I Went to a Therapist for the Wealthy to Find Out How Rich People Deal

There are lots of barriers to mental health care: is money to golden ladder that allows you to climb over them?

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Sep 27 2016, 4:00pm

Image: Sodanie Chea/Flickr

I met Clay Cockrell at the Columbus Circle entrance to Central Park. I quickly spotted him, standing under the big gold statue. He was tall, with close-cropped sandy hair, a kind smile, and bright orange sneakers.

We spent the next hour walking through the park on a pleasant August day, talking about anxiety, affirmations, and how training your mind is like training a puppy. It wasn't an odd blind date; It was a crash course session of Cockrell's brand of counseling, which he calls Walk and Talk therapy. The session cost $450.

There are many barriers to mental health care: lack of time, lack of therapists, and the stigma still associated with mental illness. But by far, one of the biggest barriers to therapy in this country is money. I wanted to see first hand if having money is the golden ladder to better mental health, so I gave Cockrell a call.

Image: Courtesy Clay Cockrell

Studies have found individuals with lower income are more likely to have a mental illness, less likely to be insured, and more likely to experience a cost barrier to mental health care—particularly if they have a severe mental illness and are also uninsured. This is compounded by the fact that psychiatrists accept insurance at a lower rate than any other healthcare professional; Studies have found just over half of psychiatrists in the country accept health insurance, compared to 86 percent of other doctors.

That means the people who are the most at risk of serious mental illness, and are the least likely to be insured, are unable to find a therapist that takes insurance even when they have it. Once they find a therapist, people with lower-income are also more likely to face discrimination when trying to make an appointment.

"There are people out there with schizophrenia who can't get mental health care but if you're a Google heir with angst you can get it no problem," said Keith Humphreys, a professor of psychiatry and public mental health at Stanford University.

In many ways, being wealthy breaks down all of these barriers at once. If you're well off, (and not, by comparison, working on an hourly wage), you might not worry about taking an afternoon off of work to visit your shrink. You can afford to travel to other parts of your state or country to seek out the best care. And you can pay for any therapist that suits you, and not have to worry whether or not they take your insurance.

Percentage of physicians who accept insurance by specialty, 2009-2010. Source: JAMA Psychiatry

Cockrell's prices are actually fairly tame by some New York therapist standards—another therapist I spoke to for this story charges $1,000 for a 45 minute session, and his average patient visits two or three times per week, meaning there are people in Manhattan spending more on therapy annually than the average Manhattanite makes in a year. Still, $450 an hour is far out of reach for many people, and Cockrell doesn't take insurance (though he said his rate goes as low as $200 an hour for lower-income patients).

Cockrell also specializes in treating patients who are wealthy, and has an affluent client base.

"I think it all started because I do the Walk and Talk therapy, and that attracts an outside-the-box thinker," Cockrell told me before our session. "I had a few outside-the-box entrepreneurs, very wealthy, and I guess my name kind of got passed around."

Cockrell definitely projects a non-judgemental vibe. He listened carefully when I spoke, and responded thoughtfully, slowly, making me feel like he was genuinely considering what I had just said. His gentle southern drawl—he's originally from Kentucky—was soothing and calm. He's not a psychiatrist, but Cockrell has a Master's degree in social work and is a Licensed Clinical Social Worker.

"You can hardly swing a cat in New York without hitting a psychiatrist."

As we strolled north past the wide lawn called Sheep Meadow, we discussed times when I feel anxious and tried to come up with some solutions. Cockrell suggested everything from meditation, to daily affirmations (where you declare, out loud, the positive things you want to believe about yourself), to visualizing my anxiety as a colored blob with a name that I would mentally shrink until I could squash it.

Since most patients do more than one session, Cockrell admitted at the end that he had tried to cram a lot of information into our hour. Some of the observations and suggestions I found useful, such as meditation and learning not to place judgement on my emotions. Others were a little hokey for my taste, but I can imagine them being useful for somebody.

The experience highlighted for me that choice is one of the biggest luxuries when it comes to mental health care. When you have money, you can easily try out different therapists offering different kinds of treatment to find the right fit: 'walk and talk,' psychoanalysis, cognitive behavioral therapy, whatever. When you're relying on insurance, or Medicaid, you have to take what you can get, if you can get anything at all.

"In New York and San Francisco, you can hardly swing a cat without hitting a psychiatrist, and yet it's very hard to find one that takes insurance," Humphreys said. "The reimbursement rates in insurance for mental health are clearly below what mental health is worth."

Though federal law requires insurers to cover mental health care and value it the same way as physical health, the rates still aren't anywhere near what therapists can make in private practice, Humphreys said. Better enforcement of the law and improved insurance rates could help level the playing field for some of the most vulnerable mental health patients in the country.

Because while hiring a therapist to leisurely stroll through Central Park with you and untangle your ennui may be a luxury, basic mental healthcare should never be.

Luxury Week is a series about our evolving views of what constitutes luxury. Follow along here.

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