As a psychiatrist, the question I get asked the most by friends and family is: “I think I (or someone I know) needs to talk to someone. Now what do I do?”
It’s a sense of confusion that’s pretty unique to mental health care.
When people think they need to see a doctor for non-mental-health reasons, they typically know whom to call and how make an appointment. But when it comes to mental health care, there are so many different types of providers — social workers, psychologists, and psychiatrists, for starters — that many people are confused about who they should see.
Then add payment issues to this confusion. Some providers take insurance, for instance, while many don’t. So the question “Can I afford this?” arises.
Finally, add a serious shortage of providers. This has long been a problem in mental health, but it’s been exacerbated by the COVID-19 pandemic. Many more people are experiencing mental health issues and may require mental health care. My own practice has seen a 3 times increase in inquiries since the start of the pandemic.
According to data published in 2021 by the U.S. Census Bureau, 37 percent of Americans live in areas that lack adequate mental health care professionals; 6,398 additional mental health care providers are needed across the United States to meet current estimated needs.
All of these things can get in the way of someone finding the right therapist and actually making that first appointment.
If you are feeling down or anxious, know that you’re not alone. And if you’re confused about how to go about seeking help, you’re not alone there, either. To help, here are some tips and resources.
1. Learn About the Different Types of Mental Health Professionals
There are different types of mental health providers, and it does get confusing. I get asked by my own patients what the difference is between a psychiatrist and a psychologist, for instance.
A psychiatrist is someone who went to medical school, obtained a medical degree (MD), and completed a residency specializing in psychiatry. A psychiatrist has been trained in the diagnosis and treatment of mental illness, including offering therapy and prescribing medication. A psychologist is someone who went to graduate school and obtained a doctoral-level degree (PhD or PsyD), and has been trained in the diagnosis and treatment of mental illness, including offering therapy. In most places, psychologists cannot prescribe medication.
Clinical social workers, psychiatric nurse practitioners, licensed marriage and family counselors, and others are also mental health professionals who may offer therapy.
2. Use Online Directories to Find Providers in Your Area
If you plan to see a provider who is covered by your insurance, a good starting place for finding a provider is your insurance carrier’s website. It will typically have a list of either “mental health” or “behavioral health” providers who accept that insurance.
Similarly, a site like Psychology Today allows you to filter for various things, including if the provider accepts insurance. Psychology Today is not a complete list, as providers need to pay to be included on the site, but many providers do.
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3. Do Consider Proximity, What You’ll Have to Pay, and Availability
If you’re seeking care from the wrong type of provider, the therapist can help navigate you to someone who can help. What you should consider right off the bat is:
- Proximity How close do you live to them? Does the provider offer virtual appointments and are you okay with this option?
- Affordability How much are the services going to cost you and can you afford to pay for them? (More on this below.)
- Availability Is the provider accepting new patients?
4. Ask (the Provider and Your Insurance Company) About Costs Upfront
Many insurance companies will allow you to submit paperwork to be reimbursed for mental health care if your provider’s office doesn’t offer that. You can call your insurance company and ask what reimbursement would be before starting care. Don’t be shy about calling potential providers before making an appointment for information that the insurance company may need to tell you how much you can be reimbursed. This is not uncommon!
RELATED: Does Medicare Cover Mental Health?
5. Do the Consult Calls
Most mental health professionals will offer a free 10- to 15-minute consult call to better understand your needs and to help determine if you both are a good fit to work with another. Take them up on this option. It is a great way to get questions answered about cost and insurance coverage, as well as get to know the provider better.
Feel free to ask the provider some questions, whether it be what they specialize in, what kind of therapy they do most often, or if they have any advice on starting therapy. Doing a few consult calls also lets you get to know more than one provider, so that when you select one you may feel more confident that the person will be a good fit.
6. Explore Lower-Cost Therapy Options
There are lower-cost was to get the help you need. A few options to consider are:
- Providers Who Offer Sliding Pay Scales Some providers will provide care based on a sliding scale. We are commonly asked if we have a sliding scale, so there is no harm in asking about it.
- Consider Seeking Care From a Trainee If you live near an academic medical center (a medical center that has a medical school or residency programs affiliated with it), there is usually a clinic that is staffed by trainees, such as psychiatry residents. These trainees are supervised, and the care of each patient is discussed with board-certified psychiatrists and licensed psychologists. Because it is a training environment, the care in these clinics is much more affordable than usual. Some of these clinics also accept insurance. Open Path Collective is also a good low-fee referral site.
- Try an Employee Assistance Program These programs, which often include counseling, may be offered through your employer and often extend to family members as well as those employed by the company.
- Consider a Support Group There are many low-cost and free support groups for a variety of mental health issues. This may be a good starting place if you are unsure you can afford individual therapy. People that you meet through the group may also be able to help you find affordable care near you. Unsure where to find a good support group? The National Alliance on Mental Illness (NAMI), Psychology Today, Anxiety and Depression Association of America, Substance Abuse and Mental Health Services Administration (SAMHSA), and Mental Health America (MHA) all have tabs on their websites with support group resources.
7. Let Your Provider Know if You Can’t Afford Ongoing Therapy
One thing that makes mental health care seem unaffordable is the potential duration. Some people have been in therapy for years, but that doesn’t mean you have to be. Be honest with your provider at the initial visit about how long you envision or can afford being in care. There are shorter, more structured, problem-focused therapies. You can even create a plan with your provider, including the number of sessions, which will allow you to budget your money.
When you start therapy, ask for recommended books and resources to use between sessions. Some people start therapy on a weekly basis to learn certain skills and then space out their sessions. They continue their work on their own and use less frequent sessions as a check-in.
Just be careful reaching for self-help resources without guidance, especially on social media. While some great free resources exist, so does a lot of misinformation. Always talk to a professional to fully understand risks and benefits before starting supplements, undergoing procedures (even if they can be self-administered), or radically altering your diet.
8. Get Your Primary Care Doctor Involved
Your primary care provider can be a great first step in finding a therapist. Ask if he or she has any names of mental health care professionals in your area.
Even though your primary care doctor can prescribe medication for mental health needs, I recommend that everyone who seeks medication has at least a consultation with a psychiatrist, because psychiatrists have been trained to assess need for psychiatric medication, decide the best type of medication, and, increasingly, to educate on other helpful interventions, such as lifestyle changes.
But once you have had a consultation or have started medication and have seen improvement, you can discuss the possibility of having your primary care doctor take over the prescription for psychiatric medication for a period of time if both providers are comfortable with that.
9. Show Up
You decided you would benefit from help, you did the work to find someone, now show up. This may seem obvious, but it can be the hardest part for some people. As a therapist, I want you to know that most people feel nervous and/or awkward at their first appointments.
10. Remember, There Is No Such Thing as ‘Getting an A’ in Therapy
Many people feel nervous about how they will “perform” in therapy. But, there is no such thing as “getting an A” in therapy and no right way to be a client. The process is individual. And, if things don’t feel right after a few sessions, don’t blame yourself. You and your therapist may just not be a good fit. Feel free to discuss this concern with them. Some people need to try more than one therapist before they find the right connection.
11. Getting Started Is the Best Place to Start
So who should you see? The answer is, it doesn’t really matter.
Some people get hung up on whether or not they need medication (and therefore need to see a provider who can prescribe medication) before finding care. The reality is, most mental health care professionals encourage lifestyle changes and therapy for mild to moderate depression and anxiety (what the majority of people seek help for) before medication is used. If you do end up needing medication, a psychologist or social worker will help you determine that and help you find a psychiatrist. Similarly, if a specific form of therapy is recommended that your initial provider does not specialize in, your provider will help you find an appropriate specialist.
This is why I always advocate for just starting care and not getting hung up on type of provider. Your first appointment or two is typically referred to as a “consultation.” During this time, your provider will recommend a treatment plan, and if that requires the help of another provider, you will have the help you need to find that provider.