If you are in crisis, call or text 988 for the Suicide & Crisis Lifeline, free and available 24/7. For ongoing low-cost care, contact your county's community mental health centre or a community health centre with behavioural health services, use Medicaid if you have it (it covers mental health care), look for university training clinics and sliding-scale therapists, and check whether your employer offers a free Employee Assistance Program.
How it works
The short version, before the detail.
Mental health services in the US are delivered through a patchwork of public and private systems. Every state runs a public mental health system, usually through county or regional community mental health centres, which serve people with low income and those with serious mental illness, often on a sliding fee. Certified Community Behavioral Health Clinics, now operating in many states, must serve anyone regardless of ability to pay and provide crisis services, outpatient care and care coordination.
Medicaid is the largest payer of mental health care in the country. It covers therapy, psychiatric care, medication, and substance use treatment, with small or no costs to you. Marketplace and employer plans must also cover mental health and substance use services under parity rules, which require that limits on mental health care be no more restrictive than for physical health.
Community health centres increasingly provide integrated behavioural health, where a counsellor works alongside your primary care doctor. This is often the quickest route to an appointment and is charged on the sliding scale.
Training clinics at universities - psychology, social work and counselling programmes - provide therapy by supervised trainees at low cost. Many private therapists also offer sliding-scale fees for a limited number of clients; directories let you filter by price. Peer support groups, such as those run by mental health and recovery organisations, are free.
In a crisis, 988 connects you by phone, text or chat to trained counsellors. Many areas also have mobile crisis teams and crisis stabilisation centres as alternatives to emergency rooms. If there is immediate danger, call 911.
Who usually qualifies
Factors the agency looks at. Only they make the final decision.
You do not need a diagnosis or insurance to seek help. Explain what you are experiencing and ask what is available.
How to apply, step by step
If you are in crisis, call or text 988
Free, confidential and 24/7. If there is immediate danger, call 911.
Check your coverage
Medicaid, Marketplace or employer plans cover mental health. Call the number on your card for in-network providers.
Contact your community mental health centre
Search your county's name with 'community mental health' or call 211.
Ask your primary care provider or health centre
Many offer integrated counselling.
Look for training clinics and sliding-scale therapists
University clinics and therapist directories that list fees.
Check your Employee Assistance Program
Many employers offer free short-term counselling.
Find peer support
Free support groups for many conditions.
What to have ready
Missing one item is rarely a reason to wait - start now.
- Insurance or Medicaid card, if any
- Proof of income for sliding fees
- List of current medications
- Any previous treatment records
What happens after you apply
How it compares
Similar programmes, and which one fits which need.
| Programme | What it covers | Best for |
|---|---|---|
| 988 Lifeline | Free crisis support 24/7 | Anyone in distress now |
| Community mental health centre | Low-cost therapy and psychiatry | Low income or serious mental illness |
| Training clinic | Supervised low-cost therapy | Ongoing talk therapy |
| Employee Assistance Program | Free short-term counselling | Employees of participating employers |
Real situations
How this plays out for people in common circumstances.
Anxiety, no insurance
A young man has worsening anxiety and no insurance.
He books with a university training clinic at a low fee and visits a health centre for a medication evaluation on the sliding scale.
Medicaid, cannot find a therapist
A mother on Medicaid struggles to find an in-network therapist.
She calls her Medicaid plan's member services line, which must help her find a provider.
Crisis at night
A person feels overwhelmed and unsafe at night.
They text 988 and speak to a counsellor; a mobile crisis team is offered.
Employee with stress
A worker is under severe stress.
Her employer's EAP provides free counselling sessions.
What people miss
True, rarely explained, and it changes the outcome.
988 is for any emotional crisis
Not only suicidal thoughts.
Insurance must treat mental health fairly
Parity rules apply.
Health centres often have counsellors
Integrated care is quick.
Training clinics are affordable
And supervised.
EAPs are free
Check with HR.
Common reasons people get stuck
Waiting until crisis
Seek help early.
Assuming therapy is unaffordable
Many low-cost options exist.
Not using plan member services
They must help find providers.
Stopping medication suddenly
Talk to a prescriber first.
Going it alone
Peer support is free.
How it differs by state
State public mental health systems, Certified Community Behavioral Health Clinics, crisis services and Medicaid coverage vary by state. 988 is national.
Key terms explained
The words on forms and letters, in plain English.
- 988
- The national Suicide & Crisis Lifeline, available by call, text or chat 24/7.
- Community mental health centre
- A public or nonprofit clinic providing mental health care, often on a sliding scale.
- CCBHC
- Certified Community Behavioral Health Clinic, which must serve anyone regardless of ability to pay.
- Mental health parity
- Rules requiring insurers to cover mental health care no more restrictively than physical health care.
- Employee Assistance Program (EAP)
- A free, confidential counselling benefit offered by many employers.
- Mobile crisis team
- Trained responders who come to a person in mental health crisis, as an alternative to police or the ER.
Questions people ask
Where can I get free therapy?
What is 988?
Does Medicaid cover therapy?
How do I find a sliding-scale therapist?
What is a community mental health centre?
Can I get mental health care without insurance?
Is there mental health help for veterans?
What is an Employee Assistance Program?
Can I get help for substance use?
What happens when I call 988?
Do I need a referral to see a therapist?
Are online therapy services affordable?
How much does therapy cost at a community mental health centre?
Can I get medication for depression without insurance?
What is the difference between a psychologist, psychiatrist and counsellor?
Can I get therapy for my child without insurance?
Is online therapy covered by Medicaid?
What should I do if I cannot get an appointment for weeks?
Numbers to call
Free lines. We are not affiliated with any of them.
Official sources
Current figures and applications live here.