“Therapy is important, but financial security is part of my mental health foundation.”
When someone is struggling with their mental health, they have a few options for what to do about it. Therapy is one of those options. A person’s decision to pursue therapy (or to stay in it) is partly determined by their answer to the question: “Is therapy worth it?”
That question can be further broken down into: “What will I gain from it?” and “What will it cost me?”
In this Progress Note, let’s focus on the latter.
The cost to see a therapist varies dramatically depending on provider credentials, location, specialty, and whether they accept insurance or not. Nonetheless, a typical patient will spend at least a hundred dollars per month on weekly therapy fees.
For many people, that’s too much.
Surveys have shown that cost is the top reason why people don’t get mental healthcare. But the true cost of therapy is more than just session fees. When help-seekers consider whether to pursue therapy, they’re making calculations far more complex than adding up co-pays.
To address cost barriers in mental healthcare we need to understand the full cost picture for patients.
Let’s start with secondary costs. These are expenses related to engaging in therapy beyond the cost of the therapy itself. Some of the most significant secondary costs are related to the physical act of attending appointments.
To get to an in-person therapy appointment, a patient may have to pay for public transportation or gas and parking. They may also have to pay for someone to cover their caregiving responsibilities while they’re away from the home.
Verywell Mind recently surveyed 1,000 people in therapy and found that almost a third of patients have to pay for childcare or eldercare, while almost half have to pay for gas to get to their appointments.
Virtual therapy sessions help eliminate some of these expenses, making therapy more accessible, especially for rural patients.
But telehealth can come with costs, too. Parents may still have to pay for childcare while they attend a virtual appointment in another room in the home. Telehealth visits may also require patients to upgrade their internet service, use up phone data, or buy headphones for privacy.
We should also consider that patients have to divert time and money away from the rest of their lives in order to engage in therapy. These tradeoffs can be significant, especially for those who are strapped for both time and cash.
The money people spend on therapy is money they can’t put toward savings or retirement. Americans already struggle to build up adequate savings for emergencies and experience financial stress and anxiety. Choosing to spend hundreds or thousands of dollars for therapy can feel like a risky financial decision, and may contribute to financial anxiety.
Further, most working Americans are hourly workers and 40% don’t know their work schedule less than a month in advance. The norm of attending therapy sessions on the same day and time each week can be incompatible with work schedules and cause patients to miss out on earnings.
Attending therapy sessions also costs time.
The time spent searching for, attending, and traveling to therapy is time diverted from other mental health-promoting activities like spending time with loved ones, going outside, or engaging in hobbies. For kids, this can be time diverted away from afterschool activities, tutors, and homework. These activities are valuable for kids, who often present to therapy with issues related to socialization and academics.
As I mentioned at the beginning, people who are struggling with their mental health likely engage in a cost-benefit analysis to decide if therapy is “worth it.”
If we want to make therapy more accessible, we have to make sure our mental health system fully considers the “cost” side from the patient perspective. Doing so can help us develop and promote models of therapy that are more accessible to patients with lower incomes. For example, we can try more flexible appointment scheduling, brief interventions, more telehealth options, embed therapy services in schools, or offer childcare services at clinics.
Considering the full cost of therapy also helps us appreciate that therapy may not be “worth it” for everyone.
Thankfully, there are other affordable sources of support. Some of those are rooted in cultural practices, like religious ceremonies or traditional healing methods. And some of those non-therapy alternatives are developed by organizations who seek to fill gaps in our current care system.
Unfortunately, most help-seekers (and service providers) don’t know where to find these non-therapy alternatives. That’s where we come in. Our goal is to ensure our directory has all affordable mental health services–therapy and non-therapy–to make it easy to find these options all in one place.
The education we provide through our blog is also meant to help people decide which options are “worth it,” and how to make them cost less and bring more benefit.
Thank you for supporting us in this work.
(For the record, I think therapy is probably worth it when you can make it work for you.)
This edition of Progress Notes was first published in our quarterly newsletter.