Barriers to care

Treatment for depression by clinicians and other healers in the United States can be costly, and it is not always easy to find an available provider who is also affordable. Many young people we interviewed ran into barriers when they tried to get therapy, counseling, medication, or other forms of care. Often those who made it past these barriers were then unable to maintain this care over time. Devin said, speaking about other young adults as well as himself, ‘I think probably a lot of people can’t deal with their depression because they do not have the means for probably insurance or something like that especially when it comes to money.'

Sierra Rose wonders why it is so insanely difficult to get help for depression.

Age at interview 18

Gender Female

Age at diagnosis 11

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Insurance problems

A number of people we interviewed described having no insurance coverage to help pay for depression-related treatment, and many others said they had some useful coverage but it was inconsistent or insufficient. Echoing a story many people told, Leanna said she has been in and out of therapy for years: ‘Whenever I can afford it, whenever I actually have health insurance to be able to do it, I do it and it’s always pretty intense.’ Sam said he ‘stopped taking medications, not on the advice of my therapist, but out of financial necessity;’ Sierra Rose described the same thing. When Marty’s insurance stopped paying for methadone, he turned back to heroin.

Even when people had insurance coverage, the portion of the bill they were responsible to pay themselves (their ‘co-pay’) was sometimes so high it made care unaffordable. Leanna says she has to pay ninety dollars out of pocket for therapy visits, which ‘doesn’t sound like a lot but it’s hard for me to come up with it.'

Sally notes that in her insurance network, psychiatrists are considered specialists and the co-pay is a lot higher than for doctors who are not specialists.

Age at interview 25

Gender Female

Age at diagnosis 19

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Another common issue people described is that only a limited network of care providers is covered by their insurance. Several people said it was hard to get access to a medical professional capable of prescribing medication (most often a psychiatrist) within their network. Others talked about difficulty in finding a good therapist. Pete, for example, said ‘it took a lot of searching’ to find a therapist. He searched through 400 people ‘to find someone that was available and that was taking the insurance. Because most people that are taking insurance have a lot of people coming and their times are really short and if they are not, it’s because they charge more.’ Colin noted that there are ‘limited options’ within his network, and he wishes he could ‘get around it’ and go to other providers.

Frankie didn’t have insurance for the longest time, and as a result didn’t get treatment for depression or other issues. Now that she has insurance, she has a list of services she wants to get.

Age at interview 24

Gender Female

Age at diagnosis 13

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Paying for care directly

Several people talked about paying for services directly. Julia looked for places with sliding-scale fees that she might be able to afford. Brendan’s family found therapists-training at a local college who provided care at a price his family could manage.

Cost has been a barrier to getting couples counseling for Jacob, but he has the capacity to pay for it if he cuts out other expenses.

Age at interview 25

Gender Male

Age at diagnosis 18

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Insurance reform

The Patient Protection and Affordable Care Act of 2010 (sometimes referred to as the ‘Affordable Care Act’ or ‘Obamacare’) changed the availability of insurance in significant ways. For example, it made it possible for young adults to stay on their parents’ insurance until age 26, and made it illegal for insurance to refuse to cover ‘pre-existing conditions.’ Health reform also created state-based ‘marketplaces’ through which low-income people enroll for insurance coverage that is subsidized according to income levels. A ‘health care parity’ law passed in 2008 mandates that treatment for physical and mental health disorders be equal*,*1 in plans covered by this Federal Act.

A few people we interviewed spoke directly about how Health Reform affected them personally. Shayne, for example, said coverage she got under the Affordable Care Act started right when she turned 27 and needed it. ‘Thankfully,’ she said, ‘I was able to not drop 1500 dollars on a month’s worth of medication.'

Whitney was able to find a psychiatrist who could provide her with some good care once the Affordable Care Act made it possible for her to get insurance through the state.

Age at interview 29

Gender Female

Age at diagnosis 9

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(See ‘Depression and school‘, ‘Getting professional help for depression‘, ‘Therapy and counseling‘, ‘Depression, medication, and treatment choices‘, and ‘Holistic and integrative approaches to depression‘).

*’Implementation of the Mental Health Parity and Addiction Equity Act (MHPAEA)’. Substance Abuse and Mental Health Services Administration, 15 June 2015, Web. 7 February 2016.
*1 ‘What is Mental Health Parity?’ National Alliance on Mental Illness, n.d., Web. 7 February 2016.

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