Mental Health Initiative
Financial hardship is closely linked to mental health challenges.
People who grow up or live in difficult social conditions are more likely to struggle with their mental health throughout their lives. These challenges are often shaped by larger systems in society that keep families stuck in cycles of poverty and poor health across generations (Kirkbride, J. B., et al., 2024). With a third of US citizens and families living below the poverty line, research consistently demonstrates that despite high levels of need, few of these individuals access quality mental health care, and numerous systemic, cultural, and individual barriers limit access for these populations (Hodgkinson, S., et al., 2017).
When it comes to accessing mental health, there are a few primary ways in which individuals pay for their services.
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Why Insurance Isn’t Always Enough
Many people assume that having health insurance means they can access mental health care without difficulty. Unfortunately, that’s often not the case.
Most insurance plans include behavioral health coverage, but the way those benefits work can create real barriers to care.
The Deductible
Before insurance begins paying, individuals often must meet a deductible — sometimes $1,000, $2,000, or more. This means they must pay the full cost of therapy sessions out of pocket until that amount is reached.
For someone already under financial strain, this alone can delay or prevent care.
Copays and Coinsurance
After the deductible is met, insurance may require either:
A copay — a fixed amount per session (for example, $30–$50), or
Coinsurance — a percentage of the session cost (often 20–40%).
While these costs may seem manageable for some, weekly or ongoing therapy can still become financially overwhelming.
The Reality
Mental health care is rarely a one-time visit. It often requires consistent support over time. When high deductibles, copays, or coinsurance combine with limited financial resources, many individuals postpone care — or go without it entirely.
And yet, we know that early and consistent treatment leads to better outcomes.
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Private pay means paying the full session fee out of pocket.
Therapy sessions often range from $120 to $200 per visit in many communities. When care is needed weekly — as it often is — this can total hundreds of dollars per month.
For families already managing housing, food, childcare, transportation, and medical costs, private pay is often simply not sustainable.
Mental health care becomes something postponed until finances improve — even when symptoms are worsening.
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Some providers offer sliding scale rates based on income. This is a generous and important practice within the field.
However, sliding scale availability is often limited:
Many clinicians can only offer a small number of reduced-fee spots.
Reduced rates may still be financially out of reach for families in significant hardship.
Waitlists for lower-fee appointments can be long.
There are some ethical concerns about offering sliding scales in general.
Often the most specialized and experienced therapists do not offer sliding scale rates, individuals with low income can not access their top services, and they often have to go to less experienced or specialized care.
Even at a reduced rate, ongoing weekly sessions can strain already tight budgets, but moreso, it makes quality mental healthcare harder to find.
The Gap That Remains
Insurance deductibles. Copays. Coinsurance.
Private pay rates. Limited sliding scale openings.
Each option helps some people — but none consistently solve the problem for families experiencing financial hardship.
As a result, many individuals delay treatment, reduce session frequency, or discontinue care altogether. And we know that inconsistent or delayed treatment often leads to worsening symptoms, greater long-term cost, and deeper disruption to families.
Whatever you're building, we're here to help you take the first step with confidence.
Our MissionWe desire to assist underserved individuals through educating the community of the gaps to access, building a network of mental health professionals who can provide symptom-appropriate and quality services, and providing informed financial assistance to make quality mental health services affordable to uninsured and underinsured people in need.
Supporting our community
with education and access.
We are the Mental Health Initiative, a non-profit seeking to fight the negative stigma of mental health and assist underserved populations in obtaining quality mental health services through education, referrals, and when necessary, financial assistance.
Here’s why that matters:
Lack of access to quality care has led to a mental health crisis.
Evidence indicates that mental health disorders are 1.5 to 2 times more prevalent among low-income populations.
