Guide for connecting to mental health care

Mental health care can be incredibly difficult to connect with. More often than not, the following barriers stand in the way: stigma from your circles (or yourself) on what it means to get mental health care, insurance confusion, high deductibles/unaffordability, not finding a strong connection with a therapist, finding therapists with no availability, and not understanding what types of care and therapy exist. This serves as a general guide for connecting yourself or a loved one to mental health care. Please note, much of this information applies to mental health services in USA.

Where to look
Check out the Sia Wellness Resource page for a list of directories, at the bottom of the page. You may start with looking on your insurance website directory, to ensure the therapist is “In-Network” (this will be explained below), and then researching the therapist to locate a personal directory page or website for more information on him/her/them. This process can be a bit tedious, but it would allow you to stay in network and also scope out the therapist.

Many directories allow you to filter by insurance, state, and other characteristics you may be looking for in a therapist (i.e. gender, specialty, etc.). Note that therapists are generally not allowed to provide therapy outside of the states which they are licensed in, even if virtual.

Low-cost therapy can often be located in university centers, where sessions are provided by supervised clinicians in training. Many towns and cities also offer low-cost therapy in community centers, which need an internet search to locate where exactly. If you find a therapist’s profile that you really connect with and are hesitant to reach out due to cost, reach out anyway. Many therapists offer sliding scales and might be able to offer you a lower rate.

There are several online therapy platforms (Better Help, TalkSpace), which can offer more flexible sessions and/or lower costs. Some are structured so that sessions are shorter and/or through messaging, rather than full in-person/video sessions. Keep in mind what type of support you may need and whether that type of format could be useful for you.

Keep in mind the different mental health professions. Psychiatrists are M.D.s and can prescribe medication. Psychotherapists is a broad term for a Masters-level clinician (i.e., LMHC, LPC, LPCC, LCSW, LMFT) while psychologists have Doctoral-level training (Ph.D.) and can provide in-depth evaluations for clinical concerns that need assessments (i.e., ADHD, learning disabilities, etc.) There are also a range of providers that are coaches, holistic healers, meditation instructors, etc., which typically have specialized training not necessarily rooted in academia.

Insurance
… in USA is incredibly confusing. Here are the basics:
In-network means that a provider accepts your insurance. Your actual coverage depends on your plan though. Typically this information is located on your insurance benefits summary and it can vary widely. I.e., one person with United HealthCare may have a $15 co-pay, while another person also with United HealthCare may have to pay 100% of the session cost until their deductible is met, after which the insurance will take over costs. When paying 100% of your session, this is typically between $100 - $150 and you can check specifically with your insurance company on what that cost would be, according to the billing codes that would be used (explained below).

Out-of-Network means that the provider does not take your specific insurance. Depending on your plan, you may have partial coverage for sessions (i.e. you pay 40% of the session cost) with an OON provider. Often, you would pay out of pocket and then submit claims to your insurance for reimbursement. If this is the case, you should ask your provider for a bill which contains a summary of all your session dates, costs, and codes. Note that most therapists will not submit these claims for you, while some larger practices may do if they have a billing manager, so this could require an extra cost and step for you.

Billing, or CPT, Codes are the insurance codes for which the service is billed. If you are unsure of your coverage, you can first ask the therapist which billing code they would be using for sessions, and then call your insurance and ask what your exact coverage is for those codes. Common therapy codes include:
90834: 45-minte psychotherapy session
90837: 60-minute psychotherapy session
90847: 50-minute family psychotherapy session

If you’re debating between going In-Network or Out-of-Network, a good place to begin (and if you’re financially conscious) is with the In-Network providers. If you cannot find a good match with availability, going Out-of-Networks offers more choices; however, the cost will likely be higher. Here is a more comprehensive guide. If you are financially able to pay Out-of-Pocket (aka “cash”), a session can range from $50 to upwards of $300.

What to ask
Most therapists will offer free 15 or 20 minute phone consultations, to assess that you are a good fit, and it’s an opportunity for you to do the same. Keep in mind that these consultations are not meant to be mini-therapy sessions. You should give a very brief overview of what you’re seeking therapy for and use the remaining time to get information on what therapy with this provider looks like. You can ask the following:
- What orientations/approaches do you use? (If you are unfamiliar with it, ask them to explain what it is)
- Given my concerns, how would our sessions look? How do you usually work with _______? (i.e. perfectionism; depression; career stress)
- Do you provide resources, exercises or suggestions for applying skills in between sessions?
- What are your thoughts on the psychological impact of racism/oppression/supremacy? How do you integrate cultural competence into your work?
- What is your availability, flexibility, and cancellation policy?

Your first session
Reflect on your expectations for therapy and express these in the first session! Many client go in wanting to quickly resolve specific concerns, or want immediate “fixes”. Therapy is a process of self-discovery and changing habits and thought patterns take time. Therapy is not necessarily a place for advice (that’s what friends are for!); it’s a place where understanding yourself better (and how to cope with what you’re dealing with) is facilitated by the therapist. Even though the provider is an expert, they cannot know exactly what is going to support you until at least a few sessions in, if not longer. Keep an open mind and pay more attention to if you feel heard, the general feelings you get from talking to this provider, and whether you feel it is a safe, nonjudgmental space.

Good luck and please do not get discouraged to give up on your mental health journey if you come across hurdles!