Finding mental health care and therapy in the U.S.

Step 1 — Decide it’s time to reach out

A move to a new country can bring stress, grief and loneliness all at once. The National Institute of Mental Health (NIMH) gives a simple guide: if milder feelings don’t improve with self-care, or get worse, talk to a health care provider; if stronger symptoms, like feeling hopeless or struggling to get through your day, last 2 weeks or more, seek professional help (NIMH — Do I need help?). Our guide on culture shock walks through these signs.

You don’t need to name the problem before you ask. A health check can rule out a physical cause, because changes in mood or concentration are sometimes due to a medical condition (NIMH — Psychotherapies).

Step 2 — Start with a primary care provider

If you don’t know where to start, a primary care provider (PCP) can do a first mental health screening and refer you to a mental health professional (NIMH). A PCP is the doctor, nurse practitioner or physician assistant you see regularly, and can often help with anxiety or depression (SAMHSA — Types of providers). No PCP yet? See where to get medical care.

Treatment usually means therapy (in person or online), medication, or both (NIMH). Therapy, also called psychotherapy or talk therapy, aims to help you identify and change troubling emotions, thoughts and behaviors (NIMH — Psychotherapies). The Substance Abuse and Mental Health Services Administration (SAMHSA), a federal agency, describes two groups of professionals (SAMHSA — Types of providers):

• Can prescribe medication: psychiatrists (M.D. or D.O.) and psychiatric or mental health nurse practitioners. PCPs can also prescribe for many conditions, including depression and anxiety.
• Provide counseling and therapy: clinical social workers (such as LCSW), counselors (such as LPC), psychologists (such as Ph.D. or Psy.D.), therapists (such as LMFT), and peer support specialists and crisis counselors.

What each one may do can depend on your state, so SAMHSA suggests asking when you set up an appointment (SAMHSA).

Step 3 — Have insurance? Start with your plan

• Ask for the list of providers. Your insurance company can tell you which local providers your plan covers, and may have an app or online directory (NIMH).
• Ask about approval rules. Some plans require you to get treatment approved before you start, often called “prior authorization” (HealthCare.gov; DOL).
• Know what Marketplace plans cover. All Health Insurance Marketplace plans must cover behavioral health treatment, such as psychotherapy and counseling, plus inpatient mental health services and substance use disorder treatment. They can’t refuse you or charge you more because of a mental health condition you already have (HealthCare.gov).
• Know about “parity”. In Marketplace plans, limits on mental health care, like copays, visit limits or approval rules, generally can’t be stricter than the limits on medical and surgical care (HealthCare.gov). A federal law, the Mental Health Parity and Addiction Equity Act, gives similar protections for certain plans; the Department of Labor explains them for job-based plans (DOL).
• Check your job. Ask human resources whether your employer has an Employee Assistance Program (EAP): a free, confidential service paid for by your company that can help with mental health, drug or alcohol use, grief and trauma (NIMH).
• Check your school. Students may get mental health services through the school’s health center or peer support groups (NIMH). See your first 30 days as an international student.

No insurance yet? Read health insurance for newcomers.

Step 4 — Low income or no insurance? Find low-cost care

• Community health centers treat mental health and substance use needs, as well as medical and dental needs. All of them adjust their fees to income and family size, and they must serve everyone, even people who can’t pay (HRSA). Search Find a Health Center and make an appointment for mental health services (USAGov).
• FindTreatment.gov is SAMHSA’s online locator for mental health services (NIMH), in person or online (NIMH — Virtual support).
• SAMHSA’s National Helpline, 1-800-662-HELP (4357) (TTY: 1-800-487-4889), is free, confidential and open 24/7, in English and Spanish. It doesn’t offer counseling; it refers you to local treatment, support groups and community organizations. Without insurance, or with too little, you may be referred to your state’s office for state-funded treatment, or to places with a sliding fee scale (SAMHSA). You can also text your ZIP code to 435748, in English only; message and data rates may apply (SAMHSA).
• Your state or county health department website may list mental health programs, and many universities and medical schools run training clinics (NIMH — Psychotherapies).
• Always ask about cost: fees, whether insurance is accepted, and whether there’s a sliding scale (fees based on your income) (NIMH — Psychotherapies).

Step 5 — Ask for care in your language

• Free language help. The HHS Office for Civil Rights says services like the emergency room, a doctor’s office or the pharmacy likely receive HHS funding or are covered by civil rights laws it enforces, and two federal laws require these programs to provide language help free of charge (HHS OCR). Tell the staff you need an interpreter when you make the appointment (Settle In). More in where to get medical care.
• Ask about experience with newcomers. You can ask if a provider shares your cultural background or has worked with newcomers before (Settle In).
• Your privacy includes the interpreter. Settle In, a newcomer resource financed by HHS, says providers and interpreters must keep what you share private unless they are concerned you might hurt yourself or someone else (Settle In). NIMH suggests asking a therapist how confidentiality works and whether it has limits (NIMH — Psychotherapies).
• Read in your language. MedlinePlus, from the National Library of Medicine, has health information in many languages, from Albanian to Vietnamese (MedlinePlus).

Step 6 — Consider online care (telehealth)

Telehealth is care by video call, phone call, text or email. Depending on your insurance and provider, it can include an assessment, therapy and prescriptions (NIMH — Virtual support). Before you choose, NIMH suggests that you:

• check with your insurer that telehealth is covered, because policies vary from state to state;
• choose a provider who uses a secure platform that protects your privacy;
• think about privacy at home, since people nearby may overhear (NIMH — Virtual support).

Health apps are different from your doctor: the FTC warns they may not be covered by health privacy laws like HIPAA. Read the privacy notice and choose more protective settings (FTC).

Step 7 — Prepare for your first appointment

NIMH suggests that you (NIMH — Tips):

• write down your questions and concerns;
• list all your medicines, including nonprescription drugs, herbal remedies, vitamins and supplements;
• bring a friend or relative if it helps;
• be honest and specific: when your symptoms started, how strong they are and how often they happen. Mention major stress or recent life changes; a move to a new country is one of them.

Questions you can ask a new provider (NIMH): What experience do you have with my issue? How do you usually treat it? How long may treatment last? Do you accept my insurance? How much will it cost?

If treatment doesn’t seem to help, talk to your provider; you may choose a different provider or type of treatment. Don’t stop treatment without talking to your provider first (NIMH).