Welcome to my monthly mental health blog which I’ll be writing through December 2023 as I work to draw attention to mental health issues in our personal and professional lives. Today I’m going to discuss options for finding mental health services and treatments, especially if you are experiencing any financial concerns.
The two main areas that I want to cover today are medication and therapy. In the nearly 30 years I’ve been in treatment, options have changed for gaining access to medication and therapy, but many of us still struggle to find affordable care. Unfortunately, I don’t have any information about the various state- or city-run programs out there. If you’d like more information on that, I’d suggest one or more of the following:
- Go online to the National Alliance for Mental Illness (nami.org). According to the website, there are over 600 NAMI state organizations and affiliates across the country. You can enter your zip code and a mileage range and see available resources in your area. NAMI also has a 1-800 number and a text line that you can use as well.
- Contact local psychiatrist offices to see if they have materials or links to websites that describe services. This might be a good option for smaller, city-run programs that don’t fall under NAMI.
- Reach out to program heads at local chapters of AA, NA or other support groups.
MEDICATION
There are a lot of variables to consider when it comes to being able to afford your medication. Especially in the early days of treatment, you may be switching dosages frequently or even switching medications if you experience intolerable side effects. Here’s a collection of tips I’ve learned for managing the costs:
If your psychiatrist is putting you on a new, name brand drug, ask if the doctor has samples available for you to take. This is especially helpful if you will be ramping up in dosage over a week or two. I’ve even had doctors provide me with a month or two of samples to make sure I tolerated the medication before they wrote me a prescription.
Also, for name brand drugs, check with your insurance company in advance to see how much they will cover. But if you don’t have insurance, the insurance company will not cover it or will not cover enough of it to be affordable, consider the following…
Not all pharmacies charge the same for the same drug, so do a little research. The site GoodRX.com will show you the drug prices for a variety of pharmacies. And let me tell you, sometimes there is a HUGE difference in price among them. Now some of the prices on GoodRX are with the use of their coupons, but even those are typically free to download and can provide a cost savings.
Look up the website for the drug’s manufacturer. Especially for new drugs, many companies will have printable coupons to lower the price of the medication. It may take a while at the pharmacy to get everything set up, but it’s usually worth the time.
Ask your pharmacy if they can offer you a discount. I didn’t even know this was a possibility until a pharmacy technician offered this to me. My husband was on a drug our insurance would not cover, there wasn’t a manufacturer discount and, at the time, I didn’t know about prescription coupon sites. I went to pick up the drug and had a brief conversation with the pharmacist where I told him my insurance wouldn’t cover the prescription. And he said, “Oh. Ok. I can offer you a discount.” I was shocked to say the least because I was at a large retail chain pharmacy and never knew it was an option.
See if there is a generic available for another form of the drug. I know I started this section talking about name brand drugs, but sometimes the same drug is available from the same manufacturer in a different formulation. The drug I take now is an extended-release version (Drug XR) so I only have to take it once a day. But the same drug existed first in a non-XR version where you took a pill every 12 hours. Once the patent expired on the regular, two-times-a-day version and it went generic, the manufacturer developed the name brand XR version. There is typically a cost savings with generics, so see if there’s an older version of the same drug available.
This cost savings option requires quite a bit of work and coordination with your doctor and pharmacist. It’s called pill splitting. Imagine you have a prescription for an uncoated 40mg tablet that is also available as an uncoated 80mg tablet. The cost difference between the two dosages is usually quite small, if there even is one. It’s counterintuitive because you’d think double the active ingredient would cost double, but that’s frequently not the case. If amenable, the doctor can write a prescription for the 80mg version and you can split the tablet in two so you have double your 40mg dose. But now for the bad news:
- If the tablet has an enteric or other coating that controls the release of the medication, the tablet can’t be split
- Doesn’t work for medication in capsule form
- Usually can’t split medication that must be taken more often than once per day or any pre-packaged drugs in specific doses
Lastly, look into cost differences in receiving a 90-day supply instead of a 30-day. Regular pharmacies may offer this option but you can also investigate mail-order pharmacies that ship the drugs to you on a schedule. I’ve found the cost savings for mail-order pharmacies in the past to be between about 30% to 60%.
Real cost savings come when you can combine these suggestions, like if you can get a generic in a 90-day supply and you can do pill splitting.
THERAPY
Now were going to run down therapy services and some tips for cost savings.
A therapist will assess, diagnose and treat mental illness and often focuses on identifying and reducing symptoms. If you are employed and have medical benefits, your first stop should be with your benefits coordinator to see what your medical insurance offers you. If you’re not comfortable speaking with someone at work, you can call the toll-free number on the back of your insurance card and see what’s available. Frequent restrictions on care are:
- The number of times per year you can speak to a therapist
- Must usually choose an in-network mental health provider
- Cost for services can vary depending on the type of insurance plan you have (HMO, PPO, etc)
Another option if you are employed is seeing if your provider has an Employee Assistance Program. EAPs are programs are added on to regular insurance to provide you with (usually) faster access to a therapist, licensed clinical social worker (LCSW) or other non-MD mental health professional. The biggest restriction on an EAP is you are limited by the number of times per year you can speak to a therapist about a particular issue. The number I usually see is seven appointments. Also, there aren’t any guarantees that the person you speak to is covered by your regular insurance. So if you wanted to continue seeing them after seven appointments, you may have to pay 100% out of pocket.
In 2023, access to a therapist has, at least it seems to me, gotten easier and harder at the same time. Coming out of the COVID pandemic, many mental health services have gone completely online. As a result, several new apps offer appointments with therapists. The biggest issue though is availability. Many people started seeking services during the pandemic, so finding an available provider through the apps can be a challenge and they are often not covered by insurance.
So when it comes to one-on-one access to a therapist, three main options are doctor’s office appointments, access through an EAP, and access through an online therapy app. The first two are great if you have employer-provided benefits, but how can you get care without them? The online app would be a flat rate to anyone, but if the flat rate is too high, what other options are available?
If you need one-on-one care, there is going to be a lot of research in your future. I hate having to write that, but it’s true. The best option is to find a therapist with an affordable sliding-scale rate. On a sliding scale, the provider’s charge is based on your ability to pay. But it means calling a bunch of doctor’s offices and asking if they have available providers with a sliding scale that you can see often enough.
When I was in college, I saw a student therapist who was getting ready to graduate. It was also possible to see psychology professors that provided clinical services. If you have a college in down with a psychology program, a call to the department office will let you know if they are looking for volunteers for their students or if the professors see patients. The biggest downsides to this option, however, are if you are talking to a student, you may only have access to them for a year or two until they graduate and your therapist may not be as experienced as you need them to be.
My favorite recommendation for therapy is to find a group. The biggest benefit to group therapy is it is often low cost or even free. Sessions may be online or in person. You don’t have one-on-one access to a therapist, but what made me a convert to group therapy is that hearing other people’s stories – and learning they were very similar to mine – gave me a great sense of peace to know I wasn’t the only one. Also, since I was suffering from severe depression, being in a group gave me some social exposure that I sorely needed. Group therapy can be hard at first as you are explaining your issues in front of multiple people and you can feel very exposed. But again, once I learned that I wasn’t alone in how I felt or what I was experiencing, it was much easier to participate. Some ways to find groups are through mental health websites (like NAMI), hospitals, doctor’s offices, religious centers and community centers.
A good solution, if you are cost conscious, may then be to attend group therapy once or more a week and have an individual appointment with a therapist once per month. In this way, you can use the individual therapy appointments to delve into the depths while gaining social exposure, acceptance, and practical skills in group therapy.
Thanks so much for reading. I’ll be back in February where I’ll begin a series of blog posts that focus on mental health issues and the workplace. As always, please keep in mind I’m still very much a student of my own condition. I’m happy to share what has worked for me and the journey that got me there. Please reach out to your own support team as you start or continue your journey as well.
If you are in need of mental health resources, please consider reaching out to Project Semicolon; they are the primary charity I’m raising money for in 2023. My goal is to raise $10k for them though my art, which you can see on Instagram at @domina_rehtaeh, this blog, and any speaking engagements I do in 2023. I’ve submitted a proposal to be a speaker at NAMIcon 2023 on mental health in business. Wish me luck!
See you all next month!