Tell people that you work in mental health, and odds are they’ll want to tell you how difficult it is to find care. While we’ve made great strides in reducing the stigma around asking for help, getting it can still be difficult. I’ve pulled together the guide below, based on my personal and professional experience, to hopefully make it a little bit easier.
(Note: This guide is primarily for people who are not in acute crisis and who are looking for routine care for mild-moderate depression and/or anxiety. If you or a loved one are in crisis and in need of help, please call 9-1-1, go to the ER, or reach out to your local mental health crisis line for support.)
Finding a Provider Through Traditional Channels
The first question is always what type of care is the best fit - medication, therapy or both? A good primary care doctor or your insurance company’s assessment nurses can help you figure this out. The general rule of thumb is that only MDs and some Nurse Practitioners can prescribe medication, while all licenses can provide therapy. A couple of other things to consider
- For medication, in some cases your PCP may be versed in prescribing medication for mild-moderate anxiety and depression. If not, you will need to see a psychiatrist.
- For Therapy, it’s worth understanding the difference between different levels of providers. Social Workers, (LCSWs or MSWs), Other Master’s Level Clinicians (MFTs, MSs), and Psychologists (PhDs or PsyDs) all provide therapy, but with different education - for instance, research vs. clinical vs. community focus - and often at different price points. What’s most important is to find someone whose expertise is right for you.
- It’s also important as to what school of thought your provider belongs. Current therapy practice has moved away from Freudian talk theory and towards more evidence-based practices like Dialectical Behavioral Therapy (DBT) and Cognitive Behavioral Therapy (CBT). CBT in particular is a good approach for people struggling with mild-moderate anxiety and depression. It is skills-based and helps you develop tools that will support you as you step down your level of care.
Once you have a sense of what you want, or if you need to talk to someone to figure it out, you can use your Employee Assistance Program (EAP) benefit, if you have one, particularly for therapy. Through these EAP programs, many employers offer short term counseling, either telephonically or in-person. If you feel you need something more on-going, it's worth asking whether your EAP network is the same as your insurance network, and if they can help you find a therapist who takes your insurance.
You can also work through your insurance to see if they can help you find someone in-network (meaning contracted to provide services at a reimbursed rate). While it used to be that insurance companies would give you three names and send you on your way when asked for referrals, a renewed emphasis on accurate provider directories and improved customer service means that many plans are trying to better facilitate appointments. Tools like Amino or ZocDoc can also provide a sense of what providers are in your area. Your employer or insurer may offer a telehealth benefit (through a larger provider like American Well or a smaller dedicated mental health player) or other tools to help you (mindfulness programs like Headspace or coaching programs like Joyable or Lantern).
In some cases, you may choose to go the private pay route, especially in major urban areas, where up to 55% of providers may not take insurance. The downside is that you will find out-of-network providers charging hefty out of pocket fees that might be 2-3x the rate at which your insurance would reimburse them. Keep in mind that if you do then submit a superbill (summary of your visits designed for you to submit) to your insurance company (using an app like Better), most insurance companies will then pay you a percentage of their contracted rate for that service, not the rate you paid. If you are looking for private pay, word of mouth or recommendations are often a good route to find someone.
Newer Provider Identification Models
One of the more promising models in the digital mental health space is the rise of in-person and virtual providers and provider networks who aim to come in at a middle price point between an in-network and out-of-network provider. Some of the more interesting/evidence-based that are available directly to consumers include the companies highlighted below. There are many other newer offerings, some of which may only be available through your employer.
- Maven Clinic: Maven is a virtual platform focused on women’s health. They offer online appointments with a variety of different appointment types, including therapists. They are particularly good for perinatal mental health needs
- Kip: While only available in San Francisco at this point, Kip pairs a curated network of therapists with a robust platform for tracking mood and homework between visits.
- Two Chairs: Another SF-only for now offering, Two Chairs is trying to be the One Medical of therapy - offering a concierge-like on-site therapy experience.
- Ginger.io (disclosure - I used to work there and have an equity position): Originally a machine-learning company, Ginger.io has reimagined itself as a virtual mental health clinic. For $129-$349/month, you can buy a package ranging from text-based coaching to monthly video medication management appointments.
While finding care can be overwhelming, the good news is that there are many people, from the biggest insurers to the smallest start-ups, working to make it more accessible. This is good news for the industry, and for everyone in need of help. These services can also help you make sure that the provider you find is a good fit for you - it is okay to have to try a couple of people before you find someone who fits. The most important thing is that care helps you move towards recovery in a sustainable way.
Do you have other tips or tricks on finding care? Companies I missed? Please let me know.