Rising costs, therapist shortages: Gen Z struggles to afford mental health care

Jazmyne Casillas, 23, describes her mental health struggles as “pretty gnarly”. She has been diagnosed with autism, borderline personality disorder, comorbid with bipolar type 2, depression, and anxiety. She also struggles with forming long term memories. “There are cycles where things are going fine, but the moment I hit a depressive slump, my life and everything I do just goes down the drain,” she says.

She knows she needs a good therapist and medication: “I’m pretty sure if I managed to get medication to handle the bipolar type 2 and generalized anxiety my life would significantly improve: I wouldn’t have to worry as much or anticipate the depressive cycles so often and I wouldn’t be so paralyzed by a lot of adult choices that I have to make.”

Casillas used to get mental health treatment through the foster care system but was left on her own after she turned 21. Now a first-year college student in Nebraska, she lacks health insurance and can’t afford care. “Finding a good therapist would be expensive, probably around $500 to $600 a month where I live,” she says, “not including any potential medication prescriptions.” To cope, she relies on her fiancée for emotional support – “She helps a lot, but most days it’s a struggle to even get up out of bed.”

Casillas is part of a cohort of young people who are reporting higher rates of mental illness than previous generations but are unable to get the help they need.

According to federal data, between 2008 and 2019, the number of teenagers between 12 and 17 who reported having at least one major depressive episode nearly doubled, and suicide rates among people between 10 and 24 increased 47%.

A January study by McKinsey found Gen Z respondents twice as likely as older people to report feeling “emotionally distressed” and two to three times more likely to report considering or attempting suicide between late 2019 and late 2020. Respondents also said they couldn’t afford mental health services, and the study found that Gen Z was the least likely age group to report seeking professional mental health treatment, in part due to its high perceived cost.

“It’s weird,” Casillas says, “you’d think with more people talking about it the cost would go down, but it feels like it’s just gotten more expensive over time.”

Young people who are insured are spending more. Though people under 25 make up 36% of the US population, they contributed 42% of all health plan-related spending on mental health and substance abuse treatment in 2020, according to new data from the Employee Benefit Research Institute.

The economist Paul Fronstin, the study’s author, said that while more employers had added mental health coverage to their benefits, costs hadn’t always gone down. “More employers are shifting people’s health plans from low deductible to a high deductible [the amount you have to pay before the insurance kicks in]. And that would drive up your out-of-pocket spending on mental health,” he told the Guardian.

Related: The big idea: should we drop the distinction between mental and physical health?

A recent national survey of Americans in therapy by Verywell Mind found that patients spent a median of $178 a month out-of-pocket on therapy fees alone – in addition to a median of $40 a month for medication. But while Gen Z is more receptive to therapy than older generations, the survey found 57% said they might have to quit therapy if their costs increased, and 48% said they were affording therapy thanks to financial help from someone else.

Amy Morin, a licensed social worker and Verywell Mind’s editor in chief, said an increased demand for therapy had run into a constrained supply of therapists.

“A lot of therapists are getting burned out,” she told the Guardian. Another issue is low pay: “As a therapist, I can say sometimes the reimbursement rates from insurance companies are so low that therapists aren’t able to pay their bills, so a lot of therapists are taking cash only, which creates a shortage for a lot of people who have insurance.”

That problem is felt acutely in less densely populated areas. “Sometimes insurance companies might have two therapists that are in-network within a 100-mile radius. So somebody might find that those two therapists have super long waiting lists because it only takes maybe one or two companies to have a huge list of employees who all have the same insurance, and they’re all vying for the same couple of therapists,” Morin said. “Or maybe you have a preference for somebody who specializes in something specific like OCD, but their nearest in-network therapists might be hundreds of miles away.”

A similar dynamic applies to psychiatrists: a 2014 study by the Journal of American Medical Association Psychiatry found that nearly half of psychiatrists don’t accept insurance due to low reimbursement rates. And psychiatrists also have fewer incentives to take on patients with complex mental illnesses, a report by Bloomberg found.

For young people without money to treat their mental illness, the alternative is more or less DIY. “A lot of Gen Z cope with it by being nihilistic and escaping into social media, which exacerbates things even more,” Casillas says. “Most students and people near me, though, seem to rely on a support network of friends, relatives and loved ones, while keeping track of their minds and taking mental health days when need be.”

Casillas’ hope is that she can land a job with mental health benefits one day: “I chose to major in secondary education specifically so I could look for jobs after graduation that had a health services package that included mental health.”

For now, though, there’s not much to do but hang in there. “I can’t say I’m even really managing. Just trying to coast along and hoping for the best until I graduate college and hopefully get a job before the next cycle of depression hits.”