This story is a portion of part I of Colorado Community Media's multipart series on mental health, Time to Talk
Jo Ann Mahoney, 34, used to be insured by Medicaid, the federal public health insurance program for low-income people. It allowed her to see a therapist for depression and anxiety. Therapy, she said, was a safe place for her to discuss her life and struggles as a mother of three young children.
The therapist, Christian-based and in private practice, helped her work through, among other issues dating back to her childhood, the pre-partum depression she was experiencing before the birth of her third child. Her therapist was available by phone or text whenever she needed to talk.
“He let me say whatever I wanted,” without judgment, she said. “He was a father himself, so he had an understanding.”
Then her husband switched jobs. His company covers his insurance but not hers, and he makes too much for her to qualify for Medicaid. The result: She can no longer afford to see a therapist.
“There are so many of us Americans all over the country where it’s the same story,” she said. “We make too much to get help but not enough to be able to afford it.”
Nationwide, 28.2 million people, or 10.4 percent, under age 65 are uninsured, according to a 2016 National Health Interview Survey conducted by the Centers for Disease Control and Prevention. Of the insured, 65 percent have private insurance and 26.3 percent have public health insurance, which includes Medicaid and Medicare, which insures people 65 and older.
Signed into law by President Barack Obama in 2010, the Affordable Care Act — according to the U.S. Department of Health and Human Services — has provided one of the largest expansions of mental health and substance use disorder coverage in a generation, by requiring that most individual and small employer health insurance plans cover mental health and substance use disorder services.
To Patti Boyd of Tri-County Health Department, the current administration’s unsuccessful attempts to repeal the Affordable Care Act show how important mental health care coverage and public engagement on the issue are to the country’s citizens.
“If people are in a crisis, they shouldn’t have to wait,” said Boyd, manager of strategic partnerships for the public agency that serves Douglas, Arapahoe and Adams counties. “We can do something about that, and getting that message across is really important.”
For those who have no health insurance — and even for some who do — the cost of mental health services can be prohibitive.
A Google search of several private counseling and therapy services in the south metro Denver area shows a price of $60 to $200 per session without insurance. Some private practices take insurance or have a sliding scale, where cost is dependent on the client’s income. Oftentimes, finding those practices takes some searching. Individuals insured by Medicaid in Colorado have access to behavioral health services in each county, which are listed at www.colorado.gov/pacific/hcpf/behavioral-health-organizations.
Even with commercial insurance coverage, the wait for mental health services can be lengthy, said Dr. William Henricks, CEO of AllHealth Network, which provides behavioral health services for Douglas and Arapahoe counties.
Because of the amount of time it takes to find a specialist and get authorization from a health insurer for the mental health service, “you may have to wait 60 days to see a psychiatrist,” he said.
The process, he said, can be frustrating.
In Douglas County, residents are generally insured.
In 2015, more than 60 percent of the county’s population of about 322,400 was covered by employer-sponsored insurance, according to the Colorado Health Institute, a research organization that provides data on healthcare in Colorado. Between 7 percent and 17 percent were covered by Medicaid or Child Health Plan Plus, a low-cost insurance for children and pregnant women that may expire Jan. 31 if Congress does not renew federal funding. Between 8 percent and 10 percent were on Medicare. About 2 percent were uninsured.
But having insurance doesn’t mean it’s always easy to access needed care.Finding a health care provider that takes health care insurance is one reason some 60 million Americans with mental illness don’t get the treatment they need, National Alliance on Mental Illness (NAMI) found in a recent study titled “The Doctor is Out,” which looks at disparities in access to mental and physical health care.
In a nationwide online survey of 3,177 individuals, more than half of respondents who looked for a new mental health provider in the last year contacted psychiatrists who were not accepting new patients or who did not accept their insurance. A third of respondents reported difficulty finding any mental health prescriber who would accept their insurance.“When people cannot find a provider, many have to go out-of-network and pay high out-of-pocket costs, including co-pays,” NAMI reports. “When people face higher out-of-pocket costs, it may lead to them seeking less care—or going without any care at all.”
Mahoney, who lives in Elizabeth on the outskirts of Parker, learned to advocate for herself when she didn’t like the therapists initially assigned to her through a public health department.
When she lost her insurance coverage, she started confiding in loved ones and attending groups for moms, such as Mothers of Preschoolers in Elizabeth and You Are Not Alone — Mom2Mom in Highlands Ranch, which hosts free weekly meetings for moms to feel connected and supported.
One time, when she had a panic attack while driving, she dialed Colorado Crisis Services, the state’s resource for mental health. The person on the line helped calm her down.
Today, she is successfully managing her depression and anxiety with the support system of the moms’ groups and close friends.
“I pride myself on being resourceful and reaching out,” Mahoney said. “But there are so many that can’t advocate for themselves or reach out.”
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