Advice for a broke young adult with mental health issues?
July 28, 2010 8:34 AM   Subscribe

How would you advise or help out a very broke young adult who needs assistance with mental health issues? I don't know how to effectively manage my mental health issues as an independent young adult...

I am in my early twenties, so I have been going through many major life changes in the past few years, including a few major (and sudden) losses. Clearly, I have been struggling with mental health issues for at least five years now. I have good health insurance coverage, however I am responsible for all of my bills & copays; even at a low price, these are very expensive to me now. I am really struggling financially to make ends meet. I am also about to change to a new (also low-paying) job, which I am not sure will be compatible with my current therapist's office hours.

Yes, I have a therapist. He is of the CBT variety with an interest in mindfulness & acceptance. I've been in weekly therapy with him for two years. Since seeing him, I have grown more assertive and developed greater skills for self-advocacy; I have a better understanding of anxiety-reducing techniques--meditating, exercise, healthy diet, identifying unhelpful thought patterns (e.g. catastrophizing). We tend to chat about day-to-day things and practical solutions during sessions. I sense that he prefers to focus on action-oriented, thought-pattern-challenging issues/topics rather than discussions of deep feelings or past experiences.

My therapist claims that I just have a depressive disorder. However, I have some pretty serious symptoms like dissociation, hypervigilance, emotional regulation issues, etc. that 1) are causing me distress and 2) worsening. These symptoms are not going away; in fact, while I am quite happy in many realms of my life, I feel that cognitively I am increasingly "losing touch" with outer and inner reality. Additionally, I crave talking about certain old memories and intense feelings, but find that very difficult to do with him. To top it off, I’m having a hard time following through with his “practical” suggestions (e.g. yoga, healthy eating, etc.) on my very low budget.

I don't think I am getting the help that I need, though that is very hard to admit to myself. There are emotional road blocks, as I am attached to my therapist and view him as a stable father-figure. My therapist does not have many patients now--in fact he has said that this is unfortunate, though he said so light-heartedly--and I do feel some responsibility towards him after all of this time. Additionally, I can't afford to "shop around" for a therapist, as I can barely afford a co-pay to see my current one once a week.

So what do I do? Some of these symptoms are very scary, and I would like them to go away. I have no idea how to approach mental health care now that I am a "young adult." How do people who work 9-5 jobs get mental health care (e.g. have time to see a therapist)? What do people do when they need satisfactory mental health care but can't afford it? Do you have any recommendations of helpful resources (books, websites, associations, etc.)? How much of this do I just have to “tough out”?

To get ahead of you: I am from NC. I have tried psychiatric meds but found they had negative effects. I will be applying for food stamps soon and will almost certainly qualify. I have considered printing this and sharing it with my current therapist, but remain indecisive.
posted by anonymous to Health & Fitness (12 answers total) 5 users marked this as a favorite
You are not responsible for keeping your therapist in business. Repeat this to yourself often. Open then yellow pages and start calling around to therapists to see who can do a sliding-scale deal with you. Be upfront; every therapist gets calls like this, and it isn't rude or awful to ask. Also, contact your county mental health office - they may referrals, free or cheap group sessions available, etc.

Regarding food, yoga, etc: Yoga can easily be free. Get a book or a DVD from the library, or hunt around on the web for free videos. Eating healthily can be very inexpensive: beans and rice can be bought in bulk, and greens are cheap (you don't have to buy the organic kind if they're out of reach). Poke around on askme for cheap recipe threads - there are tons.

Good for you for reaching out and asking for help. This is a very good thing.
posted by rtha at 8:51 AM on July 28, 2010

I was seeing a therapist when I was a "young adult" (22-28) and working. I took long lunches once a week and worked late to make up for it. I was lucky enough to be working non-shift work where that was possible, though. Some therapists have evening or weekend hours to accommodate people who can't.

As I think you know, your attachment and feelings of responsibility towards your shrink are inappropriate, not in the OMG inappropriate! sense but just in the sense that this dude isn't your dad, he's a hired professional. I do think you should print this out and show it to him, possibly in the course of asking him for a referral to someone who does another kind of therapy (or someone with a different schedule). Many therapists will do a meet & greet for free; you can see your current guy every other week and somebody new in the alternate weeks. There's no reason the switch has to be total.

What medications have you tried? Would you ever be open to trying different meds, or has is that door pretty firmly closed for you? Send me memail if you want to chat about my experiences with therapy and meds; I did therapy, no meds, for like 12 years, and then meds and therapy for a year, and then just meds for seven years, and now I'm back to therapy, no meds.
posted by KathrynT at 9:00 AM on July 28, 2010

There are usually cheaper ways to do things when you can't afford the expensive ways. If the therapist has become difficult to afford, you don't have to see him. And don't feel responsible for his financial well-being; he has to take responsibility for his life and finances just as you have to take responsibility for yours. This web-site is an excellent example of all the good and even therapeutic advice that is available essentially for free (there was the $5 membership fee, but after that it's free - and you have already paid). I read lots of the questions and answers in AksMeFi (and have asked 2 questions myself) and I am tremendously impressed by the intelligence and helpfulness of the replies. And yes, there are support groups on the internet. You can find them easily enough by a google search.

It costs money to get yoga lessons, but it costs nothing to read a library book or see a youtube video about yoga, and you can do yoga by yourself if you want to, it does not have to be a group activity (unlike baseball). Similarly, there are inexpensive ways to improve your diet. Junk food is not necessarily cheaper than good food. Rice, for example, is extremely cheap if you cook it yourself (and if you don't know how to cook it, we can tell you that too). I admit that a truly excellent diet does tend to be more expensive, but a relatively good diet is not necessarily more expensive than a relatively bad diet. And again, dietary advice is freely available, you don't necessarily have to pay for it.

So, finances can be managed, but what about the scary symptoms? Well, you already have the basic tools. You have learned about identifying unhelpful thought patterns, etc. Now you have to do it. Mental health is not something that you solve once and never have to worry about again, it is a life-long issue (much like physical or fiscal health). It requires an ongoing effort. Some people ask themselves "What would Jesus do?" You might want to ask yourself "What would my therapist advise?" You probably know, at this point, what he would advise, so instead of paying him to give you the advice that you know he will give you, you can give yourself the same advice and follow it. That's my advice.
posted by grizzled at 9:01 AM on July 28, 2010

Yep, take this to your therapist. Take this to any potential future therapists if you go looking.

Do you have any friends or relatives you trust, who could provide any sort of support? Not necessarily financial support, but maybe a willing ear, or researching other therapists if you're busy, or making you a healthy dinner every now and then, or just being a friend? (I'm asking because your question sounds very familiar to me: I have a few good friends who've lived in NC and could have written this at some point - and I see a lot of myself in the question, too. My friends are strong and smart and self-sufficient like you are, so I trust them to take care of themselves, but if any of them explicitly asked me for help, I would do whatever I could.)
posted by Metroid Baby at 9:15 AM on July 28, 2010

If you qualify for food stamps you may also qualify for Medicaid, which would require you to terminate your private insurance but at least would cover mental health treatment in the community mental health system without onerous copays and other fees. You can contact the county assistance office that handles your food stamp application and make an appointment to speak to a caseworker about eligibility and whether or not you qualify and whether or not it may be beneficial for you terminate your private insurance. Your therapist may not take Medicaid, so this is also something you want to speak to your current service provider about before making any decisions. If you do not qualify for Medicaid you unfortunately don't have much choice but to continue doing your best to cover the costs associated with your treamtment.

I'm sorry, but please disregard the above advice about symptom management. The age of onset for many serious mental health disorders is right around your current age, and you may very well not be equipped to handle the new symptoms you are encountering because they could be related to an entirely different disorder than what you originally sought treatment for. It may not be the case that you are not trying hard enough to implement your therapist's recommendations, but that these recommendations are not designed to manage new symptoms related to the onset of a different disorder than the one your therapist's current recommendations were meant to manage.

Do not substitute this forum for interaction with real life mental health professionals. Tell your therapist that you are experiencing new and different symptoms that you feel are worsening depsite your ongoing two year commitment to treatment and you feel you may need a higher level of care than the one you have now.
posted by The Straightener at 9:21 AM on July 28, 2010 [9 favorites]

For me it is always a flag when some one says "I have tried meds but found they have negative effects" Yes, they do have negative effects but that is not enough--did you try different dosages, different drugs, were the drugs introduced in a proper manner, there can be a substantial difference among SSRIs, did you augment the primary drug with other drugs. Psychiatric drugs can be unusually difficult to properly dose and combine. It takes a patient and skilled physician and a "patient" patient. I am glad the CBT is working but some of the symptoms you are describing may benefit from proper pharmacology. Two years is a bit long to be in "talk therapy" and it is particularly long for CBT. As said you are not responsible for your therapist--even more so--it is inappropriate for him to discuss his practice with you. Therapy is about you not him. Is there a local/regional community mental health center available where you might see a psychiatrist.
posted by rmhsinc at 9:22 AM on July 28, 2010

I am a clinical psychology doctoral student and work at a training clinic at a university. As we are funded through the school, sessions for community clients are $1-10 depending on income. I am not sure where you are in NC, but if there are any major universities where you live, it would be worth seeing if they have affordable training clinics. Many of my current clients are poor post-grads in their twenties, without insurance or can't pay for their co-pays, so your life position would be familiar. ;) These therapists will not yet be licensed psychologists, but they will have hundred of hours of experience.

I know Metafites love CBT and medication, and obviously these interventions work for some people who are going through rough patches. But honestly I think psychodynamic therapy can be necessary for other individuals, especially if you have tried CBT for two years and haven't found it all that helpful. I know that I personally found permanent relief from my intermittent depression through digging deep into my childhood memories and feelings, and coming to understanding how emotional conflicts from the past were playing out in my current life. The fact that you view your therapist as a "parental figure" and feel "responsible" for him, seems like a hint that you might have felt overly responsible for your parents in the past as well. (In psychoanalytic terms this responding to a therapist like a parent is called 'transference' and is really common and is not weird at all.) And regardless of debating therapeutic orientations, if you want to talk about your memories, then you need to find a therapist who will be open to that.

One last thing. I don't know anything about you, but dissociation and hyper vigilance are definitely more common in individuals who have experienced traumatic events in their past. If you think this might be so, I would definitely encourage you to seek another therapist who can help you work with the trauma, rather than being only present focused is his/her work.

Anyway, here is an example of a university training clinic in NC:

Feel free to metamail me if you like. And good luck!
posted by amileighs at 10:46 AM on July 28, 2010 [1 favorite]

Thanks for the responses so far! I am the original poster.

I actually have very good health insurance coverage as I am still on my parents' group plan (offered through a parent's job). The problem is, I am cut off from them in every other aspect. I feel embarrassed calling clinical psychology offices for any sliding scale assistance if I already have health insurance. It seems hard to explain how a college graduate *with* health insurance still can barely afford co-pays. Paying once a week is okay; it's just paying for intake interviews, etc. to find a new therapist that is really stressing me out.

Also, right now, the door is pretty firmly closed on meds. I have tried multiple kinds. I do have a prescription to a benzodiazepene which I take only on an "as-desperately-needed" basis.

KathrynT: Did you tell your boss the reason for these "long lunches"? How did you work out an arrangement like that?

Amileighs, I think you may be on target. I am starting to think that while I may like my therapist, his therapeutic style may simply not be the ideal fit with me. I am just second-guessing myself a lot. I've been looking at other types (psychodynamic, dbt, etc.) but they all seem time-consuming and expensive. The finding process feels very overwhelming and time-consuming so I haven't made much progress. I'm not totally sure how to categorize events as traumatic or not, but it could be possible that's what's going on with me.

I'm also having a hard time meeting young people my age who live affordable, healthy lifestyles and don't just go out and spend money drinking every night. I don't know where or how to meet these sorts of people and build friendship with them.
posted by Tulip at 12:18 PM on July 28, 2010

Be aware that not all therapists work a 9-5 schedule. When I had to see one for a few months, my sessions always started at 6pm or 7pm. Shop around.
posted by Wossname at 12:22 PM on July 28, 2010

I told my boss that I had a standing medical appointment, and that I was willing to be flexible about the exact time and day if need be. I thought it was pretty transparent what I was talking about, but you never know; it could have been physical therapy or fertility testing or dialysis or any one of a number of things. I held this arrangement through 3 different bosses, and not one of them ever asked any questions about the nature or content of the appointment.

As for it being hard to explain how a college grad with health insurance can barely afford co-pays; nah, you don't need to explain. I know many, many people who have been in this situation. It's really common. Like, to the point where you can ask up-front if they have a sliding scale or an option for a no-charge intake appointment.

For meeting people, I've found the best thing to do is to do things you enjoy. Eventually you'll run into either individual other people who are doing those things, or (jackpot!) a group of people who are organized around doing those things. Some of them are going to be broke, or frugal, or both. And on that note, in this economy, you don't have to feel weird or like an outlier for being broke and frugal. Lots of people are, and probably even more people should be more frugal in order to avoid being more broke. ;-)
posted by KathrynT at 1:06 PM on July 28, 2010

Depending on where you are, Easter Seals can be a great resource for low cost/free mental health services. I can't say enough good things about them, their outpatient services or their crisis centers. If you're comfortable saying what part of the state you're in, some of us may be able to provide other specific resources for you.
posted by hydropsyche at 4:13 PM on July 28, 2010

I would be more comfortable giving details over Mefi Mail, but thanks for the links, hydropsyche.
posted by Tulip at 5:14 PM on July 28, 2010

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