Mental Healthcare for Those Who need it Most

Resources can be difficult but not impossible to find for Northern Virginians living at or below the poverty line.

 Pieces of jagged ceramics that was once a porcelain dinner plate that had belonged to her grandmother lay scattered on dining room floor amidst shards of crystal, the remnants of two goblets that were that were a wedding present given to her parents. This scene is aftermath of a rampage in the Falls Church childhood home of Effi, a 28-year-old woman who was diagnosed with both Intermittent Explosive Disorder and Borderline Personality Disorder. Currently unemployed and banned from her parent’s home, she has held nine jobs within the past year. Effi says that was fired from each job because of her angry outbursts, the manifestation of her untreated mental illness. 


“I couldn’t be covered by my dad’s health insurance policy after I turned 26, she said.” I can’t afford to see a doctor or buy my medicines.  When I was covered, I was on Lamictal and Gabapentin and I saw my therapist once a week.”


Those who’ve receive a mental health diagnosis, but don’t have a plan to manage it are left to cope with the symptoms without support. 41-percent of Virginians who needed mental healthcare did not receive it because of cost.  Along with affordability, cultural differences and a mistrust of the healthcare system are among the roadblocks that keep mental health treatment out of the grasp of those who need it most.  


"There are so many barriers to mental health care for marginalized populations," said Stephanie Chalk, PhD, Assistant Professor in the School of Counseling, Marymount University.  "There are often difficulties getting to appointments because of the location or lack or transportation.  If you don't have insurance, it's hard to get quality care and when people are trying as hard as they can to get help, but they can't get it, they develop a sense of hopelessness.”


A dearth of experienced therapists and psychiatrists who offer a sliding scale or accept medical insurance or Medicaid is a hurdle over which insurmountable for some patients.

Time-consuming paperwork required by insurance companies coupled with low reimbursement rates make it difficult for experienced therapists to accept health insurance or offer sliding scales that would lower their rates, which average $215 per session or $11,000 per year in Arlington, Alexandria and Fairfax Counties according to    


“Accepting insurance requires many unpaid hours of paperwork to process claims that makes seeing enough clients and having enough unpaid hours for paperwork extremely challenging, said psychologist Stacie Isenberg, Psy.D . “Costs for practicing are expensive. We need malpractice insurance, licensing fees, association dues, continuing education fees, and if you’re in private practice, there are also corporation fees, office insurance, and rent and overhead. If you accept credit cards so that your clients can manage payments better, the credit card fees are extremely high. Many therapists have student loans that they will be paying for decades.”


 Cultural differences and a mistrust of the healthcare system are among the obstacles to effective care.  “Many people perceive stigma to mental health treatment, prefer help from those who share their language and culture, rely on their religious faith and spiritual counseling, and may not understand how mental health care can help them,” said Jerome Short, Ph.D., Associate Professor of Psychology, George Mason University, who suggests Camp Cope-A-Lot, an online service that teaches parents and children evidence-based cognitive-behavioral therapy skills.

"Often people don't seek treatment because they feel overwhelmed with their lives and don't see a therapist being able to change things for them like bad housing and poor childcare. Some are worried they will be blamed or have a fear of CPS being involved," added therapist Carol Barnaby, LCSW-C. “Often, it is the people who make too much to qualify for benefits who are most in need.  They are too rich for Medicaid and too poor to have insurance that covers therapy. They are the ones who fall through the cracks.”

Sliding Scale and Affordable Mental Health Options in Northern Virginia:

HealthWorks for Northern Virginia

George Mason University Center for Psychological Services

Northern Virginia Family Service

Inova Kellar Center.

The Pediatric Group in Fairfax County

Fairfax Pediatric Associates