Finances or therapy?

September 3, 2012 10:14 AM

What should I prioritize: finances or mental health?

I'm 24, living in the United States.

I'm the type of person that tries to be totally above-the-water financially at all times. I don't want to have any credit card debt, even month-to-month, whatsoever. I'm also someone with a history of profound clinical depression. This was worst a few years ago, when a few things came to a head at once and I spent months in inpatient and day hospital psychiatric care. Since then, I've made great steps: moved to a new city, started on a career, come out of the closet, made some friends, weaned myself (with doctor's approval, of course) off all anti-depressants. However, in recent months I've felt loneliness and depression growing on me once again.

[I should note that I am not suicidal, or close to being suicidal, or at any risk of harming myself or putting myself in danger. Whatsoever.]

I recently found a therapist who I felt comfortable with in the free first meeting, and I have an interest in seeing him. (Past therapists haven't done much for me, but maybe this one is the one I need right now?) He is out-of-network of my health insurance, however, and even with a sliding scale it'd be a stretch, if a do-able stretch, to pay him. Plus, because he is out-of-network I would have to submit a claim myself while paying him upfront, and I imagine it might take a while for the insurance company to pay their share. I would set up an appointment with him tomorrow, however, if not for the following:

I recently needed to undergo a medical procedure (unrelated to anything else mentioned here). I will be physically fine, but medical bills will probably total between $1,000 to $2,000. I imagine that I will be able to set up a payment plan of some sort, but even if I get to pay the bill over the course of a few months, it still will be a huge and unanticipated monthly charge.

The question is the following: should I wait until the medical bills are paid off to start therapy, or should I start therapy right away?

My first and gut impulse, without any doubt, is to wait until I've paid off the medical bills before signing up for therapy. (I imagine it would take some months to pay off the bills -- hell, it might even take some months for me to find the final amount I'll have to pay, simply due to the maze of insurance stuff.) I'm just the type of person who feels so much more comfortable doing one thing at a time, being on an even keel financially before starting something new, etc. On the other hand, I do genuinely want to see this therapist, and I've been feeling worse recently. What to do?

----

My guess would be that many will say see the therapist and worry about the bills as they come. Because of the type of person I am, that would take a lot of convincing to get me there. Couldn't I just re-read Feeling Good or something instead until I feel financially ready enough to start therapy? (As it happens, this therapist is not at all a CBT person, but I've done a variety of modalities in the past, and this is the one I'd like to see now.)

The unmentioned option, as I expect some will recommend, is to see a psychiatrist and get on meds. For reasons individual to me, I do not think this is the option most likely to solve my problems.

posted by anonymous to work & money (9 answers total)

I don't think getting (back) on meds is likely to solve your problems, but I think it could contribute. The best outcomes with depression are linked to being treated with both therapy and meds.

I find debt to be very stressful if it's difficult to pay (large payments, overwhelming amount) but personally 1-2k and a likely to be flexible payment plan is not something that would bother me enough to cause me to delay paying for necessary treatment. Therapy is necessary treatment, I think.

Good luck.
posted by the young rope-rider at 10:20 AM on September 3, 2012 [2 favorites]

I would argue for starting therapy now, and figuring out the money later. The scale of bills you are talking about certainly sounds worth it for better mental health.
posted by Forktine at 10:25 AM on September 3, 2012 [2 favorites]

The difficulty with waiting for therapy is that your symptoms could snowball, and you have no idea how quickly or severely that could happen. Yes, debt is stressful, but not knowing how bad the depression could get without help is far more stressful to me.
posted by frizz at 10:29 AM on September 3, 2012

i look at it this way now, didn't used to though. , Money problems are easier to recover from than health problems.
posted by udon at 10:32 AM on September 3, 2012 [2 favorites]

In general, "waiting to see a therapist until I feel ready" is a crappy plan.

You can pay back the $2000 within a year in all likelihood. Depression is going to make recovery from your medical procedure and paying the money back much more stressful than they need to be.

So, I'm on team "don't wait."
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 10:34 AM on September 3, 2012 [1 favorite]

If you need to use that credit card a little bit in the short term to start paying for therapy/medical bills or to cover cash flow issues while you wait for reimbursement from your insurance, that's what credit cards are for, even for super responsible people. The finance charges for a couple hundred or thousand paid back within 6 months or a year will be small for someone like you who should have a card with a low APR, and your credit score will be fine still.

Also, be a tough negotiator with the hospital that's billing you. Get it down to the smallest monthly payment possible. They would rather get $20/mo from you than nothing, really.
posted by slow graffiti at 11:15 AM on September 3, 2012 [2 favorites]

Can you go back on your meds, at least for a while? When you have paid down part of your medical bills, would you feel that you could risk the expense of the therapist? The indecision might be what is depressing you.
Disclaimer: I am not a doctor or a therapist, but I am someone who detests paying interest. My bills must be current like yours.
posted by Cranberry at 1:38 PM on September 3, 2012

I think the answer to this question depends largely on your personality and how much your depression impairs your ability to function. Personally, when I am feeling low, having my finances be in poor shape would only make me feel even worse. On the other hand, if your depression is so acute that it might impair your work performance (and thus affect your income) then it might be more expensive not to have it treated.
posted by wolfdreams01 at 9:23 PM on September 3, 2012

Well, you sound a lot like me.

See the therapist.

Depression, for some people, is a chronic condition with a biological basis, and you need to manage it actively so that it doesn't get worse. If you had an illness like diabetes, would you think it was okay to put it off?

Depression is pernicious in a way, since becoming more depressed actually makes it harder to seek treatment.

I'd also encourage you to consider going back on medication.

Ultimately you are 24 years old. A little debt won't hurt you as long as you are taking in more then you are paying out, but getting depressed again can set you back.
posted by gryftir at 12:45 AM on September 4, 2012