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Brian Lehrer: It's Brian Lehrer Show on WNYC. Good morning again, everyone. We want to help you find affordable mental healthcare right now for a few minutes. We're just doing a practical segment, giving you information on where you can go if you want to find that. We've been talking a lot about mental health on the show and on the station at large because May is Mental Health Awareness Month. We've been tying into that. Of course, we just talked about Heather Armstrong and some of her struggles in the last segment. We did a whole week on the show, as many of you heard and participated in last week on teen mental health these days.

It's no secret that finding a therapist or other mental healthcare can be difficult for a lot of people. It's already hard enough to get through a regular day when you're struggling with mental health. Takes a lot of courage to realize that you need help, and even more to actually seek it out. Once you begin your search for a therapist or other help that meets your needs, you're faced with high costs, confusing insurance policies if you're insured, and outdated databases full of doctors and others who aren't even accepting new patients.

These hurdles are enough to make anyone want to give up, even more so those who are suffering from mood disorders or executive functioning issues as some of them are called. We're going to jump some of those hurdles for you, or at least try to give you a head start on your search. Now as part of WNYC's Mental Health Awareness Month, WNYC and Gothamist Health Reporter, Caroline Lewis have put together a guide to help New Yorkers find affordable therapy. We're going to bring this guide onto the radio for a few minutes right now. Caroline, always good to have you on the show. Hi.

Caroline Lewis: Hi. Good morning.

Brian Lehrer: First, how does one know- because I think a lot of people struggle with this and aren't sure- if they should get into therapy?

Caroline Lewis: I certainly can't tell people if they should be in therapy, but I think that it's important to recognize that people in a lot of different situations might want or need therapy. It might be someone who is having stress at their job or is just currently having anxiety because of a certain situation they're in, or it might be someone who is starting to have psychosis and realize they might have a mental health diagnosis. It might be someone who's already diagnosed and looking for a new therapist or coming out of a mental health crisis. There's just so many different situations in which someone might need therapy. I think people are increasingly talking about how it shouldn't be stigmatized if it is something you want to explore.

Brian Lehrer: Start to talk about the finances of this. I remember a few years ago on the show when we covered what was supposed to be a groundbreaking new law that requires that mental health be covered in the same way as other kinds of physical health care under insurance policies. What's the status of that?

Caroline Lewis: That's known as mental health parity, and by a lot of metrics it has not been successful so far. I think there are efforts to try to improve mental health coverage at the state level, for instance. The issue really is that a lot of therapists still don't take insurance. They say that commercial insurance especially doesn't pay enough to cover the cost of a therapy session. Often people are going out of network to get therapy.

They might have to pay for it upfront and they get reimbursed by their insurance, or if they do have it covered by insurance, they might still have to pay a fee out of pocket. In the case of a therapy session, it happens maybe weekly or biweekly. That's a recurring cost that really might add up. There's definitely still an issue there in terms of trying to achieve parity and I think it can add to someone's stress when they're already having mental health issues to try to figure out how to pay for therapy in the first place.

Brian Lehrer: Listeners, you can help us by adding to our affordable therapy resource guide, your tips and tricks for finding affordable psychotherapy in the New York area, 212-433-WNYC, 212-433-9692, or if you're currently searching for help, you can call in and talk about the barriers that you're encountering. This might be shortage of available therapists, not just the pure financial aspects of it, but you certainly can talk about the financial aspects of it and ask Caroline a question, and help contribute that way to our affordable therapy resource guide.

212-433-WNYC, 212-433-9692 if you want to chime in with advice or with a question. In your guide, one of the things you recommend is don't sleep on mental health trainees. What is a mental health trainee, and why might a person like that be an attractive option for somebody looking for therapy?

Caroline Lewis: When people are getting an advanced degree that would allow them to do therapy, like if they're becoming a psychologist or a social worker, often they have to do a certain number of hours of practice under supervision before they can practice independently. In general, a lot of the nonprofit community clinics and programs, and hospitals in the city will have people who maybe have their advanced degree but are still working to get those hours. Sometimes you will be seeing those people when you go to a nonprofit clinic. Then there are also specifically training clinics that are tied to graduate programs or educational programs.

Some of those are a good option, especially if you're uninsured or you're having trouble finding affordable therapy through your insurance. You might look to a clinic like the Parnes Clinic in the Bronx where they don't accept insurance but they offer a sliding scale fee of $5 to $40 per session. Then there are also clinics attached to different schools like City College or NYU, or Fordham. Some of these accept insurance, and some don't. I would say if you have Medicaid, start with trying to go through a nonprofit clinic and try to use your insurance. If you don't or if you aren't able to find a therapist that takes your insurance, you might want to go through one of these training clinics,

Brian Lehrer: You highlight New York City Health + Hospitals in your guide. That's the public hospital system in New York City. Who should look into this resource, and how can they make an appointment through that bureaucracy?

Caroline Lewis: I think really a lot of different types of people might benefit from going through the public hospital system and seeing what's available. There are a lot of, for instance, special programs at Bellevue, which they partner with NYU. There's just different types of therapy programs that are available. I know there was one program that was mentioned for people who are younger and starting to experience psychosis. There's just general therapy for people who are looking for that. Someone might get referred by their primary care physician.

They can also go online to the website to make an appointment, or they can call the number for NYC Health + Hospitals to make an appointment, which is 844-692-4692. I think it's important to remember that this is a hospital system designed to serve anyone regardless of their ability to pay. They do take a lot of different types of insurance, including Medicaid, but they also have a special program called NYC Care for people who are undocumented and unable to get insurance. That really helps people navigate the system for preventive care, including mental healthcare. I think that's something to look into if you are undocumented.

Brian Lehrer: Sounds like a great resource for a lot of people, New York City Health + Hospitals. Let's take a phone call from Keith in Yorktown, who has some advice for people in a particular mental health category need. Keith, you're on WNYC. Hello.

Keith: I appreciate you taking my call. My regard is the fact that there are a lot of people that are dealing with mental health when it comes to personal family addiction and their own addiction. What I want to create is the use of the adult children of alcoholics system within a network of people who are like-minded, who have experienced the traumatic mountain illness of their family that translates to them. They have a resource they may not believe to be something that they're entitled to, but they should tap it. That is like-minded people of ACOA that could potentially give them a forum to be comfortable with and to discuss issues in time.

Brian Lehrer: Interesting, Keith. Thank you very much. Caroline, do you get into that category at all?

Caroline Lewis: I'm not familiar with that specific group, but I think that I was looking more at ways to search for different types of services that you may be interested in, different specialities. There are resources for that. For instance, if you go on NYC Well, their website has a search tool where you can look up different specific types of services you're looking for. Maybe it's substance treatment.

Maybe it's, sorry, treatment for substance use disorders. Maybe it's a support group. I think there are different ways to look for these types of services. Certainly, there are different options. You don't have to go to individual therapy. Maybe you're looking for a support group, maybe you're looking for art therapy. I think it's important for people to recognize there are all these different types of options.

Brian Lehrer: You want to talk more about group therapy? It is less expensive than individual, I imagine.

Caroline Lewis: Yes. Again, I'm not super versed in when someone should look for group therapy versus individual therapy, but I think that one of the messages I have gotten, for instance, from Sa'uda Dunlap, who works for Vibrant Health, which is the nonprofit that runs NYC Well, is that people should be open to experimenting with different types of therapy. I think especially, even just finding an individual therapist.

Sometimes people have to go through a few to find someone whose style they're comfortable with and matches their needs. They might also be looking for someone who understands their specific cultural background, whether they're an experiences, whether they're from a different country or ethnic group, or speak a different language, or LGBTQ. I think that it's important for people to be open to just exploring different modalities of therapy.

Brian Lehrer: Let's take a phone call from a therapist. Nilufer in Westchester, you're on WNYC. Thanks so much for calling in. Hi.

Nilufer: Hi, good morning, thank you for taking my call. I was just listening to the segment. I'm a mental health provider. I'm a psychologist. I actually started a practice through-- it's like an online platform where they do provide therapy through insurance. They pay out the insurance, they handle all the insurance and they pay out to the therapists. It's a great way for people to use their insurance for mental health services, and also for therapists to work with people who have insurance so they don't have to pay out of pocket.

They take a whole bunch of different insurances. You can choose which one you want to be on, and it's available through telehealth and also for in-person therapy. I wanted to put that out there. I think there's a bunch of different providers that do that now, but the one that I work with is called Alma.

Brian Lehrer: That's a good set of suggestions. I appreciate it. Can you give people a sense of what you're seeing out there these days in the field with respect to the people you counsel? We hear so much in the media about how there seems to be a mental health crisis in our society beyond what people have seen in recent decades, somewhat pandemic-related, somewhat from other things, are you seeing it?

Nilufer: Yes, I'm seeing a lot of different issues that people present with. I'd say the most common one is basically anxiety and depression symptoms. Beyond that, it's a whole lot of different issue, family issues, work-related stress. There's a lot of stress that people are experiencing. I think it is important, and I'm glad you're covering this segment, to highlight the fact that there are ways that people can get a mental health services through their insurance.

Because it's really cost-prohibitive if you have to pay, like the person who's presenting a segment says, weekly, biweekly, and sometimes therapists do charge quite a bit for their services. If you are in a situation where you need to speak to somebody, I think it's really key to be able-- and you have insurance to your workplace, or whatever, it's important to be able to access that.

Brian Lehrer: By the way, you mentioned Alma before, I see on a caller board that a number of people are shouting out Alma as being helpful. Do you want to tell us a little bit more about that, and how people access that, if you know?

Nilufer: Yes. It's website-based. You can go in and you can search for providers who cover different specialty areas. They have a list of different specialty areas that they cover, like I mentioned, anxiety, depression, trauma-based issues. You can also do evaluations through them. I am a psychologist, I do also do evaluations covered through insurance, which is also key.

Because a lot of times people thinking evaluations have to pay out of pocket. Then you can sign on with different insurances. There's a huge list of different insurances. The only ones I don't believe they cover is Medicaid and Medicare, unfortunately, but they said they're working on trying to figure out how to do that. It is private insurance. Within that, there's a lot of different options.

Brian Lehrer: Nilufer, thank you. [crosstalk] Go ahead.

Nilufer: You're welcome. Thanks so much.

Brian Lehrer: "Again it's--" You wanted to finish your thought there.

Nilufer: I was going to say it does offer in-person because I know there's another group that I get emails from called BetterHelp, which is exclusively telehealth, but it's up to each provider. They have an office space, so you can do in-person therapy as well.

Brian Lehrer: Thank you very much for your call. As we have a few minutes left with Caroline Lewis, from WNYC and Gothamist, you can go to gothamist.com and see this affordable psychotherapy resource guide. We're bringing it onto the air for a few minutes here just to let everybody know that with so much demand for mental health services these days, and always an affordability crisis in our area that everything, it seems, but certainly in that realm, we're talking about a few of the tips and tricks on the sites, and taking some others from people who are calling in, as you've been hearing. Caroline, you want to just give people an overview for a minute of what they'll see if they go to Gothamist and look at your guide?

Caroline Lewis: Yes, absolutely. I shouted out a few different search tools. Psychology Today has a really comprehensive list of-- If you're looking for individual therapists, which is more likely if you have private insurance, or paying out of pocket, but you can search by the types of insurance they accept, and even the cost of the session if you are going to be paying some of that out of pocket. The languages they speak, what they specialize in. Then NYC Well. I looked at what you might find on that site. Something called the Open Path Psychotherapy Collective, which exclusively lists people offering reduced rates.

I went into what you might find at a clinic versus private practice where if you are going to a clinic, sometimes people with private insurance don't consider it, but you might find that they have more services under one roof. They might have support groups, and addiction treatment, and individual therapy, and that kind of thing. On the other hand, they probably have people who are newer in their career, and training, and there might be some more turnover there.

I offered a bunch of different kinds of resources, which I think is important right now because as the caller mentioned, there is a lot of demand, and there are some places with really long wait lists. It's really hard to tell when you are using these kinds of search tools who's going to have any availability. Sometimes you just have to call around to find out, so it can be a bit labor-intensive. I think it's just important to know about all these different types of resources, some of which might fly under the radar.

Brian Lehrer: What about telehealth, which the previous caller mentioned? Is that a category that you get into per se, or something that in your research, you've discovered does make therapy a lot more accessible for people? Maybe this is one of the positive side effects of the pandemic, so much telehealth in various medical areas available for more people. Maybe it's a downside too, I don't know, that can be abused to restrict in-person access to people, but it's also, I think, a flourishing resource at this time.

Caroline Lewis: I will say when people think of teletherapy, they might think of all these flashy startups that they get Instagram ads for. Actually, a lot of the traditional practices whether it's an individual therapist or clinic, often offer teletherapy now. You might have the option of going in-person or remote, which helps because if you're looking for a resource, and you find something that's not accessible to you, like nearby, you might be able to do remote sessions. I think it's important to recognize that actually, a lot of providers now have this option.

Brian Lehrer: Let's go to Mandy in Maryland, who is also a provider. Mandy, you're on WNYC. Are you going to tell us insurance company horror stories? Is that what I see?

Mandy: [chuckles] I will spare you. I will spare you that, thanks for taking my call. I will just say that I actually do take insurance and I also am a provider who uses online and have had a good experience thus far. Been using this in just under a year. I worked in community health center for many, many years and started to move out of that into partial private practice because the demands were just so hard to sustain, the demands of a community health care setting.

I started out taking insurance and trying to do it all myself, unfortunately, did lead to a lot of horror stories and thousands of dollars lost just because I didn't have the resources to keep fighting them even though I just wasn't getting paid for services rendered. I will say, I just want to echo that Alma, and there's another one headway, and probably more they're coming up that I think do create a solution that's doable for many people, that's mutually beneficial to providers and to individual. I'm not sure how well the word is out, so to speak. I think it's growing because the highest number of inquiries I get are from Psychology Today, where I also have an ad.

Many people don't know about it. When I tell them about Alma for some reason, I'm not able to meet with them. but I do share that information. I do just want to say that many times I think people are frustrated with individual providers, therapists for not taking insurance. I do still take insurance, but I understand why some people have chosen not to based on my own experience. I've gotten to the point where now I've diversified so that I keep my Medicaid patients and I deal with any insurance problems.

I'm also working with other people with some private insurance. I really hope that Alma will, and others will move to covering individuals with Medicaid, because this is a really big problem still. I'm going to keep my Medicaid people, but I understand why therapists go to private pay because it's just so much. If you're an individual with a small business trying to deal with these unwieldy, unruly insurance companies, it is really, really hard.

Brian Lehrer: Do you have any one tip for other people in practice who are dealing with private insurance companies on how to get the reimbursements most easily?

Mandy: A couple quick tips I've learned along the way. One is that insurance companies don't want to tell you-- They will say that they will not try to interfere with your clinical work, but really they will in an indirect way. They do not want you to bill for an hour-long session. They want you to bill for the code that's a 45-minute up to 52-minute or something session.

If you do that, if you bill weekly for an hour session, you will probably see a lot of scrutiny, a lot of what I'd like to call bullying from the insurance companies. Thinking about how long you bill for and trying to be creative about that, just so that, again, you are still doing the work of using your clinical judgment with clients, but you're also preventing them and you from undue hardship from the insurance companies.

Brian Lehrer: Really interesting. Thank you. Very helpful to people, I think. One more, Lorraine in Queens. You're on WNYC. Hi, Lorraine.

Lorraine: Hi, Brian. Thanks for taking my call. I just wanted to mention a not-for-profit that I'm actually a part of. It's called the Open Path Psychotherapy Collective. They're actually in partnership with different clinics and private practices across the nation as well as Canada. What they do is offer clients who are uninsured or low-income really, really discounted rates, as low as $40 a session. I know some therapists who actually even charge less than that if you're really in need. It's openpathpsychotherapycollective.org.

Brian Lehrer: Open Path Psycho-- Path or pass?

Lorraine: P-A-T-H.

Brian Lehrer: Thank you. Open Path Psychotherapy Collective. Lorraine, thank you for that. Caroline, thank you for doing this. I don't know how many hits you've been getting so far since this went up, but I'm going to guess that it's a lot, and maybe it'll be a lot more now that we're giving it a little additional publicity on the radio. This is our affordable therapy resource guide. Check it out at gothamist.com. Our health reporter, Caroline Lewis, always good on so many health topics that she's come on the show over the last few years, leading and putting it together. Caroline, thanks for coming on and supporting your effort.

Caroline Lewis: Thanks for having me on to talk about it.

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