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Mental Health Care Is Too Expensive. Can Therapy Collectives Help?

They might not be completely mainstream yet, but they’re doing their best to make sure support for depression, trauma and anxiety isn’t only for the rich and well-insured

I first heard about Open Path Collective last year when I was without insurance and looking for a therapist. For a one-time lifetime membership fee of $59, Open Path offers primarily teletherapy, which starts at $30 a session, depending on your financial situation. That’s not free, but it’s notably less than what therapy usually costs out-of-pocket — upwards of $100 an hour depending on where you live. 

A positive of the pandemic is that it’s normalized teletherapy as well as made it more accessible, as a recent study found that 37 percent of U.S. counties don’t have any practicing psychologists. But as therapy from home has become more mainstream, the same cannot be said for the concept of collectives — groups of therapists who come together as independent contractors to collaborate and provide affordable and readily available counseling. Collectives have quietly surfaced over the past decade to address the ongoing mental-health crisis in the U.S. — the number of adults experiencing some form of mental illness increased by 1.5 million people between 2017 and 2018 alone — yet few know what they are and how they can help. 

Collectives help address issues around affordability and access that have persisted since deinstitutionalization in the 1960s. When asylums shut down, mental health care was put into two distinct categories: 1) community mental-health organizations that serve people with severe mental illness (nonprofits generally funded by the state); and 2) private practices for more moderate cases, which require patients to have insurance coverage or a lot of extra cash. Collectives seek to fill some of the middle ground, as most people fall somewhere in between — i.e., they’re not sick enough to qualify for community mental-health services, but they also can’t afford to pay for therapy on their own. (Approximately half of people with a mental illness receive no treatment for it, and a study of more than 20,000 adults with depression found nearly half of them cited money as the reason.)

As for Open Path, since the nonprofit was founded in 2012 by psychotherapist Paul Fugelsang, it has matched over 40,000 people with affordable mental health care across the U.S. and inspired a number of other collectives such as the Chicago Therapy Collective, the BEAM Collective and the Therapist Collective. Open Path maintains a small support staff with their one-time membership fees, and pursues grants and other forms of funding. To be a part of the Open Path network, therapists are simply asked to take on just a single Open Path client for a reduced rate. “Our model takes what therapists have been doing in their local communities and scales it up to the national level,” Fugelsang wrote in 2017.

Nicholas Mancini, a Denver-based therapist, thinks Open Path has been very successful in creating “a great platform for people who want to seek services but don’t have insurance.” He joined the Open Path network about three years ago when he was making the transition from community mental health to private practice. Working alone, Mancini was lonely and missed bouncing ideas off a team. He could’ve joined a group practice or a private practice that employs multiple therapists, but at the expense of his independence. A collective like Open Path allowed him to be a part of a community of therapists, but with the freedom of an independent contractor. Embracing teletherapy helped him provide some sessions at a reduced rate and grow his private practice of full-price customers at the same time. 

Open Path was such a positive experience for him that last year, Mancini co-founded a collective of his own with fellow counselor Eric Hilborn. “We started Collective Counseling Solutions to help bridge that gap, and to help other providers in private practice feel like they have a community of support, while also honoring their independence and autonomy,” Mancini tells me. After only a year, they’ve grown to 20 mental-health professionals across 10 different locations nationwide. 

Again, in terms of pricing, the model of a collective gives Mancini the freedom to have a sliding scale that meets people where they’re at — without putting themselves out of business. “There’s a couple people I see for free, and there are some people I see for our full rate,” Mancini says, adding that a full-price session is $165 out-of-pocket and $175 for the initial intake. When he’s at capacity or not a good fit for a person’s needs, the collective gives him a pool of colleagues to pull from, increasing the likelihood that the patient will receive care.

While Open Path is reserved for people without insurance coverage, Mancini decided to work with insurance companies because he thought the collective could reach more people that way. In addition, dealing with insurance companies was what he struggled with the most in his private practice, so he wanted to help other therapists navigate the process. In order for therapists to bill insurance companies for services, they first have to be accepted to a panel in a process known as “getting credentialed.” However, individual therapists starting new practices can get denied for reasons that have nothing to do with their licensure, education or ability, and more because of administrative errors, deadlines or capacity issues.

Among other ethical reasons, this is why many private-practice therapists don’t take insurance — they can’t. One loophole is that individual therapists don’t have to bother with getting credentialed if they’re part of a group or collective that’s already approved, which takes a massive administrative task off of their plate and incentivizes them to join.

Yet, as proud as Mancini is of the collective he’s built, he doesn’t think more of them are the answer to fixing the mental-health crisis. At least not until people stop treating therapy like a dark secret, and the stigma around mental-health treatment is better addressed through education and media.

To that end, Mancini encourages his clients to talk about their experience with therapy to whatever extent they feel comfortable, because it could help someone else. The goal is to make “going to a mental-health provider like going to the doctor and getting an annual physical.” “It’s part of your overall wellness,” Mancini argues. “The question isn’t about more collectives, but about how do we as a nation address mental health?”