Affordable mental health treatment for the moderately poor

July 6, 2007 1:32 PM

Most economical way to get treatment for anxiety and depression?

I (think) I am ready to finally seek help for the anxiety and depression related issues I've been suffering from for a number of years. I do have insurance but with a deductible so high that I may as well not. I've been told that a general practitioner can sometimes provide assistance in these cases but I do not attend a doctor regularly (or ever) so I don't have a general practitioner. Should I look for one or seek out a psychologist/psychiatrist/mental health counseling specialist? I'd like to take the most effective course of action but I'm also concerned about getting referred elsewhere, not being able to afford weekly counseling sessions for eternity and otherwise racking up bills that I cannot afford to pay. I have located a sliding scale counseling center but my combined household income exceeds their requirements. Best route to take?

posted by anonymous to health (15 comments total)

Call your insurance company and upgrade your coverage to have a lower deductible.
posted by The World Famous at 1:38 PM on July 6, 2007

The cheapest way would be to find a GP in your network and go in for a checkup. Tell him your problem. He will probably put you on an SSRI or recommend a specialist.

Your other options are self-help (this is generally considered an excellent workbook) and cheaper group therapy options.
posted by damn dirty ape at 1:50 PM on July 6, 2007

Don't assume you will have to go every week for a long time to see results. When I did cognitive-behavioral therapy for anxiety and depression it took about a year, but by the end I was only going once a month. In CBT the focus is less on talking everything through and more on excercises you do on your own time to address your issues.

Also, many therapists will work with you on deductibles. You might have better luck with a center that is not focused on low income patients.
posted by InfidelZombie at 2:01 PM on July 6, 2007

Seconding the GP. Might as well go with the easy and cheap first line SSRI therapy and see if it works. Sometimes it does. My first crack at treatment was with a GP at a walk-in clinic that I had never met before and I found him to be sympathetic and supportive. It was a good experience. He referred me to talk therapy sessions - I did a total of 8 max (this was socialized medicine in Canada so I wasn't sick enough qualify for more). It was enough to get me functional. This would give you a total cost in the US system under $1k (if you are taking generic drugs).
posted by crazycanuck at 2:37 PM on July 6, 2007

In addition to getting formal help, regular exercise and sunshine really help a lot.
posted by theora55 at 3:08 PM on July 6, 2007

You might try bibliotherapy first: that is, if you've got 8 bucks you can get a copy of Feeling Good, the standard cognitive-behavioral therapy self-help book. If you work all the exercises, you'll be doing a lot of the same things you'd be doing in therapy with a cognitive-behavioral practitioner. This regimen is enough for lots of people; why not try it first, and if it doesn't work, start looking into more expensive options?
posted by escabeche at 3:11 PM on July 6, 2007 [1 favorite]

Seconding damn dirty ape's book suggestion. I recently got off anxiety/depression meds and I think the book helped me more than the meds.

Also, are you a student? Or does your employer offer an employee assistance program?
posted by desjardins at 3:12 PM on July 6, 2007

This website has some extensive cognitive therapy exercises that might be a good place to start http://moodgym.anu.edu.au/
posted by whoaali at 3:43 PM on July 6, 2007

I don't really have any recommendations regarding your medical insurance issues but you might want to look into bolstering your body chemistry through nutrition.

Dr. Andrew Stoll is a psychiatrist and an assistant professor at Harvard Medical School. He maintains that Omega-3 deficiency is linked to depression and cognitive disorders such as attention deficit.

His book is called, "The Omega-3 Connection: The Groundbreaking Antidepression Diet and Brain Program." My computer won't let me do the fancy linking so here's the URL:

http://www.amazon.com/Omega-3-Connection-Groundbreaking-Antidepression-Program/dp/0684871394

If you decide to try supplementing your diet with Omega-3 be sure that the supplement does not contain Omega-6. I have forgotten the science behind this but I do know that Omega-3 is the way to go. Stoll explains the details in his book.

I buy Omega-3 at Costco. It does not smell fishy and it does not cause 'repeating' (for me). It's the Kirkland (Costco house) brand. It contains 200 softgels of Maximum Strength Enteric Coated Fish Oil and costs about $15 US. The label says:

- Contributes to Heart & Vascular Health
- 1700 mg Concentrated Fish Oil with 800 mg Omega-3 Fatty Acids per serving.

I take about 5 or 6 softgels per day but YMMV.
posted by Soda-Da at 3:44 PM on July 6, 2007 [2 favorites]

I'd look into getting a GP and an exam if you can afford it. It's a good idea to have a GP regardless. There's a lot of threads here for self-treating anxiety and depression, which are good to read and try out. Exercise, diet, daylight exposure, easing up on yourself, meditation/mindfulness, Omega-3 (I use sardines, flax oil, and cod liver oil in liquid form, not pills), following your interests, and CBT/Feel Good Handbook, can all help and can work together synergistically. But if you have a serious issue, definitely get to a doc.
posted by DarkForest at 5:36 PM on July 6, 2007

If you do decide to go the route of drugs, explain the situation to your doctor or nurse practitioner so that they can prescribe something generic that will be cheaper. Walmart has been offering generic drugs for $4/month and you can go to their web site and look under Pharmacy for a list of what's available, so you have something to print out and bring with you.

Stephen Ministry is a nationwide service that a lot of protestant churches have. It is not particularly churchy, so if you would be ok with getting counseling through a church it could be a good option. The Stephen Ministers are members of the church who take a class (yearlong, I think) learning basic counseling skills. I took a mini version of the class (6wks). Depression is the common cold of mental illness and the Stephen Ministers are trained in the basics. You could probably google for churches in your area that have this and email them asking if they take people in the community who aren't members of the church. I bet a lot of them do.
posted by selfmedicating at 6:12 PM on July 6, 2007

Inquire at your county health department. They usually have directories of therapists who work on a sliding scale, even if your income is not on what they consider the poverty level. A friend of mine had a steady job with OK wages, lousy insurance and couldn't afford private counseling. The county health department was able to fix her up with a therapist who adjusted her rates accordingly. Good luck to you.
posted by Oriole Adams at 10:57 PM on July 6, 2007

If you do end up getting prescribed anti-depressants and your insurance doesn't cover prescriptions, Costco is pretty much the cheapest available especially if you're already a member.
posted by dagnyscott at 9:03 AM on July 7, 2007

Try 5HTP over the counter, perhaps at a health food store. Do NOT take with an SSRI. Works great for anxiety/depression. Studies indicate it can be as effective as SSRI's but without the drug problems. 100 mg/day pref in AM. YMMV. One book.
posted by kch at 9:49 PM on July 7, 2007 [2 favorites]

If you're in the U.S., you can see if your county has a mental health department and go from there.
posted by cass at 9:38 AM on July 9, 2007