When to get help for yourself, and how to find affordable care

When money is tight and everything is changing, your own mental health is easy to put last. If you have been telling yourself you will deal with it once things settle, that is understandable, but you deserve better than to wait. But how you are coping shapes every decision you make, and it shapes how your children get through this. The good news is that effective help is often shorter, more practical and cheaper than people expect, and in some places it is free.

This guide covers when to get help, what effective treatment actually involves, and where to find free and low-cost care in Canada and the US. For choosing a therapist and what to ask in the first session, see our guide to finding a therapist for separation.

When to get professional help

There is no threshold you have to reach. If you are struggling, that is reason enough to talk to someone. But these are clear signals:

• Low or empty mood, hopelessness, or loss of interest in things you used to enjoy, most of the day, nearly every day, for two weeks or more. That is the timeframe the US National Institute of Mental Health (NIMH) uses for depression.
• Sleep, appetite or energy getting worse rather than better.
• Panic attacks, or worry that stops you doing ordinary things.
• Drinking or using more than you used to, or to get through the day.
• Anger or irritability that is spilling onto your children or your work.
• Struggling to care for your children during your parenting time.

Get help today, not next week, if you are having thoughts of suicide or of not wanting to be here, or you are afraid you might harm yourself or someone else. Call or text 9-8-8 in Canada, or call, text or chat 988 in the US, at any time. If anyone is in immediate danger, call 911.

If you are not sure you want treatment yet, that is a choice too. The UK's NICE depression guideline suggests that people who do not want treatment have a further check-in, normally within two to four weeks. A reasonable plan is to see your doctor now and book a follow-up visit in that window, so things do not drift.

For more on specific problems, see our guides to depression, anxiety, panic and sleep and alcohol and coping.

What effective treatment looks like

Knowing what works helps you spend limited money and time well.

• Start with the least intensive option that fits. For milder depression, NICE recommends considering the least intrusive option first, such as guided self-help based on CBT, and does not recommend antidepressants as a routine first step unless that is the person's informed preference.
• Structured talking therapies are first-line. Canada's 2023 CANMAT depression guidelines name cognitive behavioural therapy (CBT), interpersonal therapy (IPT) and behavioural activation as first-line treatments. NICE notes IPT may be especially helpful for depression linked to transitions in relationships, loss or changing roles.
• Format is flexible. CANMAT reports that CBT works in individual, group, telephone and digital formats, which is why many free programs use phone coaching and online courses.
• It is not open-ended. CANMAT gives 12 to 16 sessions as the usual optimal course of a first-line psychotherapy for most people.
• Combined care helps in moderate depression. A 2020 international analysis of 101 trials found therapy plus medication was more effective than either alone, and judged it the best choice for moderate depression. NIMH notes antidepressants usually take 4 to 8 weeks to work; talk to your provider before starting or stopping any medication.
• Exercise is a treatment. CANMAT recommends supervised exercise (30 to 40 minutes, three to four times a week, for at least nine weeks) as a first-line treatment for mild depression.

NIMH puts the bottom line simply: "Most people with depression benefit from mental health treatment."

Start with what you may already have

Your family doctor or nurse practitioner

A doctor can check for physical causes, talk through options, prescribe if needed, and refer you to publicly funded programs. In Ontario, a referral from a health professional is the standard route into the free program below.

An employee assistance program (EAP)

The US Office of Personnel Management describes an EAP as "a voluntary, work-based program that offers free and confidential assessments, short-term counseling, referrals, and follow-up services," including for "stress, grief, family problems, and psychological disorders." That description is of US federal EAPs, but many employers in both countries offer something similar. Benefits vary, so check your HR portal or benefits booklet, or ask HR in confidence.

Workplace health benefits or insurance

Our therapist guide explains how to check which professions your plan covers and up to what amount.

Free and low-cost options in Canada

Ontario

• Ontario Structured Psychotherapy Program. According to the Government of Ontario, "Individuals aged 18 years and older can access the Ontario Structured Psychotherapy Program to get confidential cognitive behavioural therapy and other services free of charge." It is for people with symptoms of depression or anxiety-related concerns. After an assessment, you are matched to self-led resources guided by a coach, group therapy, or individual therapy, in person or virtually. Ontario Health says most people begin with the self-led resources, and that the program is "not suitable for everyone." Referral is usually through a doctor, nurse practitioner or other health professional; in some areas you can refer yourself.
• BounceBack Ontario (Canadian Mental Health Association). A free program for adults and youth aged 15 and over, with trained coaches offering up to six confidential phone sessions plus online tools for low mood, stress, worry, anxiety and depression. It is described as an evidence-based CBT program. bouncebackontario.ca
• ConnexOntario and 211 Ontario. The Ontario government lists ConnexOntario as a free, confidential, 24/7 helpline for mental health, addiction and gambling, and 211 Ontario for information on community, government, social and health services, including mental health.

British Columbia

• BounceBack BC (CMHA BC). "A free skill-building program designed to help adults and youth 13+ manage low mood, mild to moderate depression, anxiety, stress or worry," delivered online or by phone with a coach. bouncebackbc.ca

Quebec

• Info-Social 811. A free, confidential telephone consultation service available 24 hours a day, 365 days a year, for people living in Quebec, including for family or relationship problems.
• Programme québécois pour les troubles mentaux (PQPTM). Quebec's public program offers stepped care "from self-care to psychotherapy," described by the Ministry as universal and free and inspired by England's IAPT talking therapies program. Access usually starts through general social services at your CLSC or your family medicine group (GMF).

Other provinces and territories

Publicly funded programs differ across the country. Your family doctor, nurse practitioner or local community health centre can tell you what exists near you, and the local help box at the end of this guide lists services FairWell has checked for your region. If you have seen Wellness Together Canada mentioned in older articles, note that it is no longer operating.

Free and low-cost options in the US

• SAMHSA National Helpline: 1-800-662-HELP (4357). "A free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish)." It does not provide counselling itself. If you have no insurance or are underinsured, it can refer you to your state office for state-funded treatment, and often to facilities that charge on a sliding fee scale or accept Medicare or Medicaid. TTY: 1-800-487-4889.
• FindTreatment.gov. SAMHSA's "confidential and anonymous resource for persons seeking treatment for mental and substance use disorders" in the US and its territories. findtreatment.gov
• SAMHSA's Find Help page links to Medicaid and CHIP information by state, guidance if you don't have insurance, and a "Find Free or Low-Cost Treatment" section. samhsa.gov/find-help
• 211. A confidential service run by United Way that connects you to local help, including with bills, food and housing, which often sit underneath the stress. 211.org
• NIAAA Alcohol Treatment Navigator, if drinking is part of the picture. It is free, has no commercial sponsors, and notes that "The most expensive option isn't always the best." alcoholtreatment.niaaa.nih.gov
• 988 is not only for suicidal crisis. The Lifeline says it is for "mental health struggles, emotional distress, alcohol or drug use concerns, or just need someone to talk to."

Options in both countries

• Open Path Psychotherapy Collective. A nonprofit network of therapists offering sliding-scale sessions to people without insurance or whose insurance does not cover enough. You pay a one-time membership fee, with no recurring fees. At time of writing, its site listed individual sessions at $40 to $70 USD in the US or $50 to $90 CAD in Canada, and a membership fee of $65 USD or $89 CAD. Fees can change, so check the site before you sign up. openpathcollective.org
• HeadsUpGuys (University of British Columbia) offers free self-checks and an international therapist directory, designed for men. headsupguys.org
• Sliding-scale fees. Some private therapists and community agencies reduce fees for people on lower incomes. It is always worth asking.
• The FairWell directory lists verified therapists by region, including those who work with separation.

Where to start: a quick guide

What to say when you call

You do not need to explain everything. A short, honest summary gets you to the right place faster.

Making limited sessions count

• Before the first session, write down the two or three things you most want to change.
• Ask what approach the therapist uses and how you will both know whether it is working.
• Do the work between sessions. Structured therapies rely on it, and it stretches a short course much further.
• Use free tools while you wait: guided self-help, a regular exercise routine, and the crisis lines if things get worse.
• If something is not helping after several sessions, say so. A good therapist will adjust or refer you on.

Help for you helps your children

Studies of mothers treated for depression with medication (a US study published in 2006) and with talking therapy (a 2015 review of nine trials) found that when the parent's depression improved, children's symptoms tended to improve too. Most of this research involved mothers, but there is no reason to think a father's recovery matters less. If you share parenting with the other parent, keep in mind that joint sessions or shared counselling may not be appropriate in every family.

If there has been family violence, shared communication, joint arrangements and face-to-face handovers may not be safe. Your safety and your children's safety come first. See our guide to safety planning during separation. Press Shift+Esc to leave this site quickly.

If you are worried about your child as well, our guide to signs your child is struggling explains when to seek an assessment, and the local help box below includes children's services where we have them.

Sources

1. National Institute of Mental Health. Depression. Undated publication page. https://www.nimh.nih.gov/health/publications/depression
2. National Institute for Health and Care Excellence. Depression in adults: treatment and management (NG222). 2022. https://www.nice.org.uk/guidance/ng222/chapter/Recommendations
3. Lam RW, Kennedy SH, Adams C, et al. CANMAT 2023 Update on Clinical Guidelines for Management of Major Depressive Disorder in Adults. Canadian Journal of Psychiatry. 2024. https://doi.org/10.1177/07067437241245384
4. Cuijpers P, Noma H, Karyotaki E, et al. A network meta-analysis of the effects of psychotherapies, pharmacotherapies and their combination in the treatment of adult depression. World Psychiatry. 2020. https://doi.org/10.1002/wps.20701
5. Government of Ontario. Mental health services. Updated 2026. https://www.ontario.ca/page/mental-health-services
6. Ontario Health. Ontario Structured Psychotherapy Program. Undated. https://www.ontariohealth.ca/clinical/mental-health-addictions/structured-psychotherapy
7. Canadian Mental Health Association. BounceBack Ontario. Undated. https://bouncebackontario.ca/
8. Canadian Mental Health Association, BC Division. BounceBack BC. Undated. https://bouncebackbc.ca/
9. Gouvernement du Québec. Info-Social 811. Undated. https://www.quebec.ca/en/health/finding-a-resource/info-social-811
10. Ministère de la Santé et des Services sociaux du Québec. Programme québécois pour les troubles mentaux : des autosoins à la psychothérapie. 2020. https://www.msss.gouv.qc.ca/professionnels/sante-mentale/programme-quebecois-pour-les-troubles-mentaux/
11. Substance Abuse and Mental Health Services Administration. National Helpline. Undated. https://www.samhsa.gov/find-help/helplines/national-helpline
12. Substance Abuse and Mental Health Services Administration. FindTreatment.gov and Find Help. Undated. https://findtreatment.gov/; https://www.samhsa.gov/find-help
13. US Office of Personnel Management. What is an Employee Assistance Program (EAP)? Undated. https://www.opm.gov/frequently-asked-questions/work-life-faq/employee-assistance-program-eap/what-is-an-employee-assistance-program-eap/
14. Open Path Psychotherapy Collective. Undated. https://openpathcollective.org/
15. United Way. 211. Undated. https://www.211.org/
16. National Institute on Alcohol Abuse and Alcoholism. Alcohol Treatment Navigator. Undated. https://alcoholtreatment.niaaa.nih.gov/
17. HeadsUpGuys (University of British Columbia). Undated. https://headsupguys.org/
18. 988 Suicide and Crisis Lifeline. Undated. https://988lifeline.org/; 9-8-8 Suicide Crisis Helpline. https://988.ca/
19. Weissman MM, Pilowsky DJ, Wickramaratne PJ, et al. Remissions in maternal depression and child psychopathology: a STAR*D-child report. JAMA. 2006. https://doi.org/10.1001/jama.295.12.1389
20. Cuijpers P, Weitz E, Karyotaki E, Garber J, Andersson G. The effects of psychological treatment of maternal depression on children and parental functioning: a meta-analysis. European Child and Adolescent Psychiatry. 2015. https://doi.org/10.1007/s00787-014-0660-6

This guide is general information for parents, not medical, psychological or legal advice. It draws on published research and guidance from recognised health and family justice bodies, listed under Sources. Every child and family is different. If you are worried about your child or yourself, talk to your family doctor or a qualified professional. FairWell can help you find one through the professional directory.