Getting Started With Mental Health Care

How urgent is this?

If you or someone else is in crisis or thinking about suicide, call or text 988 (988 Suicide & Crisis Lifeline), call 911 or go to the nearest ER. Don’t wait for a callback or an intake appointment.

Hearing or seeing things others do not, or feeling unable to function, makes psychiatry promptly a reasonable first step, with emergency care if safety is a concern. Otherwise, there is rarely one correct door. You can usually start with either a primary care doctor or a psychiatrist.

Could something physical be part of this?

It can be. NIMH says certain medications and medical conditions, such as viruses or thyroid disorders, can cause the same symptoms as depression. A provider can check through a physical exam, interview and lab tests. So mention fatigue, weight change or other physical symptoms that come with low mood or anxiety.

Please do not stop a medication because you suspect it. NIMH cautions that people should not stop taking a prescribed medication without the help of a health care provider.

What should a clinician hear early?

• Stretches of high energy. If you have ever had stretches of little need for sleep, racing thoughts or unusually high energy, or if a close relative has bipolar disorder, mention it to whoever you see first. NIMH says people with bipolar II disorder may seek help only for depressive episodes. It also explains that for people with bipolar disorder, antidepressants are not used alone because they can trigger a manic episode or rapid cycling. If you take an antidepressant, do not stop it on your own; tell your prescriber.
• Treatment that did not help. A psychiatrist or psychiatric nurse practitioner can review what was tried, for how long and what else might be going on.

What if the person who needs help is someone else?

In most situations, you cannot make an adult get mental health care. SAMHSA says it plainly: “You can’t force someone to get care.” It says the best thing you can do is be there and listen without judgment, and it notes it may take many conversations.

Once there is even a small opening, practical help can matter more than more persuasion. You might look up two or three clinicians, sit with them while they call, or suggest one visit to their regular doctor. This article on helping someone who refuses care has more.

If you are worried about suicide, ask directly. Asking does not plant the idea. Call or text 988 for guidance, including on the person’s behalf. In immediate danger, call 911 or go to the nearest ER, and do not leave a person alone if you believe they may act on it right now.

New York has legal options for narrow, serious situations. These decisions rest with clinicians and courts, rules vary, and this is not legal advice. You can also get help yourself even if the other person refuses, through individual therapy or, when someone is ready, family therapy.

Who does what in New York

“Therapist” describes what someone does, so the useful question is which license stands behind it. Other states differ.

Role	Core training	Talk therapy	Prescribes in New York
Psychiatrist	Medical school, then psychiatry residency	Yes, though practices vary	Yes
Psychiatric nurse practitioner	Registered nurse, then nurse practitioner education in psychiatry	Often some counseling	Yes, within the certified specialty
Psychologist	Doctorate in psychology and supervised experience	Yes	No
Therapist (LCSW, LMHC and others)	Usually a master’s degree and supervised experience	Yes	No

Psychologists are often the clinicians people see for formal psychological or neuropsychological testing. They are doctors, but they are not medical doctors, so “Dr.” alone will not tell you who can prescribe. See who does what and what the letters after a name mean.

Who to see first

These starting points are general guidance and cannot account for your situation.

• You want to talk through patterns, stress, grief or relationships: a therapist or psychologist.
• You are wondering about medication, or already take it and it is not helping: a psychiatrist or psychiatric nurse practitioner.
• You have severe symptoms, a past hospitalization, or several conditions at once: a psychiatrist is a sensible first step, with a therapist added as needed.
• You do not know where to begin: primary care, which can do an initial screening and refer you, or a psychiatric evaluation.
• Your plan requires a referral: primary care, after confirming the rule with your plan.

In network or out of network?

Your plan type is a first clue. With a PPO you can generally go outside the network at extra cost. An HMO generally won’t cover out-of-network care except in an emergency, and an EPO covers services only from network providers, except in an emergency. Your Certificate of Coverage governs.

If you have out-of-network benefits, whether they are worthwhile depends on three numbers: your deductible, your coinsurance and the allowed amount. New York regulators describe a separate out-of-network deductible, often higher than the in-network one. The allowed amount may be lower than the clinician’s fee, and you are responsible for the difference. Most New York regulated plans must give you an approximate reimbursement figure on request, though it is not binding and can change. Many of these protections apply only to state-regulated coverage, so ask your employer’s benefits team if you are unsure.

For some people the numbers will favor in-network care, especially for weekly therapy on a tight budget. For others, a specific expertise, a clinician they trust or an in-network wait may make the higher cost worth it. Both are reasonable choices.

Before you call

1. If you may use insurance, call your plan. Ask five things: whether you have out-of-network mental health benefits, what deductible applies, what share it pays and of what amount, whether anything needs approval first, and how claims get filed. Even a clear answer is not a guarantee, because payment depends on the claim, your plan’s terms and how the service is coded.
2. If you will pay without insurance, ask for a written Good Faith Estimate. If a practice may file a claim for you, or you may submit a claim or superbill yourself, say so, because federal estimate and dispute rights may not apply to that care.
3. Gather what you can. None of this is required, but your insurance card, a list of current medications and doses, including supplements, and your availability can save a second call.

What the call is like

An intake call is a practical conversation about whether a practice is a good match and how to get started. It isn’t therapy or an evaluation. At Mind Body Seven, you request a consultation or call (212) 621-7770, and the intake team can confirm fit, scheduling and costs.

Questions vary across practices, and a sentence or two about why now is enough. Some practices ask about suicidal thoughts, self-harm or recent hospital stays, so they can point you to the right level of care. If you are thinking about suicide or are in immediate danger, call or text 988 (988 Suicide & Crisis Lifeline), call 911 or go to the nearest ER.

How soon you can be seen depends on the practice, the clinician and the service, so ask directly, and say so if your need feels urgent. It also helps to ask about fees for the first visit and follow-ups, the cancellation policy and limits to confidentiality. If things get worse while you wait, tell the practice or your primary care provider. In an emergency, use the crisis options above.

If you submit your own claims

Keep a small log of each session date, the date you submitted the claim, any confirmation number and what the plan paid. For state-regulated coverage, New York regulators say the law requires insureds to submit claims within 120 days after the date of service, unless it was not reasonably possible. Your plan’s Certificate of Coverage may state its own terms, and self-funded plans follow their own documents.

If it does not feel right later

You have three reasonable options: name it and see whether things improve, change something about how you work together, or move to a different clinician. Unless you feel unsafe, it’s often worth raising the problem once before leaving. There isn’t a proven number of sessions, so ask, “How will we know if this is working, and when should we check?”

If your clinician prescribes for you, leaving a clinician doesn’t have to mean leaving a medication. Do not stop treatment without talking to a provider. Check your refills, ask who will cover prescriptions until your new clinician takes over, and where possible book the new prescriber before your final visit.