How do I know if investing in private practice mental health support is right for me?

To help you answer this question here is a breakdown of costs and benefits of various mental health service options that may be available to you.

The following is a breakdown based on this writer’s experience within the mental health field (within the geographical area of Calgary Alberta, Canada).

* The following article is not meant as a diagnosis or to say what is right for you given your individual circumstances. And it is not a substitute for seeking your own qualified medical advice. Use your own wise judgement in finding the right option for you.

The main providers of mental health services (again, within Alberta, Canada) can generally be broken down into non-profit services, provincial health care services, School/Academic Based Supports, Employee Assistance Programs (EAP) and Private Practice Services.

Non-Profit Community Agencies:

We are fortunate to live in a city and country where there are many non-profit community agencies that offer free or sliding scale mental health services. Many services within the non-profit sector focus on clearly defined types of mental health support services. These services may range from emergency crisis counselling, walk-in mental health counselling, family counselling, sexual assault counselling, grief support or more general short terms counselling services. With the exception of certain more specialized programs the majority of non-profit supports offer services based on more of a brief support model.

The benefits of such services are that there are many skilled providers and they can be more accessible, especially if finances are a concern. For more specialized services the benefits can be connecting to a program and service tailored to your needs.

The downside can be that areas outside of the program often would require a referral. There are also areas that are more specialized and therefore agencies may not be equipped with the budget and staffing to employ specialists in certain areas. If you develop a relationship with your counsellor you may or may not be able to return to them again in the future, especially if it is a more specialized service and your concerns no longer fall within the scope of the program.

Non-profit counselling centres can also be great resources for free or low cost counselling. The downside can be long waitlist times if your concerns do not constitute an immediate safety risk. There may be less choice and control over goodness of fit with your counsellor or available appointment hours. Many centres also offer spaces for sliding scale fee arrangements for those with financial concerns. These spaces may be provided by Master’s level graduate psychology or social work students, or those completing their professional registration hours or may also be offered by Registered mental health professionals. Also the majority of agencies have requirements and guidelines for determining financial needs which are often based on the poverty guidelines for Canada . They often include an assessment or proof of income and number of legal dependents. If financial concerns are based more on willingness to invest or income going to non-essential expenses rather than true financial need you may not qualify for reduced rates.

Health Services Supports:

There are also excellent services within the provincial health care system. The benefit is that in services under Provincial Health Care are most often provided at no cost to the client (regardless of income) as a part of overall health care services. There are many specialized programs and supports and like all health services patients are triaged depending on urgency and need. This can be a positive thing for those who are really struggling and are at risk.

The downside can be that for those whose needs are not as urgent may be facing varying wait list times to be connected to supports.There is also the issue of confidentiality to consider. Although your records are not available to everyone there is information that may become a part of your overall health care record. This may or may not be a concern but it is important to fully understand the limitations to confidentiality and potential risks and benefits. (It is for this reason that some clients may prefer to go the private route in seeking assessment and diagnosis information).

School/Academic Based Mental Health Supports:

If you or your children are connected to a school or academic program, school based and academic institutions can be another resource for mental health and counselling supports. The types of supports and services can vary widely between school districts and specific academic programs. It would be worth inquiring about available services within your school or academic program.

The benefits for school/academic based supports are that service providers are often more familiar with the specific challenges faced by school based and academic populations. Services are often offered on site and many supports are often available at no change or included as a part of tuition fees or are available at greatly reduced costs compared to the private sector.

The downside can be a high demand for services which can result in specific eligibility requirements for services (including type of services offered, session limits and timelines for service delivery, etc.). Longer wait list times for non-urgent concerns and outside referrals may also be required for more specialized concerns.

Employee Assistance Providers (EAP):

If your employer or health benefits program is connected to an Employee Assistance (EAP/EAPP) provider you may have access to counselling services at no charge as a part of your overall extended health benefit plan. EAP providers are often companies that hire their own full time staff and/or contract mental health support staff and plans are purchased through employers.

EAP providers can be great resources for many generalized concerns. The majority of plans focus on brief mental health support.

The downside can be that most plans also have a set number of sessions that you and/or your family may access each benefit year. Some plans will clearly communicate the session limits while others try not to directly disclose this. In most cases EAP programs do not offer specialty services so if your needs would best be met with something more long term or specialized this may not be the most appropriate option in the long run. Also if you have a connection with your counsellor and wish to return to them again in the future this may or may not be an option. It is also important to be clear on the limits of confidentially and what information is collected and shared with your employer before starting services. Most plans aim for as much confidentiality as possible but this is important to clarify as plans can range in their own specific policies and limitations.

Private Practice Providers:

Private practice providers tend to be more specialized in certain niche areas (although this is not always the case). There also tends to be a lot more flexibility in terms of how your treatment is structured. If it is important to you to establish an ongoing relationship with a professional who you can reach out to when you feel the need for additional support this is one of the benefits of private practice. Private practice can be a longer term relationship and often has more flexibility. Private practice tends to work well for those who like to be able to access services in a timely fashion and have more flexility on the types of concerns addressed and timeline for therapy while avoiding potentially more lengthly intake processes and waitlists. Also private practice providers may or may not see fewer clients overall so that they have more energy to give to each client. There are often more options for ideal appointment times, such as evenings and weekends. They may offer a higher standard for service provision in terms of office location, decor and overall ambience. The client often has more control and flexibility in selecting the right therapist to work with, which may increase the likelihood of a good fit. Goodness of fit between client and therapist is the number one predictor of positive change within therapy.

Depending on the nature of your concerns over time there still may be times where your private practice therapist may (and should) refer you to another professional when concerns fall outside of their areas of expertise or if there may be a conflict of interest, one therapist may not be able to meet all your needs over time.

The downside to private practice may be cost of services. Therapy within private practice may require a significant investment of time and resources. Depending on your health benefit provider many people do receive a yearly amount of coverage for mental health services provided by a Registered Psychologist or Registered Social Worker. This may or may not be enough to cover your treatment depending on the frequency and severity of concerns. If finances are an area of concern and it would put you in a stressful situation to invest in private services it may be a better option to go with a non-profit, provincial health service, an EAP provider, or combination of supports, at least until your financial situation improves.

As a mental health service provider myself when I seek my own support I personally find the benefits of private support services are worth the investment and are a part of my personal and professional self-care budget. I have worked in almost all the the above settings (and more) in my career.

I went into private practice because I value the freedom and flexibility of being able to draw from a variety of approaches and to provide services when clients need them.

It is also important for me to be able to create the type of client support I wanted to be able to provide. For me this means see fewer clients but can offer more than I was able to do in other settings and I am grateful to be able to do work that lights up my soul and to be of service in this way.

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