How to get treatment for depression without income or health insurance?

March 18, 2009 4:14 PM

I suspect I am suffering from Depression and I have no health insurance or current source of income - how do I get help?

Three months ago I quit my high-paying job due to extreme job dissatisfaction, and with the job, I also lost my employee sponsored health care. I have since missed the deadline to file for COBRA (I live in California).

As a result I am currently unemployed (by choice) and without health care. I am 26 years old and am extremely fit and healthy physically (gym 3x at least per week), but mentally I suspect that I am suffering from depression.

I was diagnosed with depression as an 18 year old, but overcame it and within a year and a half became happy and healthy again.

Within the last two years, however, I have felt "flat," and I feel the familiar pangs of depression - a general all-encompassing apathy, constant anxiety and intrusive negative thoughts, as well as the random urge to cry or hole myself away in my bed. My omnipresent negative emotions and worries, I feel, prevent me from reaching my potential. These feelings partly led to my decision to quit my job, which was only exacerbating my condition. I committed to take time off for a few months to work on personal projects, explore other possible career paths, and to try to handle my negative feelings. I have saved up money (quickly running out) in order to facilitate this plan.

I would like to see a therapist and get a diagnosis, as well as schedule regular therapy sessions. In my normal state I am a very vibrant and social person, who has a zest and love for life - and I would very much like to have that person back and get him working again...but I feel I need treatment.

QUESTION:
So...what is an unemployed person without health insurance to do? How do I go about getting help? I can afford CHEAP health insurance for a few months (100-150 dollars per month). I have looked into Tonik, and am going to give them a call but it is unclear to me whether they have mental health coverage - furthermore, should I be mentioning my condition when calling health insurance companies or will that get me denied or put me in a waiting period for treatment? I assume my options are to see a therapist of my choice out of pocket or to buy health insurance and have them foot the bill for an in-network shrink. In the meantime are there any free or state-sponsored options I can look into? Any help on the matter would be greatly appreciated!

posted by jnnla to health & fitness (16 comments total)

Where in California do you live? Depending on your location, there may be specific community mental health services available by city or county. Services can be free or at least available on a sliding-scale.

If you don't have a formal diagnosis of depression currently, I wouldn't mention it when applying for health coverage. The underwriting process may still ask about previous diagnoses, though (in my experience, sometimes they ask for a 5-year range, sometimes they ask for a 10-year range).
posted by scody at 4:28 PM on March 18

This was my approach:

1. Get the highest deductible, highest percentage coverage you can from Blue Cross Blue Shield (or whoever, but this is what I have). Get a plan with copay office visits and drug benefits. This will cost you in the neighboorhood of $100 a month ($125 with dental).

2. Go see a PPO doctor on your plan for a ~$25 copay. Get a new prescription for whatever meds you need, preferably one that is sold in generic form.

3. Use the drug benefits to get the cheap generics, monthly.

Finding an insurance plan was the hardest part, and I avoided it for a really long time. I'm like you -- young and healthy -- and insurance within your ballpark is definitely available. MeMail me if you want some pointers on where to start.
posted by JohnFredra at 4:35 PM on March 18 [2 favorites has favorites]

You could take the cheapskate route: pay whatever you must to see a doctor, maybe get some health insurance for a couple months. Get your dosage figured out, then drop it all. Start ordering generics from India over the internet for twenty cents a pill. It'll cost you less than insurance would to pay for your medication.
posted by floam at 4:38 PM on March 18

I should mention that many of the plans I looked into didn't offer a mental health benefit but for HMOs like Kaiser Permanente. But if you get the high deductible insurance and can find a sliding scale therapist, it will (hopefully) stay within the range of what you can afford.
posted by JohnFredra at 4:49 PM on March 18

I'd second the recommendation for exercise.

Also consider doing some reading online on Cognitive Behavioral Therapy.

Both of these can be effective low-cost ways to address the issue.
posted by leotrotsky at 5:00 PM on March 18

I have some professional knowledge on this.

The first thing is that there is no solution for depression that works for everyone. You have to try and see what may work for you.

Meditation is not a bad thing to try first. It does help in some cases, and can be a useful like skill in any case.

Assuming meditation doesn't solve your problem, I would try next cognitive behavioural therapy (CBT). You would need about 10-12 sessions, so it may be doable on your budget. CBT is the main type of therapy that actually works with a sizeable proportion of patients. It is as effective as drug therapy, and if it works the cure lasts longer (a booster session every 6 months or so is a good idea to keep the benefits).

Do not waste your money on generic talk therapy (and certainly not psychanalysis!). It is extremely unlikely to help (never does on randomised controlled trials), and can actually make you worse.

If neither meditation nor CBT works you can give drug therapy a try. There are generics to go for, and you can even start with St. John's Wort, which is a mild anti-depressant drug. There are many types of drugs you can try. This could, unfortunately, get expensive.

Finally, if all else fails electroconvulsive therapy often works.
posted by Hediot at 5:04 PM on March 18

Also, make sure you do not withdraw socially, or otherwise spend all your time at home. Going out with friends is helpful even if you don't feel like it because of your depression.
posted by Hediot at 5:07 PM on March 18

You can get free counselling at your local church. I recommend Presbyterian (UPCUSA) or some other mainstream denomination because of the strenuous training they receive and the lack of judgemental, evangelical or Jebus-based advice.

You don't have to be a member of the church.

From what I gather, they're trained in counselling and in helping people find help. This includes finding local social programs that might get you the assistance you seek.

Full disclosure: SJP=agnostic leaning towards atheism. Both parents were UPCUSA ministers.
posted by stubby phillips at 5:25 PM on March 18

Different counties in California offer different degrees of mental health services for indigent people. You don't give any indication of where you live, but look for your county mental health system in the phone book. However, given the budget crisis, many of these programs are contracting and don't offer therapy, though they might be happy to prescribe anti-depressents, if that's an interest of yours.

Another low cost way of getting low cost therapy is to go to counseling centers run by local colleges and universities. You would typically see a graduate student in training who is being supervised by licensed faculty members. I've supervised many student therapists, and some of them are great and others are meh -- pretty much like licensed therapists. You can always see what the "fit" is like for you, and request a change if you don't feel there's a good match. In any event, these places usually have sliding scales, and you could get services for low cost.

FWIW, I think Hediot's dissing of talk therapy is overstated. Many people have been helped by talk therapy.
posted by jasper411 at 6:22 PM on March 18

Do not waste your money on generic talk therapy (and certainly not psychanalysis!). It is extremely unlikely to help (never does on randomised controlled trials), and can actually make you worse.


What? This is a truly bizarre thing to say. True, there really is no one-size fits all "cure" for depression, but many people, myself included, have seen a lot of benefit from "talk therapy" (such as psychodynamic therapy). I don't think it hurts anyone to gain deeper personal insight and awareness. Yes, you may need to combine it with other things, such as medication or some types of CBT exercises, but I wouldn't dismiss it out of hand.

Many cities and counties in California have low-cost or sliding scale type resources for counseling, so if you post with your location you might get more specific answers.

Best of luck to you. You aren't alone.
posted by JenMarie at 6:45 PM on March 18

If you think it would be helpful to have something to do to help fill up your time, you can always volunteer. I found when I was unemployed that my mood was greatly improved by volunteering.
posted by ocherdraco at 7:00 PM on March 18

Thanks for the answers! I should note that I did just recently get a home-based CBT program that I have yet to start, but I am hoping it helps me out. I agree on not withdrawing socially...I try to be as social as possible and it really, really helps (as does my exercise regimen). On the other side of the coin, when I am alone (or when I was at work) all the negative thoughts and anxiety come back and it can be really really tough.

Also, to inform other commentors...I live in LA and based on the above answers would be interested in hearing about specific local counseling resources I might consider. Thanks again so much!
posted by jnnla at 7:58 PM on March 18

When I was feeling low a decade ago -- possibly depressed -- I found that St. John's Wort was effective. It's an herbal supplement -- you can get it at a health food store in pills. Its active ingredient is chemically similar to other serotonin re-uptake inhibitors. For a while there, if I was having a bad day and snapping at people, it was because I'd forgotten to take a quarter pill of St. John's Wort. Needless to say, it's a hell of a lot cheaper than prescription pills.

Like other SRI's, it it said to take some time (days, weeks) to kick in, but my experience was that it helped immediately.
posted by musofire at 8:24 PM on March 18

The place I was going to recommend if you were in the Bay Area is The Women's Therapy Center. Two of my friends have had good things to say about their counseling services (actually, I see you don't mention your gender, so I'm not sure this rec applies). Since that's not local to you, maybe you could call to find out their recommendations for Los Angeles?

This askme could help you with the low cost issue.

(Sorry, I know this doesn't help with your insurance related questions, but I don't have an informed answer about that.)
posted by JenMarie at 10:55 PM on March 18

JenMarie, with respect you may not be in a position to say what helped you. As in any disease, there is the well-known placebo effect. The mere fact that you expected therapy to help you must have been of some help. Second, depresion has a very high natural recovery rate. It is possible that your depressive episode would have ended at that point in any case, and it is only because you happened to be on therapy at the same time that you ascribe your cure to the psychodynamic therapy.

This is why the thing to trust is Randomised Controlled Trials (RCTs), which look statistically at many patients and compare different therapies. RCTs show that psychoanalytic therapy is useless or worse. It can actually be worse than useless, first because it distracts attention from solving current problems --- which is what successful therapy is about --- and puts the patient's attention instead on long gone events that can no longer be changed. Second, opening up wounds that have healed can itself cause further psychological distress.

So what does help?

The first line of attack is exercise. Meditation may also help. I would even try getting a pet.

Then, perhaps together with the above, self-help often helps in mild cases. Self-help can take the form of cognitive behavioural therapy books, and computerised CBT is probably even better. Try The mood gym.

If this doesn't work it's time for CBT and/or other problem solving oriented therapy with a qualified therapist. Then there are drugs, and if all else fails electroshock therapy. Sure, other things may help you, or seem to help you, but the above is what experts recommend (see for example the NICE recommendations).
posted by Hediot at 2:21 AM on March 19

After 45 years of suffering from clinical depression, I found the source of my problem and corrected it. I haven't been depressed for a single day since. It's likely that the same approach will work for you. Get the whole story in my book, $16 at Amazon, but you're welcome to download it free: http://www.scribd.com/doc/13433353/Up-Without-Meds
posted by markcmyers at 4:12 PM on March 19 [1 favorite has favorites]