Mental health support — where to turn

Moving to a new country can bring excitement, opportunity, and significant stress. You might be dealing with language barriers, cultural adjustment, being far from family, or visa uncertainty—all of which can affect your mental health. The good news is that the United States has accessible pathways to mental health support, whether you have insurance, are uninsured, or are somewhere in between.

Crisis support: 988 anytime, anywhere

If you are in a mental health crisis or having thoughts of suicide, or if you just need someone to talk to right now, the 988 Suicide & Crisis Lifeline is available 24 hours a day, 7 days a week, 365 days a year. You can call 988, text 988, or start an online chat. The service is completely free and confidential—you do not need insurance, and no one will ask for your immigration status.

If you are not alone in your struggle, 988 also welcomes people calling or texting on behalf of someone else they are worried about. You do not need to be suicidal to use 988. Counselors at the other end are trained to listen and help with depression, anxiety, substance use concerns, loneliness, relationship problems, or any emotional distress.

Language and specialized support

• Spanish: Call 988 and press 2, or text AYUDA to 988
• Interpreting services: More than 240 languages are available for phone calls
• Veterans: Call 988 and press 1
• American Sign Language (ASL): Use a videophone to call 988

Mental health coverage through insurance

If you have health insurance, you are legally entitled to mental health coverage. Under the Affordable Care Act (ACA), mental health and substance use disorder treatment are 'essential health benefits' that every Marketplace plan must cover. This applies to individual plans, family plans, and small-group plans sold through Healthcare.gov or your state's health insurance marketplace.

What is covered

Your health plan must cover behavioral health treatment, including therapy and counseling with a psychologist, therapist, or social worker. Inpatient psychiatric care, medication management, and substance use disorder treatment are also required. Additionally, depression and anxiety screenings are covered at no cost to you. These protections apply whether your plan is on the Marketplace or through your employer.

Finding a therapist in your network

Your mental health coverage depends on your specific plan, including your monthly premium, deductible, copay, and which providers are in your insurance network. To find therapists covered by your plan, start by calling the phone number on the back of your insurance card and ask for a list of mental health providers in your area. You can also ask whether you need a referral from your primary care doctor, and whether prior authorization (advance approval from your insurer) is required for therapy.

Online directories can help you search for in-network providers. Psychology Today, GoodTherapy, and Zocdoc allow you to filter by location, insurance accepted, languages spoken, and the type of therapy offered. When contacting a provider, ask how they handle international credentials, whether they have experience working with immigrants, and what your out-of-pocket costs will be.

Employer-sponsored plans and Employee Assistance Programs

If your employer provides health insurance, mental health coverage is required and must be offered on equal terms with physical health care. Many employers also offer an Employee Assistance Program (EAP), which is a separate benefit that provides free, confidential counseling sessions—often three to five sessions per year—for employees and sometimes their families. Your HR department can tell you whether your workplace has an EAP and how to sign up. Unlike your health insurance, EAP services typically have no deductible or copay.

Affordable care if you are uninsured or underinsured

Not having health insurance should not prevent you from getting mental health support. Community Health Centers (also called Federally Qualified Health Centers, or FQHCs) operate across the United States and are required by federal law to offer mental health counseling, psychiatric care, and substance use disorder treatment. These services are offered on a sliding fee scale, meaning you pay based on your income. If your income is very low, services may be free or nearly free.

How sliding scale works

A sliding fee scale is simple: the cost of your counseling or therapy sessions rises or falls depending on what you earn. If you have little or no income, you may pay nothing. If you have moderate income, you might pay ten to twenty dollars per session. The center's financial counselor will help you determine your rate based on your household income. You do not need insurance, a Social Security Number, or proof of immigration status to use a community health center.

Community Health Centers offer a range of mental health services: screening and assessment, individual and group therapy, psychiatric evaluation and medication management, crisis counseling, and treatment for substance use issues. Many centers are located in underserved neighborhoods and rural areas, and many offer telehealth (online) appointments, which can be helpful if transportation is difficult.

Finding a community health center near you

To locate a community health center, you can search online by your zip code on the Health Resources and Services Administration (HRSA) health center locator, or call the SAMHSA National Helpline at 1-800-662-4357 (available in English and Spanish) to ask about mental health services in your area. In some states, you can also dial 211 to reach a local helpline that connects you to mental health resources and other social services.

Private therapists on sliding scale

Some independent therapists and counselors also offer sliding scale fees to uninsured or underinsured clients. About four in five mental health facilities in the U.S. offer some form of payment assistance. When searching for a therapist online, many directory sites allow you to filter by cost or payment arrangements. You can also directly ask a therapist whether they work on a sliding scale—many set aside a certain number of low-cost or free slots for clients who cannot afford their regular fee.

Telehealth and online therapy

Telehealth—mental health care delivered by video, phone, or text—has grown significantly in recent years and can be a good option if you have transportation challenges, live in a remote area, or prefer to connect with a provider from home. Telehealth sessions can include one-on-one therapy, group therapy, psychiatric medication management, and addiction counseling. You can receive telehealth through your insurance, through a community health center, through a private therapist, or through specialized telehealth platforms.

If you are insured, check whether your plan covers telehealth mental health visits. If you are uninsured or underinsured, some communities have nonprofit and educational programs offering low-cost or free telehealth therapy. Ask your local community health center whether they offer virtual appointments, or search online for programs specific to immigrants and refugees in your area.

Navigating the health system as an immigrant

As an immigrant or international person in the U.S., you may face unique barriers to mental health care: language differences, cultural beliefs about mental illness, distrust of institutions, concerns about immigration enforcement, or lack of awareness of what services exist. It is okay to take time finding a provider who understands your background and respects your culture. A good mental health provider will ask about your experience and adapt care to fit your needs.

Some organizations specifically serve immigrants, refugees, and international students. When looking for help, search for culturally responsive services or ask your community center, school, or employer whether they have partnerships with mental health providers experienced in working with immigrant communities.

Kinds of mental health professionals

In the U.S., mental health care comes from different types of licensed professionals, and it is helpful to know the difference when seeking care:

• Psychiatrist: A medical doctor licensed to diagnose mental health problems, provide therapy, and prescribe medication.
• Psychologist: Trained in psychology and licensed to diagnose and treat mental health conditions and provide therapy. Most cannot prescribe medication in the U.S., though they may work with a psychiatrist who can.
• Licensed Therapist or Counselor: Licensed to provide therapy and counseling. This includes social workers, licensed professional counselors (LPCs), and licensed mental health counselors (LMHCs).
• Primary Care Provider: Your regular doctor can do mental health screening, provide basic counseling, prescribe some psychiatric medications, and refer you to a specialist.

Getting started: practical next steps

1. If you are in crisis: Call or text 988 right now.
2. If you have insurance: Call the number on the back of your insurance card and ask for mental health provider referrals. Check what your copay and deductible are.
3. If you have an employer: Ask your HR department whether your workplace offers an Employee Assistance Program.
4. If you are uninsured: Search for a community health center near you using the HRSA locator, or call your state's 211 line or the SAMHSA helpline (1-800-662-4357).
5. If you speak another language: Ask the center or provider directly whether they have interpreters available.
6. If you are unsure where to start: Call 988 to talk with a counselor who can help connect you to local resources.

Your mental health matters. Whether you are struggling with homesickness, the stress of immigration processes, cultural adjustment, work pressure, family separation, or any other challenge, reaching out for help is a sign of strength, not weakness. The U.S. has resources available to you regardless of your insurance status, immigration status, or English fluency. Take the first step today.