Online Therapy: The Complete 2026 Guide (Cost, Insurance, Platforms)

Online therapy is psychotherapy delivered by a licensed mental-health professional over the internet instead of in an office - by live video, by phone, by live text chat, or by asynchronous messaging that you and your therapist exchange over days. The clinical work is the same work: a trained clinician helps you understand patterns in your thinking, emotions, relationships and behaviour, and teaches evidence-based techniques for changing them. What changes is the room. Instead of a couch and a commute, the session happens wherever you have a connection and some privacy.

The terms you will see used for the same thing include teletherapy, telehealth counseling, e-therapy, virtual therapy, telemental health, and online counseling. In the United States, all of them describe care that must be delivered by someone licensed in the state where you are physically located during the session - a point this guide returns to, because it decides who you can legally see.

It helps to be precise about what online therapy is not:

• It is not a meditation or wellness app. Guided meditation, sleep stories and mood trackers can be genuinely useful, but they are self-guided tools, not treatment by a clinician. headspace, the best-known example, is a mindfulness app first; it runs a separate therapy service with licensed clinicians, and this guide treats the two as different products because they are.
• It is not an AI chatbot. A conversational program can offer coping prompts, but it cannot diagnose, cannot be licensed, and cannot carry clinical responsibility for you. Every platform covered here connects you to a human professional.
• It is not crisis care. Online therapy is built for ongoing, scheduled support. If you are in danger right now, the right resource in the US is the 988 Suicide & Crisis Lifeline - call or text 988, free, 24 hours a day - or 911 in an immediate emergency. Platforms say this themselves, in their terms and in their intake flows.
• It is not automatically psychiatry. Most online therapy is talk therapy. Medication requires a prescriber - a psychiatrist, psychiatric nurse practitioner or physician - and only some platforms offer that alongside therapy. Talkspace does; betterhelp does not; headspace's therapy service does not prescribe.

Who delivers online therapy?

The same professionals who deliver it in person. Depending on the platform and your state, your therapist may be a licensed clinical psychologist (PhD or PsyD), a licensed clinical social worker (LCSW), a licensed professional counselor (LPC or LPCC), a licensed marriage and family therapist (LMFT), or a licensed mental-health counselor (LMHC). The credential letters differ by state, but every one of them means a graduate degree, supervised clinical hours, a licensing exam, and an active license that a state board can discipline or revoke. Platforms verify these before a clinician can see clients, and you can verify them yourself through the state board's public lookup - something this guide recommends doing once, early, so you never wonder.

How is online therapy different from in-person therapy?

Clinically, less than most people expect. The techniques, the therapeutic relationship and the goals are the same. Practically, the differences are real and worth naming:

Our separate online vs in-person comparison goes deeper on when each wins. The short version: the format matters less than whether you will actually keep attending.

From signup to your first session, online therapy follows the same arc on every major platform: a questionnaire, a match with a licensed therapist, scheduling, and then an ongoing rhythm of sessions and messaging. Here is what each step actually involves, so nothing surprises you.

Step 1: The intake questionnaire

You answer a structured set of questions - usually ten to twenty minutes - about what brings you to therapy, how you have been feeling, any previous therapy or medication, your preferences for a therapist (gender, age range, faith background, specialties, language), your availability, and your location. The location question is not marketing: it determines which clinicians are legally allowed to treat you. Some questionnaires include brief screening instruments for depression and anxiety; answer them honestly, because they shape the match and give your therapist a baseline.

Step 2: Matching

Platforms match you with a therapist based on your answers, their specialties, and licensing in your state. On betterhelp, the largest network, matching happens in as little as two days; some platforms let you browse and pick from a short list instead. The match is a starting point, not a verdict. Every platform in our coverage lets you switch therapists, and the community feedback we track says the second match is often the one that sticks. Treat switching as normal, not as failure.

Step 3: Choosing a format and schedule

You pick how you want to meet. Live video is closest to a traditional session. Phone suits people who find video draining or whose home lacks a private corner with good light. Live chat is typed conversation in real time. Messaging is asynchronous: you write when you want, and your therapist responds within their stated window, typically on a set number of days per week. Most platforms let you mix formats, and most people settle into a weekly live session plus messaging in between.

Step 4: The first session

The first session is an extended conversation about your history, your goals, and how you prefer to work. Expect your therapist to ask about your current symptoms, sleep, relationships, work, substance use, past treatment, and safety. Expect to talk about confidentiality and its limits, and about what happens in a crisis. You are also interviewing them: ask about their experience with your concern, the approach they use, and how they will measure progress. If something feels off, that is information. Our guide to online therapy for beginners walks through this session in detail.

Step 5: The ongoing rhythm

Therapy works through repetition. Weekly sessions are the standard starting cadence; some people move to every other week as they stabilize. Between sessions, messaging lets you capture a thought while it is fresh or ask a quick question. Many therapists assign practice between sessions - a thought record, an exposure exercise, a conversation to attempt. Doing that work is where most of the change happens.

Step 6: Reviewing progress, switching, or finishing

Good therapy has checkpoints. Around session four to six, you and your therapist should be able to say what is better, what is not, and whether the approach fits. If it does not, switch. When your goals are met, you taper or stop, usually with a plan for what to do if things slip. Subscriptions can be paused or cancelled; read the terms before you start, because cancellation and refund rules are the most common source of complaints at every subscription company.

What you need on your side

• A device with a camera and microphone for video, or any phone for audio.
• A stable connection - video needs more bandwidth than you think; a wired or strong Wi-Fi link avoids the frozen-face problem.
• A private space for the session. A parked car, a closed office, a walk with earbuds for phone sessions - people get creative, and therapists have seen it all.
• Headphones, which keep your therapist's voice private and reduce echo.
• Something to write with. Noting one takeaway per session compounds.

For the most common reasons people seek therapy - anxiety, depression, stress, relationship difficulties and adjustment to life changes - therapy delivered by video or phone is widely accepted as an effective way to receive evidence-based psychotherapy, and the professional bodies that set standards in the field treat telehealth as a legitimate mode of care rather than a lesser substitute. The American Psychological Association describes psychotherapy as an effective treatment across a wide range of concerns and publishes guidance on practicing it via telehealth; the National Institute of Mental Health lists psychotherapies, including cognitive behavioral therapy, among established treatments for depression and anxiety disorders. Both are linked in the sources at the end of this guide.

Three honest qualifications belong next to that answer.

1. The active ingredient is the therapy, not the screen

What makes therapy work is a structured, evidence-based approach delivered by a competent clinician inside a trusting relationship, applied consistently over time. Video and phone carry all of that. What they do not change is the need for the ingredients themselves. A poorly matched therapist or a vague, unstructured approach will not work better online than it would in a room, and a good one will not work worse.

2. Consistency beats format

The single strongest predictor of benefit that you control is attendance. People who show up weekly, do the between-session work, and stick with a therapist long enough to build trust tend to improve; people who attend sporadically tend not to, whatever the format. Online therapy's real advantage is that it removes the reasons people stop: the commute, the scheduling fight, the waitlist. If the office version is the one you would skip, the online version is the one that works.

3. Some situations call for in-person or higher-intensity care

Online therapy is best matched to mild-to-moderate concerns. Severe or complex presentations - active psychosis, severe eating disorders, acute suicidality, some trauma presentations, situations where a clinician needs to observe you physically or coordinate closely with a medical team - may need in-person care, intensive outpatient programs, or hospitalization. A good online therapist will tell you this and help you find the right level of care. Our guide to the evidence on online therapy covers what the research does and does not show in more depth.

What about messaging-only therapy?

Asynchronous messaging is the newest format and the one with the least consensus. It suits people who process in writing, who want to reach their therapist between live sessions, or whose schedule makes live sessions hard. It is less suited as a sole format for people who need real-time dialogue, who struggle to express themselves in text, or whose concerns are more acute. Most clinicians, and most of the community feedback we track, treat messaging as a strong complement to live sessions rather than a replacement. If you choose a messaging-first plan, know your therapist's response schedule in advance so silence is never a surprise.

Online therapy fits most adults with mild-to-moderate mental-health concerns who want flexible, consistent access to a licensed therapist. It is a poor fit for emergencies, for severe or unstable conditions, and for anyone who cannot secure a private space to talk. The checklist below is the one we would run before signing up.

Online therapy is a strong fit if you:

• Are dealing with anxiety, low mood, stress, burnout, grief, relationship strain, a life transition, or a long-standing pattern you want to change.
• Live somewhere with few therapists, long waitlists, or none who match your needs or identity.
• Have a schedule - shift work, caregiving, travel, a new baby - that makes a fixed weekly office slot unrealistic.
• Find it easier to open up from your own space, or want the option of phone or messaging on hard days.
• Want a wider choice of therapist than your zip code offers: a specialist in your concern, a therapist who shares your language, faith or background.
• Have insurance that covers an online platform, or an employer benefit that includes one.

Look at other options first if you:

• Are in crisis. Call or text 988 in the US, or 911 in immediate danger. Online therapy platforms are explicit that they are not emergency services.
• Have a severe or unstable condition that needs close monitoring, physical examination, or coordination between therapist, prescriber and medical team.
• Need a court-ordered evaluation, a formal diagnostic assessment for disability or legal purposes, or testing for conditions like ADHD or autism. These usually require specialized in-person assessment; many platforms do not provide them.
• Cannot get privacy. Therapy where someone might overhear is therapy where you hold back. If home is not private, consider phone sessions from a car or a walk, or an in-person option.
• Are under 18. Age policies differ by platform and by state law on minors' consent to treatment. Check the policy before signing up, and expect a parent or guardian to be involved.
• Need medication and the platform does not prescribe. Choose a platform with psychiatry on board, or plan for a separate prescriber from the start. The therapist-vs-psychiatrist section below explains how to decide.

A note on couples and families

Couples and family therapy work online, with two caveats. Everyone needs to be in a place where they can speak freely - which sometimes means separate rooms on separate devices. And not every platform offers it: Talkspace has a dedicated couples plan at $109 per week; betterhelp focuses on individual therapy, so check each platform's couples options before signing up. Our guides to online family therapy and online couples therapy cover what to expect.

Online therapy in the US is priced in one of three ways: a weekly or monthly subscription paid out of pocket, a per-session fee, or an insurance copay when a platform is in your network. Of the platforms we cover, Talkspace publishes its self-pay prices openly - $69 to $109 per week for therapy, billed as a subscription - and insured members typically pay a copay between $0 and $30 per session. We publish a price only after verifying it, so this section quotes exactly what has been verified and says plainly where a number is still missing.

Verified prices: Talkspace (checked October 2026)

Weekly subscription prices are usually billed monthly, so a $99-per-week plan is roughly $396 to $436 a month depending on the number of weeks billed. Our dedicated Talkspace pricing guide breaks each tier down and explains how insurance changes the math.

betterhelp and headspace: what we can and cannot say

betterhelp prices its subscription within a range that varies by location, therapist availability and preferences, and it quotes you a figure at signup after a short questionnaire. It also offers a financial-aid questionnaire that can reduce the price for people on lower incomes, and, since it began accepting insurance, copays cited from around $23 per session for covered members. We have not independently verified the current self-pay range at the time of writing, so we do not print one; betterhelp shows yours before you pay anything. headspace's meditation app and its therapy service are billed separately; the app is a consumer subscription that is HSA/FSA eligible, and the therapy service is billed through insurance where covered. We are in the process of verifying headspace's current app prices and will publish them when we have them. Our betterhelp cost guide and headspace cost guide explain each company's pricing structure and what to check at signup.

The six levers that decide what you actually pay

1. Insurance coverage. The biggest lever by far. A covered platform at copay rates is cheaper than almost any self-pay deal. Check it first, every time.
2. Employer benefits and EAPs. Many employee assistance programs include a block of free therapy sessions per issue per year, and some employers include headspace or a therapy platform in their benefits. Ask HR before you pay anyone.
3. Plan tier and format. Messaging-only plans cost less than plans with live video. If you mainly want live sessions, compare the per-session math, not the headline price.
4. Financial aid and sliding scales. betterhelp's questionnaire can lower its subscription; many independent therapists offer sliding-scale fees based on income.
5. HSA and FSA funds. Therapy and, where offered, app subscriptions can be eligible pre-tax expenses. Check your plan's rules.
6. Out-of-network reimbursement. If your plan has out-of-network benefits, a superbill - an itemized receipt any licensed provider can produce - lets you claim back part of a self-pay fee after meeting your deductible.

Our online therapy cost guide and best-value platforms comparison apply these levers to each platform.

Yes, increasingly. Talkspace is in-network with many major insurers - including Aetna, Cigna, Optum, Anthem plans, Medicare and TRICARE - and with many employer assistance programs, with copays that typically land between $0 and $30. betterhelp, long the holdout, now accepts insurance too, with copays cited from around $23 per session. headspace's therapy service accepts insurance with a coverage check on its site. Coverage still depends on your specific plan, your state and the clinician's licensing, so the eligibility check each platform offers is the only answer that applies to you.

How insurance billing for online therapy works

When a platform is in-network, each session is billed to your insurer like a medical visit. You pay your copay or, if you have a deductible that applies to mental-health visits, the contracted rate until the deductible is met. Under federal mental-health parity rules, insurers that cover mental-health care must generally apply terms no more restrictive than those for medical care, which is why many plans now cover therapy at a straightforward copay. Telehealth visits are typically covered on the same basis as in-person visits, though a few plans still distinguish them. Ask your insurer three questions: Is this platform in-network? Does my plan cover telehealth therapy at the same cost as in-person? Is there a visit limit or a prior-authorization requirement?

Platform by platform

Medicare, Medicaid and TRICARE

Talkspace lists Medicare and TRICARE among the plans it works with, which matters for people over 65, people with disabilities and military families, who have historically had the fewest online options. Medicaid coverage is state-specific and platform-specific; if you have Medicaid, run the eligibility check and, if the platform is not covered, look at community mental-health centers in your state, which are built to serve Medicaid members. Our insurance-friendly platforms comparison and Talkspace insurance guide go plan by plan, and our complete guide to insurance and online therapy covers copays, deductibles, Medicare, Medicaid, EAPs and superbills in depth.

If nothing is covered

You still have options, in roughly this order: your employer's EAP (free sessions), out-of-network reimbursement via a superbill, betterhelp's financial-aid questionnaire, a messaging-only plan at the lower tier, and the genuinely low-cost routes in the next section. And remember that insurance-billed care creates a claims record with your insurer; that is a normal part of healthcare, but it is one reason some people choose to self-pay for therapy specifically. The privacy section below explains the trade-off.

Genuinely free online therapy exists in a few specific forms: employer assistance programs that include a set number of sessions, the 988 Lifeline and SAMHSA helplines for crisis and referral support, community mental-health centers and university training clinics, and insurance plans with a $0 copay. "Free trial" offers from subscription platforms are rarer than the search results suggest. Here is the map, from most to least likely to cost you nothing.

1. Employer assistance programs (EAPs)

If you are employed by a medium or large company, there is a good chance your benefits include an EAP: a confidential service that typically provides a handful of free counseling sessions per issue per year, often by phone or video, plus referrals for ongoing care. Many people never use it because they do not know it exists. Call the number on your benefits card or ask HR; using it does not get reported to your manager.

2. Crisis and referral lines

The 988 Suicide & Crisis Lifeline - call or text 988 in the US, free, 24/7 - connects you to a trained counselor immediately. It launched in July 2022 as the three-digit successor to the National Suicide Prevention Lifeline and handles emotional distress broadly, not only suicidal crisis. The SAMHSA National Helpline (1-800-662-4357) is a free, confidential, 24/7 treatment referral and information service for mental-health and substance-use concerns. Neither is ongoing therapy, but both are free, immediate, and staffed by people trained to help you find the next step.

3. Community mental-health centers and training clinics

Community mental-health centers offer therapy on sliding scales tied to income, often including telehealth, and are built to serve people on Medicaid or without insurance. University training clinics - attached to graduate programs in psychology, counseling and social work - offer low-cost therapy delivered by supervised trainees, frequently including video sessions. The clinicians are not yet licensed, but they are closely supervised by licensed faculty, and the care is often excellent and current with the research.

4. Insurance with a $0 copay

If your plan covers Talkspace or another in-network platform at a $0 copay, that is free therapy in every sense that matters. Talkspace publishes $0 for many members; run the check.

5. Financial aid and sliding scales

betterhelp's financial-aid questionnaire reduces its subscription for people on lower incomes; it is a discount, not free care, but it can be a substantial one. Independent therapists frequently offer sliding-scale slots; directories let you filter for them.

6. What about free trials?

Therapy platforms rarely offer free trials of live sessions, because a licensed clinician's time is the product. Meditation apps commonly do: headspace offers free content and trial access to its app, which is a reasonable way to decide whether a daily practice suits you before paying. Do not confuse a free app trial with free therapy.

Our free online therapy comparison and free and low-cost options guide walk through each route with the questions to ask.

Our ranking places betterhelp first for subscription talk therapy, Talkspace second as the strongest choice for anyone with insurance or who may need medication, and headspace third as a daily mindfulness practice with a separate therapy service - three genuinely different products that happen to share a search result. The table below shows what we verified for each, including the Trustpilot scores exactly as captured from the live profiles in August 2026.

A word on those ratings. Aggregate customer scores at telehealth and subscription companies are driven at least as much by billing, cancellation and support experiences as by clinical care, so read them as a customer-experience signal and read recent reviews for the current picture. We show them unchanged, including headspace's strikingly low score, because an honest comparison is the point. Our ranking methodology explains how we weigh each factor, and our full reviews cover each platform in depth.

betterhelp is the largest online therapy platform, built around a subscription that includes a weekly live session - by video, phone or chat - plus unlimited messaging with a licensed therapist, with matching in as little as two days and free therapist switching. It is the default choice for subscription talk therapy for a reason, and it has real trade-offs that most reviews skip.

Verified facts

• 31,739 therapists on the network, every one licensed, accredited and in good standing in their state.
• Matching in as little as 2 days; switch therapists at any time at no cost.
• Live sessions by video, phone or chat, with messaging between sessions included.
• Insurance now accepted, with copays cited from around $23 per session for covered members; a financial-aid questionnaire can reduce the self-pay subscription.
• Over 6.6 million people helped, by the company's own count.
• Trustpilot: 3.9 across 9,652 reviews - solid but mixed on the category's largest review base. Praise centers on accessibility and therapist quality; complaints cluster around fit and billing.

The trade-offs

No psychiatry. betterhelp is talk therapy only. If medication may be part of your care, you will need a separate prescriber, and coordinating two providers is the most common friction point in online care. Privacy history. In 2023 betterhelp settled with the US Federal Trade Commission over its past sharing of user data with advertising platforms. The practices at issue predate the settlement and the company changed them, but it is a fact worth knowing before you choose, and our betterhelp review covers it rather than burying it. Subscription mechanics. You are billed for the subscription whether or not you use every session; read the cancellation terms. Fit takes a try or two. The community feedback we track says the first match is not always the right one - switching is painless, so use it.

Who it is best for

People who want talk therapy started quickly, who value the most live-session flexibility, and who want the largest pool to match from. Our guides answer the questions people search most: is betterhelp legit, does betterhelp take insurance, and betterhelp alternatives.

Talkspace is the platform to look at first if you have insurance or might need medication: therapy and psychiatry on one platform, in-network with many major insurers and employer assistance programs, published self-pay prices from $69 per week, and the best verified Trustpilot score in our coverage. Its messaging-first design is a strength for people who process in writing and a limitation for people who want live dialogue every time.

Verified facts

• Licensed therapists and psychiatric prescribers on one platform; a therapy-first company operating since 2012.
• Self-pay therapy: $69 per week (messaging only), $99 (video plus messaging), $109 (video, messaging and workshops); couples therapy $109 per week; extra live sessions $65 each.
• Self-pay psychiatry: $299 initial evaluation, $175 per follow-up.
• Insurance: in-network with Aetna, Cigna, Optum, Anthem plans, Medicare, TRICARE and many EAPs; copays typically $0 to $30, and $0 for many members.
• Trustpilot: 4.4 across 2,370 reviews - the best verified score in our coverage; the captured reviews carry Trustpilot's "Invited" tag, meaning the company invited customers to review.

The trade-offs

Messaging response times depend on your therapist. Responses come on a set schedule - typically five days a week - not instantly; know the schedule before you rely on it. Live sessions cost more. The video tiers are $30 to $40 a week above messaging-only, and session length and count per plan are worth checking. Insurance changes everything, in both directions. Covered, Talkspace is very hard to beat; self-pay, its live-session tiers are a meaningful monthly cost.

Who it is best for

Anyone whose insurance or EAP covers it, and anyone who may need both therapy and medication without juggling two providers. Our Talkspace review, Talkspace pricing guide and Talkspace insurance guide cover each angle.

headspace is two products under one name. The app is a best-in-class guided meditation, sleep and stress library - a daily practice, not treatment. The therapy service is a separate offering with licensed clinicians by video that accepts insurance. Judge each on its own, and do not mistake the app for therapy.

Verified facts

• Guided meditation, sleep and stress content in one app, with an easy learning curve and more than 105 million downloads.
• Online therapy service with licensed clinicians, with an insurance coverage check on its site.
• HSA/FSA eligible; many employers include headspace in their benefits.
• The app subscription and therapy billing are separate.
• Trustpilot: 1.5 across 770 reviews - strikingly low for so popular a product, and worth weighing against the app-store popularity headspace cites. Low scores at consumer subscription companies are often driven by billing and renewal complaints; read recent reviews and understand the renewal terms before subscribing.

Where it fits

headspace is the right choice if what you want is everyday stress management, better sleep and a mindfulness habit - alongside therapy, or before it, or instead of it when there is no clinical concern. It pairs well with real therapy rather than competing with it. If you need a therapist, compare its therapy service against betterhelp and Talkspace on the same terms as any other platform. Our headspace review and headspace cost guide separate the two products in detail.

Choose betterhelp for fast, flexible talk therapy with the largest network; choose Talkspace if you have insurance or might need medication; choose headspace if you want a daily mindfulness practice rather than a clinician. Those three sentences settle most decisions. For the rest, the matrix below maps common situations to the platform that fits.

For the full head-to-heads, see betterhelp vs Talkspace, headspace vs betterhelp and Talkspace vs headspace. For a four-question method that works for any platform, see how to choose an online therapy platform.

A therapist delivers talk therapy and does not prescribe medication; a psychiatrist is a medical doctor who diagnoses mental-health conditions and prescribes and manages medication, and typically does not provide weekly talk therapy. Many people benefit from both at once, which is why the platform choice should follow this question rather than precede it.

What each one does

How to tell which you need

A reasonable rule of thumb: if you want to work through thoughts, patterns, relationships or life stressors, talk therapy is the natural starting point. If your symptoms are significantly disrupting daily functioning - you cannot sleep, cannot work, cannot get out of bed, cannot stop the panic - or a therapist or doctor suggests medication may help, that points toward a psychiatric evaluation. You do not have to diagnose yourself in advance. Starting with a therapist and asking "do you think I should see a prescriber?" is a normal, good conversation; starting with a prescriber who recommends therapy is equally normal.

Why many people use both

Medication and therapy work on different levels and often reinforce each other. Medication can ease symptoms enough that you have the bandwidth to engage with therapy; therapy builds the skills and insight that medication alone does not provide. For a range of conditions the combination is a well-recognized approach, which is exactly why platforms that connect the two matter. Starting therapy-only and bolting on an outside prescriber later is the most common coordination failure in online care: two providers who never speak, two sets of notes, two bills. If medication is plausible, choosing a platform with psychiatry from the start avoids that. Our therapist vs psychiatrist guide covers the decision in depth.

Online psychiatry is a video evaluation with a licensed psychiatric prescriber who reviews your history and symptoms, works toward a diagnosis, and - where appropriate - prescribes medication and monitors it over follow-up visits. Common medications for anxiety and depression are routinely prescribed this way; some controlled substances face additional telehealth prescribing rules, and a responsible service will tell you so up front.

What a first visit looks like

Expect a longer appointment than a routine check-in: a structured review of your symptoms, their history and severity, your medical history and current medications, substance use, family history, and what you have tried before. The prescriber may use standardized rating scales. If medication is appropriate, they will discuss options, likely side effects and what to expect in the first weeks, and set a follow-up schedule - often two to four weeks after starting, then less frequently once things are stable. Prescriptions are sent electronically to the pharmacy you choose.

What can and cannot be prescribed online

Antidepressants (SSRIs, SNRIs and others), non-stimulant medications, many sleep and mood medications, and the common first-line treatments for anxiety and depression are routinely handled by telehealth. Certain controlled substances - stimulants used for ADHD and benzodiazepines among them - are subject to federal telemedicine rules under the Drug Enforcement Administration that have changed several times since 2020 and may change again; whether a given platform prescribes them, and under what conditions, is something to confirm directly with the service and to expect to be stricter than for other medications. A legitimate service will state its policy plainly and will never promise a specific medication before an evaluation.

How to spot a legitimate online psychiatry service

• A real, unhurried evaluation with a licensed prescriber - not a questionnaire that ends in a prescription.
• Genuine ongoing follow-up, with the same clinician where possible.
• Clear, honest limits about what can and cannot be prescribed remotely.
• Coordination with therapy, on the same platform or by sharing records with your therapist.
• Transparent prices and insurance handling before you commit.

Of the platforms we cover, Talkspace offers psychiatry alongside therapy under one account, at $299 for the initial evaluation and $175 per follow-up when self-paying, and many insurance plans cover it. Our online psychiatry comparison and online psychiatry guide go further.

Online therapy is most commonly used for anxiety, depression, stress and burnout, relationship difficulties, grief, life transitions and long-standing patterns such as low self-esteem or perfectionism - the concerns where structured talk therapy has its strongest evidence base and where weekly video or phone sessions deliver it well. Below is how the common concerns map to what online platforms can and cannot do.

Anxiety

Generalized anxiety, social anxiety, panic and health anxiety are among the most frequent reasons people start online therapy, and cognitive behavioral therapy - the approach most online therapists are trained in - is a first-line treatment for them. Online delivery suits anxiety well: exposure exercises can be planned in session and practiced in your real environment between sessions, and messaging lets you report back while it is fresh. Our anxiety platforms comparison and anxiety guide cover what to look for.

Depression

Mild-to-moderate depression responds to several structured therapies, including CBT, behavioral activation and interpersonal therapy, all of which translate to video and phone. Online access can matter especially here, because low motivation and energy make a commute a real barrier. Severe depression, depression with suicidal thinking, or depression that has not responded to therapy may need a psychiatric evaluation, closer monitoring or a higher level of care; a good therapist will say so and help you get there. See our depression guide.

Stress, burnout and life transitions

Work stress, caregiver burnout, a move, a breakup, a new baby, a diagnosis, retirement - these are the bread and butter of therapy and a natural fit for the online format, where flexibility is the whole point.

Relationships, couples and families

Communication patterns, recurring conflict, trust after a rupture and parenting disagreements are all addressed in online couples and family therapy, provided everyone can speak freely from where they are. Talkspace offers a dedicated couples plan; our family therapy comparison explains the options.

Grief and loss

Grief therapy helps when loss becomes stuck or complicated - when months later the weight has not shifted, or when the circumstances of the loss were traumatic. The online format lets people stay with a therapist through a season of life when leaving the house feels impossible.

Trauma and PTSD

Trauma-focused therapies, including trauma-focused CBT and prolonged exposure, are delivered online by clinicians trained in them, and EMDR has been adapted to video by some practitioners. Trauma work needs a therapist with specific training; ask directly about it when matching. Complex or severe trauma presentations may need in-person or more intensive care.

ADHD, OCD, bipolar disorder and other conditions

Online therapy supports people living with these conditions - skills, routines, relationships, coping with the impact - but formal diagnostic assessment for ADHD or autism, medication management for bipolar disorder, and specialized exposure-and-response-prevention therapy for OCD need clinicians with specific training and, often, a prescriber. Say what you are dealing with in the intake so the match reflects it, and choose a platform with psychiatry if medication is part of the picture. Our overview of types of therapy matches approaches to conditions.

Live video is the closest match to a traditional session and the default for most people; phone works as well for many and better for some; live chat and asynchronous messaging suit people who think in writing or who want contact between sessions. The format that works best is the one you will keep using - and most people end up combining two.

Platform differences matter here. betterhelp offers the most live-session flexibility, with video, phone and chat plus messaging on every plan. Talkspace is messaging-first, with live video added by plan tier. headspace's therapy service runs by video. If you know you want phone sessions, confirm the platform offers them before you sign up.

Nearly every mainstream, evidence-based approach is delivered online: cognitive behavioral therapy (CBT) most of all, plus dialectical behavior therapy (DBT) skills, acceptance and commitment therapy (ACT), psychodynamic and person-centered therapy, solution-focused therapy, interpersonal therapy, and couples and family approaches. The name of the approach matters less than whether it is a good fit for your concern and delivered by someone trained in it; here is what each one looks like.

Cognitive behavioral therapy (CBT)

The most researched and most widely offered approach. CBT works on the links between thoughts, feelings and behaviour: identifying unhelpful thinking patterns, testing them against evidence, and changing the behaviours that keep problems going. It is structured, goal-oriented and usually time-limited, with between-session practice. It is a first-line treatment for anxiety disorders and depression and adapts naturally to video. Our guide to CBT online explains what a course of it involves.

Dialectical behavior therapy (DBT)

Developed for intense, hard-to-regulate emotions, DBT teaches skills in four areas: mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness. Full DBT programs include group skills training; online therapists commonly offer DBT-informed individual work and skills coaching.

Acceptance and commitment therapy (ACT)

ACT focuses less on changing thoughts and more on changing your relationship to them: noticing them, making room for difficult feelings, and committing to action in line with your values. It is widely used for anxiety, chronic stress and pain, and works well in a video format.

Psychodynamic and insight-oriented therapy

Longer-term, less structured work that explores how past relationships and unconscious patterns shape present difficulties. It suits people who want depth and understanding rather than a symptom-focused toolkit, and it translates to video and even phone, where some people find it easier to reflect without a face to watch.

Person-centered, solution-focused and interpersonal therapy

Person-centered therapy emphasizes the relationship and your own capacity for growth. Solution-focused therapy is brief and future-oriented, building on what already works. Interpersonal therapy targets the relationship patterns and role transitions that sustain depression. All three are common online.

Couples and family therapy

Approaches such as emotionally focused therapy and the Gottman method are delivered by video with everyone present. The practical requirement is that each person can speak freely, which sometimes means separate devices in separate rooms.

Mindfulness-based approaches

Mindfulness-based cognitive therapy and mindfulness-based stress reduction are structured programs, often group-based, that teach meditation practice as a clinical tool. This is where a practice app like headspace can complement therapy - as daily practice between sessions - while remaining distinct from treatment. Our types of therapy guide matches each approach to the concerns it suits best.

Online therapy delivered by a licensed clinician is covered by the same confidentiality rules as in-person therapy, and platforms that bill insurance or handle health information are subject to HIPAA, the US federal health-privacy law. The real privacy questions are about the platform's business practices - what it does with the data around your therapy, such as signup answers and app usage - and about the claims record that insurance billing creates. Both are manageable once you know where to look.

What is protected, and by whom

Your therapist is bound by professional confidentiality and state law: what you say in session stays between you, with narrow exceptions every therapist must explain at the start - imminent risk to yourself or others, abuse of a child or vulnerable adult, and court orders. The platform's handling of your health information falls under HIPAA where the platform acts as a covered entity or business associate, which the major therapy platforms do. Session video and messaging on legitimate platforms are encrypted in transit.

The betterhelp FTC settlement, plainly

The category's record is not spotless, and the clearest example is betterhelp's 2023 settlement with the US Federal Trade Commission over its past sharing of user data - including information from signup questionnaires - with advertising platforms. The FTC's position was that the company had promised users their information would stay private and then used it for advertising. betterhelp changed the practices at issue, and the settlement bound it to limits going forward. We mention it because it is a fact a prospective user should know, and because it illustrates the general point: the therapy itself was never the exposure; the data around it was.

Five privacy checks before you sign up anywhere

1. Read the current privacy policy, specifically the sections on advertising, analytics and data sharing with third parties. Look for plain statements about what is not shared.
2. Check whether you can opt out of marketing data use in the account settings or at signup.
3. Understand what is health information and what is not. Clinical notes and session content are protected strongly; account metadata and app analytics may be treated differently.
4. Know what insurance billing creates. Billing a session to your insurer creates a claims record with a diagnosis code. That is a normal part of healthcare and protected by HIPAA, but some people choose to self-pay for therapy specifically to keep it out of their insurance history. Neither choice is wrong; make it consciously.
5. Secure your own side. Use a strong, unique password and two-factor authentication where offered, keep sessions on a private device, and be aware of who can see your screen and hear your voice.

Yes - on every platform we cover, therapists must hold an active license in the state where you are located during sessions, and the platform verifies it before the clinician can see clients. Licensing is state by state, which is why your location shapes who you can see, and why moving or travelling can require a new match.

Why location decides your therapist

Mental-health licenses are issued by state boards and are valid in that state. A therapist licensed in Texas can treat a client who is physically in Texas - at home, at work or in a parked car - but generally not a client sitting in Oklahoma, even by video. Platforms handle this by asking where you are and matching accordingly. That is why the largest networks have an advantage: more therapists licensed in your state means more choice, especially in smaller states where the local pool is thin. Our state-by-state guide covers licensing, insurance and platform coverage in each state, from California to Texas to New York.

Interstate compacts

Some professions have agreements that let a clinician licensed in one participating state practice telehealth in others. PSYPACT is the interstate compact for psychologists; a growing number of states participate, and it allows participating psychologists to deliver telepsychology across member states. Counselors and social workers have compacts at various stages of adoption. The practical effect for you: if your therapist holds a compact privilege, travel or a move between member states may not interrupt care. Ask your therapist; do not assume.

Travelling, moving, or living in two states

Tell your therapist before you travel. A short trip is often fine depending on state rules and your therapist's credentials; a move usually means a re-match with someone licensed in the new state, which platforms handle routinely. Students, remote workers and people who split time between states should raise it at intake so the match is made with that in mind. Our online therapy near me guide explains why "near me" barely matters online - and when it does.

How to verify a license yourself

Every state licensing board has a public lookup. Search for your state plus "psychology board license verification" or "counselor license lookup", enter your therapist's name, and confirm the license is active and unencumbered. It takes two minutes and settles the question permanently. Platforms also display credentials on therapist profiles; the state lookup is the primary source.

Preparation for a first online session is mostly logistics and a little reflection: a private space, a tested connection, and a rough sense of what you want help with and what you want to ask. You do not need a polished story; you need to show up.

The week before

• Complete the intake questionnaire honestly and thoroughly - it shapes the match and gives your therapist a head start.
• Read your therapist's profile. Note anything you want to ask about their approach or experience.
• Check the platform's cancellation policy and how to reschedule, so a conflict never costs you a session.

The day before

• Decide where you will take the session and test it: video and audio, lighting, background noise, who might walk in.
• Install any app, log in, and confirm notifications work.
• Write three things: what brought you here, what you want to be different in three months, and one question for your therapist.

In the session

• Expect questions about history, symptoms, relationships, work, sleep, substance use and safety. Answer as honestly as you can; nothing you say will surprise them.
• Expect a conversation about confidentiality and its limits, and about what to do in a crisis.
• Ask how they work, how they will measure progress, and what they expect from you between sessions.
• Notice how you feel. Comfortable is not required on day one; respected and heard is.

Afterwards

Write one line about what landed. Book the next session before you close the app. If the fit felt wrong, give it one more session unless something was clearly off - and then switch without guilt. Our beginners guide covers what the intake asks, what a first session looks like, and why switching is normal.

Therapy is working when, over several weeks, you can point to specific changes: fewer or shorter bad days, a situation you handled differently, a pattern you now notice before it runs, sessions that produce something you take into the week. It is time to consider switching when, after four to six sessions, there is no sense of direction, you do not feel understood, or the approach plainly does not fit.

Signs it is working

• You can describe what you are working on and why.
• You leave sessions with something to try, and you try it.
• Symptoms you tracked at the start are moving, even slowly.
• You feel understood even when challenged.
• You look forward to sessions, or at least do not dread them.

Signs it is time to switch

• Several sessions in, you cannot say what the plan is.
• You regularly leave feeling judged, dismissed or unheard.
• Your therapist lacks experience with your specific concern and is not addressing it.
• Logistics keep failing: missed sessions, late responses, technical problems that never get fixed.
• You have raised a concern and nothing changed.

How to switch

Every platform in our coverage lets you request a new therapist from your account, usually in a couple of clicks, with a new match within days. You do not need to justify it, though telling the platform what you want different improves the next match. The community feedback we track says this repeatedly: the second match is often the right one. Finding the right therapist can take more than one try, and the ease of switching is a real advantage of online platforms over starting a local search from scratch.

How to finish well

When your goals are met, say so and plan the ending together: a taper to every other week, a final session that reviews what you learned, and a plan for what to do if things slip. Pausing a subscription rather than cancelling can be sensible if you expect to come back; check the terms so you are not billed while paused.

Online therapy serves some groups especially well - people in rural areas, caregivers and new parents, shift workers, people seeking a therapist who shares their identity or language, and people who find in-person settings hard. The requirements differ by group, and so do the platform fits.

Women

Many women seek therapy around perinatal mental health, caregiving load, hormonal transitions, relationship dynamics and the specific pressures of work and family. Online matching lets you request a therapist by gender and specialty, and flexible formats fit around children and work. Our online therapy for women comparison covers matching options and what to ask.

Couples and families

Everyone needs to be able to speak freely, which can mean separate rooms and devices. Talkspace offers a dedicated couples plan at $109 per week; our family therapy comparison and what is family therapy guide explain how it works online and who offers it.

Teens and young adults

Age policies vary by platform and state law governs minors' consent to treatment, so check the platform's policy before signing up and expect parent or guardian involvement for under-18s. College students should also check their campus counseling center, which is often free, and whether their coverage follows them out of state during the term.

Men

Men start therapy less often and leave sooner, and the online format removes some of the barriers - no waiting room, phone sessions from the car, messaging that lowers the stakes of a first disclosure. Requesting a therapist experienced with men's mental health is a reasonable, common ask.

LGBTQ+ clients

Online matching makes it realistic to find an affirming therapist, and many platforms let you request one explicitly at intake. Ask directly about experience with the concerns you bring; an affirming stance and specific experience are different things.

Veterans and military families

TRICARE is among the plans Talkspace lists, which matters for military families with few local options. Veterans should also check VA mental-health services and the Veterans Crisis Line, reached by dialing 988 and pressing 1.

Older adults and Medicare

Medicare coverage of telehealth mental-health services has expanded, and Talkspace lists Medicare among the plans it works with. Phone sessions are a legitimate option for people who find video difficult, and a family member can help with setup without being present for the session.

People in rural areas or with mobility limits

This is the group for whom online therapy changes the most: a statewide pool of therapists instead of a one-hour drive to the nearest office, and sessions that do not require leaving home. Phone sessions handle poor bandwidth. If your state's pool is thin, the largest networks are the best bet; our state pages show what serves each state.

The first month of online therapy follows a predictable shape: a week of setup and matching, a first session that is mostly history and goals, two or three sessions that establish a working plan, and a first checkpoint where you decide whether the fit and approach are right. Knowing the shape in advance makes the slow parts feel like progress instead of stalling.

Week 1: setup, matching, first contact

You complete the intake, get matched - on betterhelp in as little as two days - and usually exchange a first message with your therapist before any live session. Use that message well: a few lines on what brings you here and what you hope changes gives your therapist a head start. Book the first live session for a time and place where you will not be interrupted, and test the technology the day before.

Week 2: the first session

Expect a structured conversation: your history, current symptoms, sleep, work, relationships, substance use, safety, previous therapy and what helped or did not. Expect the confidentiality conversation and a crisis plan. You will probably leave with one or two small things to notice or try. It is normal to feel that not much "happened" - this session is the foundation, not the house.

Weeks 3 and 4: the plan takes shape

By the second and third live sessions, a good therapist will have named what you are working on and how: the pattern you are tracking, the skill you are building, the conversation you are preparing for. Between-session practice begins in earnest. Messaging, where your plan includes it, becomes useful here - a quick note when a pattern shows up mid-week gives the next session something concrete to work with.

The 30-day checkpoint

Around session four, ask yourself three questions. Can I say what we are working on? Do I feel understood, even when challenged? Have I noticed anything, however small, shifting? Two or three yeses means keep going. Mostly noes means switch therapists - not quit therapy. Every platform in our coverage makes the switch a couple of clicks, and the second match is often the one that works.

What to expect from yourself

Some weeks you will not want to log on. Go anyway; the sessions you least feel like attending are often the ones that matter. Some sessions will feel flat. That is normal in any course of therapy and not a sign of failure. The measure is the trend over weeks, not the quality of any single hour.

Online therapy platforms earn revenue from subscriptions you pay directly, from insurance reimbursement for covered sessions, from employer contracts, and - for some apps - from consumer subscriptions to self-guided content. Understanding the model explains most of what you will read in reviews, and most of what to check before you pay.

Subscription platforms

betterhelp and Talkspace's self-pay plans bundle sessions and messaging into a weekly price, typically billed monthly. The model gives you predictable cost and between-session access; it also means you pay whether or not you use every session, and it makes billing and cancellation terms the most common source of complaints across the category. The fix is simple: read the billing cycle, the pause option and the refund policy before you enter a card.

Insurance-billed platforms

Talkspace, betterhelp and headspace's therapy service bill insurers for covered sessions, which drops your cost to a copay. The platform's incentive is to keep clinicians in-network and sessions documented, which is why insurance-billed care comes with diagnosis codes and claims records. It is the normal way healthcare works, and it is the single biggest cost lever available to you.

Employer contracts

Many platforms sell to employers, who offer them to staff as a benefit - sometimes free, sometimes subsidized. This is why asking HR before you pay anyone is the first step in every cost section of this guide: the care you are about to buy may already be included.

Consumer apps

headspace's meditation app is a consumer subscription, like a streaming service. The incentive is retention, which is why renewal terms and cancellation friction dominate its low Trustpilot score. Try the free content first and know how to cancel before you subscribe.

Where we fit

Top Online Therapy may earn a commission when you click a link to a platform and sign up. That does not affect which platform wins a comparison, what price we print, or any medical statement - our rankings follow the published methodology on how we rank, prices appear only once verified, and medical statements are reviewed under our medical review policy. We say this plainly because trust is the only reason a comparison site is worth reading.

Everything factual in this guide traces to one of three places: each platform's own published information, the platform's live Trustpilot profile as captured in August 2026, or an authoritative public-health source listed at the end of the page. Where a fact could not be verified, the guide says so rather than estimating.

• Prices. Talkspace's self-pay and psychiatry prices were verified in October 2026 and are quoted exactly. betterhelp's self-pay range and headspace's app prices were not independently verified at the time of writing, so they are described structurally and not quoted.
• Ratings. Trustpilot scores and review counts are shown as captured from the live profiles - 3.9 across 9,652 reviews for betterhelp, 4.4 across 2,370 for Talkspace, 1.5 across 770 for headspace - including the uncomfortable ones.
• Clinical statements. Claims about what therapy is and how it works draw on the American Psychological Association and the National Institute of Mental Health, and are kept general; this guide does not quote outcome percentages it cannot source.
• Community feedback. Where the guide says "the community feedback we track", it refers to verified public discussion threads we review and quote on the platform pages, used as a signal of customer experience rather than as clinical evidence.
• Medical review. Medical and scientific statements across this site are reviewed by a named medical content reviewer under the policy linked above. Prices, rankings and platform selection are editorial and are not part of that review.

This guide is updated when platform prices, insurance coverage or policies change materially. The date at the top of the page is the last substantive update. Found an error? Tell us through the contact page with the statement in question, and we will correct it.

Online therapy is not an emergency service, and every platform says so. If you are in immediate danger, call 911. If you are in emotional crisis, thinking about suicide, or worried about someone who is, call or text 988 in the United States - the Suicide & Crisis Lifeline, free, confidential and open 24 hours a day - or chat through 988lifeline.org. Knowing this before you need it is part of using online therapy well.

Why platforms draw this line

Scheduled therapy, by design, is not staffed for immediate response. Your therapist may be offline; messaging is answered on a schedule; a video session is an appointment, not a hotline. Crisis services are built differently: staffed around the clock, trained for acute risk, and able to connect you to local emergency help. A good therapist will ask about safety at intake, will give you a crisis plan, and will tell you plainly to use 988 or emergency services when needed. That is not a deflection; it is the correct level of care.

What to do, in order

1. Immediate danger to yourself or someone else: call 911 or go to the nearest emergency department.
2. Emotional crisis or suicidal thoughts: call or text 988. Veterans can press 1 after dialing 988. Spanish-language support is available by pressing 2.
3. Need treatment referral or information, not in crisis: the SAMHSA National Helpline, 1-800-662-4357, free, confidential, 24/7.
4. Afterwards: tell your therapist what happened at the next contact, so your plan can be adjusted and the right level of care considered.

Building a crisis plan with your therapist

Ask for one early. A good plan lists your warning signs, the coping steps that help, people you can contact, the numbers above, and what to do if nothing else works. Keep it where you can find it - on your phone, in the app's notes, on paper. Having it is one of the most useful things a first month of therapy can produce.

The mistakes that derail online therapy are rarely about the therapy. They are about choosing a platform before checking insurance, treating the first match as final, picking the wrong format, skipping between-session work, and misreading subscription terms. Each is avoidable in a minute once you know it is there.

1. Comparing prices before checking coverage

A covered platform at a $0 to $30 copay beats every self-pay deal. Run the eligibility checks at Talkspace and betterhelp, ask HR about EAP sessions, and only then compare subscription prices.

2. Treating the first match as the last word

Matching algorithms are a starting point. If the fit is wrong after a session or two, switch - it is free, fast, and the single most common piece of advice in the community feedback we track.

3. Picking a format that does not fit your life

Video needs privacy, light and bandwidth you may not have at the time you can meet. Phone and messaging exist for a reason. Choose the format you will actually keep, and confirm the platform offers it before signing up.

4. Starting therapy-only when medication is plausible

If symptoms are disrupting daily functioning or a clinician has raised medication, start on a platform with psychiatry rather than adding an outside prescriber later. Two providers who never speak is the most common coordination failure in online care.

5. Skipping the between-session work

Therapy is a weekly hour and a week of practice. The practice is where most of the change happens. If your therapist assigns a thought record, an exposure, a conversation - do it, and report back.

6. Misreading subscription and cancellation terms

Billing and cancellation complaints dominate negative reviews at every subscription company. Before you pay, know the billing cycle, how to pause, how to cancel, and the refund policy for unused sessions.

7. Expecting the app to be the therapy

A meditation app is a practice, not treatment. If you have a clinical concern, you need a clinician. Use the app alongside therapy, not instead of it.

8. Not verifying the license

Two minutes on your state board's lookup settles it permanently. Do it once, early.

9. Holding back because the room is not private

Therapy where someone might overhear is therapy where you edit yourself. Solve the privacy problem first: a car, a walk with earbuds, a booked meeting room, a different time of day.

10. Quitting at week three

The early weeks are history-taking and trust-building; the work that changes things usually starts after. Give it four to six sessions before judging the approach - and if the fit is wrong, switch therapists rather than abandoning therapy.

The vocabulary of online therapy mixes clinical, insurance and subscription terms. These are the ones that come up most, defined plainly.

If you want to start online therapy this week, this is the whole process in nine steps, in order. Most people can finish the first six in an evening.

1. Decide what you need. A licensed therapist for a clinical concern, a prescriber if medication is plausible, or a daily practice app for stress and sleep. The sections above explain how to tell.
2. Ask HR about your EAP. Free sessions may already be included in your benefits. One email settles it.
3. Run the insurance checks. Talkspace's and betterhelp's eligibility checks take minutes and tell you what you will actually pay. headspace's therapy service has its own coverage check.
4. Pick the platform that fits the answer. Covered platform at copay rates first; otherwise betterhelp for flexible talk therapy, Talkspace for messaging-first or psychiatry, headspace for practice.
5. Read the billing and cancellation terms before entering a card: cycle, pause, cancel, refunds.
6. Complete the intake honestly, including therapist preferences and your exact location.
7. Verify the license on your state board's lookup once you are matched. Two minutes.
8. Set up your space and test the technology the day before: privacy, light, headphones, connection.
9. Book sessions two to four in advance, and save 988 in your phone. Then show up.

Print this list, or screenshot it, and work down it in order. Every step is small and most take minutes; the only genuinely hard one is the first.

Online therapy is real therapy, delivered by licensed clinicians, through a screen or a phone. For most adults with mild-to-moderate concerns, it is an effective, flexible and often cheaper way to get consistent care - and consistency is what makes therapy work.

The decision comes down to four questions. Do you need a clinician or a daily practice? Might medication be part of your care? Does your insurance cover any platform? And which session format will you actually keep? Answer those, and the platform picks itself: betterhelp for subscription talk therapy with the largest network and the most live-format flexibility; Talkspace if you have insurance or might need psychiatry, with published prices from $69 per week and the best verified rating in our coverage; headspace for a mindfulness practice alongside or before therapy, judged honestly against its 1.5 Trustpilot score.

Whatever you choose: run the insurance check first, verify the license once, give it four to six sessions, switch without guilt if the fit is wrong, and keep 988 within reach. Our platform ranking, reviews and guides are here when you want the detail - and every medical statement on this site is reviewed under the policy on our medical review page.

This guide is general information, not medical advice, and not a substitute for care from a licensed clinician. If you are in crisis in the US, call or text 988, or call 911 in immediate danger.