As a private psychotherapist, Paul Fugelsang understands the struggle between saying “yes” to middle-class clients who can't afford his services and “no” to people in need.
“Once you have your minimum amount that you can afford to see financially, you have to start turning people away,” the Asheville-based therapist shares. “It's heartbreaking, because these are people who have taken the time to pick up the phone and ask for help.”
To meet both of these challenges, Fugelsang recently launched a national nonprofit, the Open Path Psychotherapy Collective. Its mission is to make it easier for people to find the counseling they need at a price they can afford, and to reward and encourage counselors to say “yes” to a group Fugelsang says is “falling through the cracks.”
“The whole idea of this program is to reach people who are typically middle-class individuals — people who are making too much money to qualify for city or county services, but … who aren't making enough money [to] pay $100 per week for psychotherapy. It's really out of reach for so many,” he says.
According to results from a telephone survey conducted last year by the regional collaborative WNC Healthy Impact, cost or lack of health insurance proved to be the No. 1 deterrent preventing people from seeking mental health care when needed.
To bridge this gap, Fugelsang issues a challenge to therapists who join Open Path: Take on one client who can receive in-office care at the reduced cost of $30 to $50 per session. At press time, Fugelsang reports, 160 therapists nationwide have applied.
Starting local, thinking national
Fugelsang’s eighth-floor office in the Flat Iron building overlooks downtown Asheville, but the mountains can still be seen in the distance. Though he's only been practicing privately in Asheville for a year, he explains that his vision for the nonprofit follows a five-year plan. In the first year, the nonprofit will target about 150 cities, starting with Asheville, he says.
“The way we chose the cities was that they had to be a city with a strong middle class, be pro-therapy, which usually translates into a more progressive population, and have a very relatively high therapist-per-capita ratio,” Fugelsang says.
Of the 160 therapists nationwide who have applied to join the collective, 24 of them, like counselor Meghan Doubraski, are from Asheville. Fugelsang told her about his idea for the collective one day over lunch, after they completed a training session. After hearing his pitch, she was certain about joining the network.
“Since I've been in practice, it seemed to me that it's only gotten more challenging for people to have access to not only affordable mental health care but to quality, affordable mental health care,” she says, noting she has been practicing for seven years.
By word of mouth, publishing notes and creating groups on LinkedIn, a popular online network for business professionals, Fugelsang reached out to local therapists. Along with the chance to broaden the new nonprofit’s funding opportunities, he envisioned Open Path going national rather than staying local for two reasons: “You can't cast a wide net with a brick-and-mortar community center or mental health center. And, here,” he says as he pulls up the collective's website, “people can search online.”
A virtual reception
One of the first steps to improving access to mental health providers for the middle class, Fugelsang suggests, starts with a click. With the growth, popularity and omnipresence of the Internet, he explains, “We can create a place where the website is the reception room” that welcomes people and directs them to a clinician.
Before filling out an application and paying a one-time $100 fee, participants can search the website for Open Path providers in their area. Profiles indicate therapists’ area of expertise, how long they’ve been in practice, where their office is and, most importantly, whether they are currently accepting Open Path clients. This information, Fugelsang explains, is crucial.
“What happens for many clients is they need to call around, and ask therapists if they can see them for a certain fee. As you might imagine, it's a very vulnerable thing to have to do,” he says. Open Path “eliminates that problem for people because the rate is more or less established and they know that the therapist will work within that rate. It takes away the tricky financial part,” he says.
As for the $100 fee, Fugelsang reports some push-back. He emphasizes that it supports both the nonprofit itself and clients who cannot afford the upfront costs. “Every single penny we get donated to us goes toward that $100 fee because it's important for us to make our services as available as possible.”
And Fugelsang wanted to create a network that would give consumers a user-friendly website for finding professional therapists, he explains. For example, each Open Path therapist must answer four questions and have proof of both a clinician's license and liability insurance.
In addition to helping clients find a therapist to fit their needs, this network was created to reward providers who offer their services at a reduced rate, Fugelsang says. “One thing we wanted to do with this was to not only help people who can't afford quality therapy, but we also wanted to assist private-practice therapists in their businesses,” he explains. “We wanted to give these clinicians a sense of community in doing this work, and two, to reward them for their benevolence.”
A network of altruism
However, Fugelsang says the true reward comes from the relationships built between client and counselor. As Doubraski notes, the reason she joined the collective was because of her desire to help others. “When people do this work with passion and aren't just going through the motions, the idea of people falling through the cracks is really tough to swallow when you also have clients that come in and have the ability to come as often as they need to and you see real, long-lasting change. To think of people wanting that change and not being able to do that to improve their lives is frustrating and heartbreaking.”
Seeing a price tag dissuade people from getting help, Fugelson says, remains the biggest challenge. However, he hopes that Open Path will create an avenue to well-being that may not have been available otherwise. The results, he shares, can be life-changing.
“In therapy, people get the opportunity to get to know their own minds. They don't have to be in crisis to be in therapy. [It’s] for people who are in a survival place in life, but it's also for people who are in a growth phase of life,” he says.
For more information about the Open Path Psychotherapy Collective contact Paul Fugelsang at email@example.com, or visit openpathcollective.org.
— Send your health-and-wellness news and tips to Caitlin Byrd at firstname.lastname@example.org or email@example.com, or call 251-1333, ext. 140.