How To Access and Pay For Mental Health and Addiction Recovery Services

Access to mental health services is just as important as access to physical health services. Good mental health is critical to each person’s emotional, psychological, and social wellbeing. According to the National Institute of Mental Health, nearly one in five U.S. adults lives with clinically recognized mental illness. For this reason, the availability of mental health services is a necessity, not a luxury. With drug overdoses on the rise and an undeniable connection between substance abuse and mental health, the availability of mental health access has never been more important.

Through access to mental health and addiction services, it can be easier to identify conditions and disorders that may require treatment. Knowing when to seek these services, what the options for treatment are, and how to pay for them are vital in getting the appropriate help. Whether you’re insured, receiving public benefits, or paying out of pocket, having the right information on access and coverage for mental health and addiction services can mean the difference between getting help or battling these issues alone.

Mental Health Conditions

There are many mental health conditions that may require some kind of intervention. Each condition may present itself in different ways for each person, but access to mental health services is an important aspect of treatment and diagnosis. Some common mental health conditions include:

ADHD/ADD

ADD is characterized by a pattern of inattentive behavior, often combined with impulsivity and in some, hyperactivity. This pattern of behavior makes it difficult to focus on details, sustain attention, listen to others, and follow through on instructions.

Anxiety Disorders

Everyone experiences anxiety, but when it becomes overwhelming and repeatedly impacts a person’s life, or their ability to work, it may be an anxiety disorder. Some anxiety disorders present themselves with physical symptoms as well as mental which can make finding the right diagnosis difficult.

Autism

Autism is a mental disorder that begins in childhood that is characterized by persistent impairments in social communication and interaction with others. A person with autism often has restricted, repetitive patterns of behaviors, interests, or activities. The symptoms are present since childhood, and impact a person’s everyday living. Autism exists on a spectrum: severity of the condition can range widely from person to person, hence the term “Autism Spectrum Disorder” or ASD being used to describe individuals with any number of related symptoms. People with severe forms of autism may have a difficult time with everyday activities that significantly limit the kinds of things they do as an adult.

Bipolar Disorder

Bipolar disorder, also known as manic depression, is a mental disorder that is characterized by serious and significant mood swings. A person with this condition experiences alternating “highs” (mania) and “lows” (depression).

Depression

A person who’s suffering from this disorder may not seem sad to others. They may instead complain about feeling completely unmotivated to do just about anything. Even simple things — like getting dressed in the morning or eating at mealtime — become large obstacles in daily life. Those who struggle with depression may feel sad and depressed for weeks or months on end.

Dissociative Disorders

There are different types of dissociative disorders. The main characteristics of dissociative disorders are how they affect a person’s memory and self-perception. They may feel detached, depersonalized, confused, or experience amnesia. Dissociative identity disorder, also known as multiple personality disorder, is one type of dissociative disorder.

Eating Disorders

Those who live with an eating disorder are so preoccupied with food and weight issues that they find it hard to focus on other aspects of their life. They may go to extreme lengths to achieve weight loss or overhaul their diet that it can be extremely dangerous to their health.

Obsessive Compulsive Disorder

Obsessive-compulsive disorder is a mental disorder whose main symptoms include repetitive, uncontrollable thoughts, urges, and physical behaviors. Obsessive thoughts can include everything from paranoia or phobias (intense, irrational fears) to an acute preoccupation with order and symmetry; meanwhile, compulsive behaviors can manifest as physical ticks, constant hand washing, or frequently checking on things to make sure they are ok.

Panic Disorder

People with panic disorder have feelings of terror that strike suddenly and repeatedly, often with no warning. The frequency and severity of panic symptoms can vary widely. A person with this condition usually can’t predict when an attack will occur, and so many develop intense anxiety between episodes, worrying when and where the next one will strike.

Personality Disorders

Personality disorders typically aren’t diagnosed until an individual is a young adult, often not until their 20’s or even 30’s. Most individuals with personality disorders lead pretty normal lives and often only seek psychotherapeutic treatment during times of increased stress or social demands.

PTSD

Post-traumatic stress disorder (PTSD) is a debilitating mental disorder that can occur when a person has directly experienced — or even just witnessed — an extremely traumatic, tragic, or terrifying event.

Schizophrenia

Schizophrenia is a serious mental illness characterized by a person experiencing a combination of delusions and hallucinations. Because these delusions and hallucinations feel as real as the world around them, a person with untreated schizophrenia can sometimes have trouble distinguishing actual reality from this altered reality that their brain is telling them.

When to Seek Mental Health Services

Many times, mental health struggles will affect the very basic activities of a person’s life. They may find it difficult to maintain relationships, stay employed, or even leave their home. For this reason, getting proper help is vital. Because of the negative stigma associated with mental health struggles, many people may keep their problems with mental health private. Unfortunately, leaving mental health conditions untreated can be extremely dangerous.

Making people feel safe enough to talk about mental health is a step in the right direction for keeping health care services available. Not only should people feel safe enough to speak to professionals about their mental health struggles, they should also feel safe within their support system of family and friends. If you’re struggling with mental health issues, discuss pursuing outside support with the people close to you in order to go through your options. There are services available to ensure you’re not alone. What is more, getting an official diagnosis and beginning treatment can help you protect yourself from discrimination at work or school, and may even entitle you to some level of accommodation.

Treatment Options

Not only does each condition require a different type of treatment, but each person may require something different as well. From psychotherapy, to support groups, or peer support, there are a variety of different treatment options to know about. People may choose one or the other, or combine a few of these options in a way that helps them the best.

Psychotherapy

Psychotherapy is a therapy that can be used for any form of mental illness. Psychotherapy means using a psychologist or a psychiatrist to talk through your mental health struggles. The difference in the two is that a psychologist will focus extensively on treating emotional and mental suffering in patients with behavioral intervention. A psychiatrist can prescribe medications. They spend much of their time with patients on medication management as an aspect of treatment. They can work in tandem, both offering psychotherapy for their patients.

Counseling is a great resource for people experiencing a mental health issue in any capacity. You can discuss coping skills, goals, gain an understanding of your diagnosis, learn added skills, and discover ways to live with your illness instead of battling it. This type of medical necessity is extremely helpful for those living with a mental illness as an aspect of their treatment.

Support Groups

For some people, the use of a support group is powerful in helping them understand their mental health condition with others in the same boat. Individuals come together to share their stories with a community of people who understand them. These groups may focus on sharing experiences, talking about ways to cope, and, overall, creating a closeness with others that can help with the isolation that mental health conditions can create. You can choose between an online support group, or one that is local.

Peer Support

Peer support is different than a support group in that it’s a little more one-on-one, and models that of having a sponsor. Those who have achieved significant recovery can assist others in their recovery. They may offer support, individual talk sessions, coping tools, and networking opportunities. They offer coaching and companionship in a way that is relatable. To find peer support in your area, you may look into Peer Services through Mental Health America, or contact your local organization with the National Alliance on Mental Health (NAMI).

Substance Abuse Disorders

Substance abuse and mental health can oftentimes be similar issues. Though they can happen independently of each other, it’s not uncommon to see a dual diagnosis in terms of mental health and addiction issues. Some common substance abuse disorders are:

Alcohol Use Disorder

Drinking alcohol doesn’t in itself mean there’s signs of alcohol abuse disorder. Once the drinking becomes excessive and dangerous, alcohol use is considered substance abuse. To be diagnosed, individuals must meet certain diagnostic criteria. Some of these criteria include problems controlling intake of alcohol, continued use of alcohol despite problems resulting from drinking, development of a tolerance, drinking that leads to risky situations, or the development of withdrawal symptoms.

An estimated 88,000 people die from alcohol-related causes annually, making alcohol the third leading preventable cause of death in the United States. In 2016, there was an alcohol-impaired traffic fatality every 50 minutes in 2016. Though not everyone who drinks or is involved in a drinking related death has an alcohol use disorder, the chances of alcohol related death is higher for those who do.

Stimulant Use Disorder

The most commonly abused stimulants are amphetamines, methamphetamine, and cocaine. Whether illicit or prescription, the abuse of these stimulants is extremely dangerous. Symptoms of stimulant use disorders include cravings, continued use despite interference with major obligations or social functioning, development of tolerance, and withdrawal symptoms that occur after stopping or reducing use, including fatigue, vivid and unpleasant dreams, sleep problems, increased appetite, or irregular problems in controlling movement.

The number of overdose deaths due to psychostimulant abuse — a drug category that includes prescription and illegal stimulants — jumped nearly 30% last year. In 2017, 7,663 people died from a stimulant overdose, up from 5,992 in 2016.

Opioid Use Disorder

Opioids like heroin, oxycodone, and hydrocodone are all extremely dangerous regardless of their legal status when used too much. Opioids reduce the perception of pain but can also produce drowsiness, mental confusion, euphoria, nausea, constipation, and, depending upon the amount of drug taken, and can depress respiration.

Opioid use has become a widespread epidemic. Drug overdoses killed 63,632 Americans in 2016. Nearly two-thirds of these deaths (66%) involved a prescription or illicit opioid. Illicitly manufactured methadone is mixed into counterfeit opioid and benzodiazepine pills, heroin, and cocaine, likely contributing to increases in overdoses involving these other substances.

When to Seek Substance Abuse Treatment

Because some substances are legal, prescribed, or used casually, it can be difficult to determine when the use of a substance warrants treatment. When substance use is a problem, it can be difficult to admit. Addiction is a complicated situation, but it’s important to know when it’s time to seek treatment, and when substance use has turned into abuse.

• When you’ve experienced legal problems as a result of substance use: Don’t risk your freedom or safety for any substance. If you’ve done something illegal while on or for a substance, it’s time to seek treatment.
• If you have health problems connected to substance use: Many substances deteriorate your body after prolonged use. Some can cause fatal side effects even after a short time. If you have health problems as a result of your substance abuse, seek treatment.
• If you’re exhibiting dangerous behaviors connected to substance use: Dangerous behavior can harm you or others around you. Driving while under the influence, being around children while using, or going into depression as a result of withdrawal are all dangerous behaviors.
• When you’ve harmed others in connection to substance abuse: If you’ve ever harmed someone else because you’re under the influence, seek treatment.
• If you’re experiencing withdrawal symptoms: Withdrawal is felt once your body is reliant on a substance. The feelings of withdrawal help to fuel addiction and push addicts away from sobriety.
• Your friends and family have asked you to stop using: Sometimes friends and family see the problems before you do. If your loved ones have asked you to stop, it might be time to be honest about your substance use.
• If your substance abuse has affected your normal life: Losing relationships, getting fired, and dropping out of school are just a few examples of normal life that can be ruined by substance abuse.
• When you have tried to quit using but you’re unable to do so: If you’ve tried to quit and you can’t. Or you know you should and you don’t want to, it is time to seek a treatment center to help with a successful journey to sobriety.

Treatment Options

Like anything else, treatment is not a one size fits all situation. Different types of treatment options will help different types of people. For this reason, there are many different options available. From group counseling, to inpatient rehab, to recovery support services, there are various treatment options to help each person and what works for them.

Individual/Group Counseling

The individual and group counseling treatment option is a broad category. It encompasses things like cognitive-behavioral therapy, contingency management, motivational-enhancement therapy, and 12-step programs like Alcoholics Anonymous and Narcotics Anonymous. Individual therapy will focus on skills to quit and abstain from substance abuse along with tools, resources, and coping skills for long-term success. It also focuses on understanding why substance abuse happens, any underlying causes including self-medicating for any mental health conditions, and what triggers are there. Counseling will involve a recovery plan and building family relationships.

Group counseling can be used instead of or in addition to individual counseling sessions. These meetings provide social reinforcement in recovery. They may provide tools, advice, and stories that are more relatable by people who have really experienced substance abuse.

Residential and Inpatient settings

Residential and inpatient treatment facilities are typically for more developed addictions. These facilities offer an extremely structured and health-forward environment that may help people who are in extreme cases of dependence or who have had issues staying sober in their own setting. These facilities have options for detox, individual counseling, group counseling, medical treatment, and various treatment activities. The next phase of treatment is outpatient treatment once patients have reached success milestones with their sobriety.

Recovery Support Services

Recovery support services are non-clinical treatments meant to work in addition to substance abuse treatment. Since long-term success in addiction recovery requires ongoing engagement with recovery, recovery support services are there to provide some of that support. Some examples of recovery support services include: Clinical case management, housing and transportation assistance, mental health services, trauma-informed services, family engagement, behavioral therapy, vocational and educational services, financial services, child care services, primary care and oral health, and HIV services, among others. Addiction recovery is it’s own world, but it can work in tandem with services to help many causes and effects of substance abuse.

Paying for Mental Health and Addiction Recovery Services: Insurance, Medicare, and Medicaid

Private Insurance

As of 2014, Marketplace and most private/small group insurance plans must offer mental health and substance abuse disorder services. Each plan is different on what it covers, but if you have medical insurance, some coverage of these services will be available. Whether you get insurance through the Marketplace, through your employer, or privately, you should have access to your enrollment materials that will clearly explain your mental health and addiction recovery services. Otherwise you can speak to someone with your insurance company, or your company’s HR department if you have insurance through your employer.

If your employer doesn’t offer insurance, you can get insurance privately, or through the Marketplace. All Marketplace plans cover mental health and substance abuse services as essential health benefits and offers the opportunity for you to apply for a tax subsidy if you qualify for financial help to pay a portion of your health insurance plan depending on income. You can also get private insurance through an insurance company itself and your network will be larger, though the plan may be more expensive.

In order to find the right avenue to obtain health insurance, do your research to find a plan that covers mental health and addiction services that will work for you based on your desired network (if you have a provider you like), any preexisting conditions you have, and your income level.

Medicare and Medicaid

Medicare and Medicaid are government run insurance programs for those who are 65 and older or have a severe disability, or who have very low income. If you qualify for either one, it’s helpful to understand the mental health and addiction recovery options available to you.

Medicare

Medicare will cover a wide range of mental health services. Medicare Part A is largely inpatient care that includes your room, meals, nursing care, and other related services and supplies. Medicare Part B covers much of your medical including visits with a psychiatrist or other doctor, visits with a clinical psychologist or clinical social worker, and lab tests ordered by your doctor. Medicare Part D is your prescription coverage and has its own list of covered drugs.

Medicaid

Medicaid is currently the largest source of funding for America’s public mental health system. All Medicaid programs provide some mental health services and some offer substance use disorder services to beneficiaries. These services often include counseling, therapy, medication management, social work services, peer supports, and substance use disorder treatment. However, each state offers different coverage options for Medicaid. To get a complete and accurate list of coverage, it’s important to contact local Medicaid offices.

Paying for Mental Health Care Without Insurance

Mental health and substance abuse resources aren’t always accessible — especially if you’re not insured at all. Paying for these services can seem impossible, for that reason it’s important to be aware of the public resources available to those who aren’t insured.

Public Resources for the Uninsured

Before seeking mental health or addiction services that require payment and attempting to pay out of pocket, look into the public resources you may have in your community. However, seeking out public assistance like Medicare, Medicaid, and Social Security will provide health care that is much more comprehensive.

Free Clinics

Free clinics can come in many forms from women’s health to mental health or addiction recovery. These clinics are usually offered by local non-profits and are built to help those with low income. Find a free clinic near you.

Community Mental Health Centers

Similar to a free clinic, community mental health centers are created to aid those with mental health needs and low-income at a lower rate or free of charge. Though they differ by area, each community mental health center is there to provide cost effective mental health services.

Pastoral Counseling

Your church or chosen religious community may be able to put you in touch with a pastoral counseling program or similar resource. Some religious mentors offer a type of counseling or mentorship for free to members of the church or community.

Self-Help Groups

Many communities have peer support resources that are free to those who join. Alcoholics Anonymous, Narcotics Anonymous, and support groups specific to your mental health needs my exist within your community. There are support groups for anxiety, depression, PTSD, etc. all over the country.

Mental Health/Substance Abuse Hotlines

There are many mental health and substance abuse hotlines that are there for you any time of the day, any day you need them. These hotlines are free of charge and can even provide you with resources in your community to seek help. They are also anonymous.

Paying Out of Pocket

While it’s not recommended to pay out of pocket for your medical needs, sometimes it’s unavoidable. Just be sure you’re exhausting all of your other options before settling on paying out of pocket costs for your mental health or addiction recovery needs.

• Dispute inaccurate claims: Always be sure to review your bill and ask questions if you don’t understand some of the charges. Disputing a medical bill can be a pain, but if there’s an inaccurate claim, it’s best to dispute it and save yourself some of the money — especially when you’re paying out of pocket.
• Negotiate a payment plan: Discuss a payment plan for your medical bills. Many hospitals have a standard for how this works, so don’t feel like you can’t ask about your options in terms of repayment.
• Applying for financial assistance: Financial assistance can mean something different for each provider, but it doesn’t hurt to ask an apply. It involves a lot of paperwork, but it may lead you to some amazing savings. Discuss any options for financial assistance with your medical provider.

Mental health and addiction recovery services are basic needs in each person’s health coverage. Without access to these resources, it can be difficult to even identify a mental health condition, let alone understand the treatment options available. With substance abuse disorders being so closely connected with mental health struggles, knowing the signs of addiction and having treatment options available can save lives. No matter what type of coverage you have, from private coverage to being uninsured, it’s important to know that there are options for you regardless of your circumstances. If you’re struggling with a mental health condition, or battling addiction recovery, know that there are treatment options available to you.