Mental illness can be present in any race, gender, geographic region, or class, but have you ever wondered why it seems more prevalent in those who are homeless or on the low-income portion of the class totem pole?
It isn’t that poor people are more suseptable to things like bipolar disorder, but that they often can’t afford to get the treatment that would help.
When I was at the Bipolar Disorder in Focus conference a month or two back, the lead speaker made it very clear that he has seen dozens of cases of lawyers or doctors who go to a regularly scheduled ECT (electroconvulsive therapy) session and continue on with their lives, business as usual.
Is someone in the upper class more likely to get better care? Have more treatment options? And have received care at an earlier stage in their illness? Yes, yes, and yes.
It isn’t that lower income people are more prone to mental illness, but that they are more prone to going longer without treatment because they can’t afford it, often making the illness worse. I’m totally guilty of this myself.
On top of that, treating mental illness is extremely expensive, and as patients we’re told that this expense will last the rest of our lives. Even with insurance, many plans wont cover mental health, and the combination of the two put us in a real pickle.
So, that said, I want to share some of the tips and tricks I’ve picked up along the way over the course of my journey to receive treatment, even if there were cartoon moths flying from my empty wallet.
Seeking any kind of treatment can be scary, it can be infuriating, and it can be heartbreaking to find out just how much it costs. But there is hope! If money or lack of insurance is an issue, you still have some options.
Seeing a Therapist
There have been times where the fear of spending hundreds of dollars on medications (that I didn’t have) has kept me from seeing a psychiatrist, for better or worse. Personally, in those times seeing a therapist once a week (or once every two weeks) has still been incredibly helpful.
- Low-Income Clinic – some areas have low-income clinics for therapy that can either provide therapy for free or at a significantly reduced cost. Some of these clinics even have a prescribing psychiatrist on staff, to help people avoid the costs of seeing a psychiatrist as well.
- Sliding Scale – many independent therapists will offer therapy at on a “sliding scale” depending on your income. I’ve found that this is usually still more expensive than the clinic, but working one on one with your therapist you might be able to make some kind of arrangement.
- Students – students at local schools in programs for counseling have to practice somewhere, so if there is a school in your area it might be worth asking. Therapy with a student can often be free, or they may charge a small fee like $5 per session.
Seeing a Psychiatrist
This has been a big problem for me. Without insurance, I can afford to see the psychiatrist (but not afford my medications) or I can afford my medications (but can’t afford to see the psychiatrist!). Here are a couple ideas.
- Low-income Clinics – again, these facilities often have one or two psychiatrists on staff, but since there is only one or two expect to have a waiting period before there is a slot available to be seen. Do keep in mind that in some areas (usually urban ones like here in Seattle) these clinic psychiatrists can be completely booked, period.
- See a Registered Nurse – some facilities will allow you to see a RN who can prescribe instead of a full-fledged psychiatrist, and the cost is much cheaper. I’ve heard mixed reviews about people’s experience with this, but some people swear by it, so that’s an option.
- Going Through a Hospital – some hospitals will allow people to see a doctor on call, or be assigned a psychiatrist to see regularly. Many hospitals (but not all) will waive the fees associated with these visits if you meet a certain financial criteria. On top of that, some will allow you to apply for this fee to be waived before going to the appointment (instead of trying to clear a bill you’ve built up) which I have found incredibly helpful. Ask you local hospital about such kinds of financial aid (this information usually wont be readily available, and you’ll probably have to speak with someone in a specific department).
- State Coverage – state coverage varies from state to state and is not available everywhere, and if it is available there will probably be some serious criteria for applying. Here in Washington state, for example, you can’t be working while you are being covered by the state, and you have to qualify as having a disability. I was skeptical but applied as sort of a last-chance option, and they approved me right away -so if this is an option for you, I wouldn’t hesitate about trying to apply. Also, state coverage might only include specific doctors in the area (who may or may not be completely booked due to demand) so that is something to consider and ask about before applying.
- Medicare & SSDI – so this is the “big guns” sort of option, as applying for SSDI can be incredibly frustrating and take a very long time. Most people are initially rejected, and must apply a second, third, or fourth time before being awarded. There are also some big emotional hurdles associated with the idea of being on “disability” so I would certainly say this is something that should be very seriously considered before going down this road. That said, if you can’t work or pay for your medications because things are so severe, it might be the right fit for you.
Paying for Medications
- Patient Assistance Programs – this is something that is totally awesome and I would highly recommend. Most big pharmaceutical companies have programs where people who can’t afford their (overpriced) medications can get them for free after having their doctor fill out a few forms. Drugs like Abilify, Zyprexa, Seroquel, & more are available this way. I’m adding a section to the links page with more information, it is definitely worth checking out!
- Samples – if your psychiatrist practices privately, he/she may have some “samples” laying around that were given to them (for patients) by the pharmaceutical companies. This is excellent if you’re trying something for the first time, because you wont have to fill an entire prescription with the possibility that you might decide you don’t like it a couple days in. Free samples make trial and error a lot more cost effective.
- Changing the Dosage – some doctors are willing to write prescriptions in such a way that they will be cheaper for you to purchase. For example, prescribing a dosage double what you’d normally use, and then you break the tablets in half and take half at night so one “refill” lasts twice as long. Obviously this is completely at the discretion of your psychiatrist, and some are happy to tweak things a little so they’ll be more cost-effective for their patients.
- Changing the Fill Amount – this is another prescription writing “trick” that can help when trying new medications. Have your doctor write an initial prescription for just a few days or a week’s worth to avoid paying for a month’s worth of something you may not entirely use. If the drug works out, have them write a full prescription, and if it doesn’t, no financial harm done!
- Change Your Pharmacy – as I discovered fairly recently, the cost of each medication will change depending on the pharmacy (they’re allowed to add on as much of a mark-up on the price as they want). Some big-name pharmacies can offer you a lower price since they are buying in such huge bulk, I’ve heard a lot of good things about Costco, for example. I recently switched to getting my prescriptions at Target, and I am paying $25 a month less than I was paying previously.
- Buy Abroad – I’ve had a few people tell me that it is much cheaper for them to buy their medications in Canada, for example (and hey, it is right up north for us here in Seattle). I’ve never bought any of my medications abroad, but some people feel comfortable even getting their drugs for a reduced rate over the internet. This can be risky since the formula for each drug can vary, depending on where you get it. Lithium purchased here followed by lithium purchased on the internet from India will not be identical, so changes in levels can occur. I would say that if you’re planning on going this route, I would highly recommend getting familiar with your sources and doing as much as possible to check them out.
Let’s face it. Sometimes a trip to the emergency room is necessary, and unfortunately sometimes even an inpatient stay in necessary. I always try to hold out as long as possible before taking either of these steps, but it is never because I don’t need the help. They are expensive, especially without insurance! However, avoiding treatment because of expense will usually only make matters worse. There are things we can do to work around these problems.
- Charity Care – as I mentioned above in regard to seeing a psychiatrist through the hospital, many hospitals have a “financial aid” program to help people who can’t pay their bills. This can potentially fully cover ER visits, inpatient hospitalizations, and ambulance rides as well. However, each hospital is different, some have limitations about the amount they’re allowed to help you cover, and others don’t have a program at all. This is why it is so important to have an emergency plan in place before an emergency situation. If you do a little research to figure out which hospital in your area will be able to help you cover the cost, you can potentially save yourself a lot of financial trouble down the road. Talk to the billing department at your local hospital for more information.
- Bankruptcy – I’m not all too familiar with the concept of bankruptcy, but I’ve heard a lot of people I know with big medical bills talking about it. It can be really easy to rack up big medical bills, especially with bipolar disorder, so declaring bankruptcy is something to consider as an option to clear up those bills.
Now, I wanted to add a little something about research studies on the end, because they will often provide completely covered therapy, doctor’s visits, and, well, medication potentially (at least what you’ll be receiving for the study) free of charge. In fact, some will even pay you for your time, or your transportation costs. This is something I’ve often considered, especially when I was without any resources. Obviously, this isn’t the right choice for everyone, but it can be a really helpful resource for folks who need help -or folks who want to help others!
Alright, so bipolar disorder is an expensive thing to treat, but there are things we can do to work around that fact. For someone who is low-income and has bipolar disorder, it often seems like we are in a position where it is easy for others to deny us insurance or care. I’m hoping that with the ideas I’ve provided, we’ll take the time to stop denying ourselves care!