, twice a month, etc) but when I have said "I only have 10 sessions to get me through this academic year," or "my budget doesn't allow for weekly sessions," other options were presented. I have been able to schedule when I need to (not always an option offered) or scheduled in advance to make sure I could be seen at important times. 
  • Coding my visits so that they're covered by insurance. When I was in my third year, my insurance denied a few of my visits, saying that I had reached the cap for a certain condition. Working with the in-house billing and taking another diagnostic test, I was able to have those sessions "re-coded" and re-billed so that they did qualify. It was frustrating at the time, but it saved me a lot of money in the long run to have those visits subsidized by insurance. 
  • Although I've always had insurance and never used a sliding scale structure, I do have friends and colleagues who have transferred to sliding scale clinics after their insurance ran out, or their financial situations changed. Having your therapist assist you in that transition, especially if your care is critical to your continued well being, can help cut through some of the waiting time and assure you are seen regularly. 
  • Using "free" services to supplement less frequent individual care. At various points, I have worked with my practitioners to "stretch" my limited individual sessions with other kinds of care. By adding in group therapy, or doing working on my own in workbooks in between less frequent sessions, I was able to do a lot of "day to day" stuff in other venues, leaving my individual appointments to do really specialized work. 

Unfortunately, the onus is on you to find affordable mental health care. 

This is the downside, unfortunately: almost all of these options required extra leg work on my part. Extra forms, lots of phone calls, educating myself on my insurance benefits - none of these things were easy to accomplish, especially in the pits of my depression or anxiety. The administrative and billing staff in many of the clinics and centers I visited were places chock full of resources and help for these questions though, and once I told someone I was overwhelmed, I got the support I needed to find the care I could afford. 

My biggest piece of encouragement is to start looking, know your coverage, understand your options, and make a plan BEFORE you need it. When I arrived on new campuses as a student, I investigated their mental health offerings, and learned how to be seen (where to go, when to go, how to pay) before I was in a crisis, so that it was that much easier to get help when I did need it. Learning about your benefits and finding places to get care seems overwhelming, but even if you only have one or two appointments, establishing these relationships and figuring out the systems can pay off, both in time and money. 

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