What to Know Before Leaving Community Mental Health

Before I ever had a private practice of my own, I worked in community mental health. I spent years in partial hospitalization and intensive outpatient programs, mostly with adults who had severe and persistent mental illness. I loved the work deeply, but when it was time to move on, I assumed private practice would be a natural, easy transition.

Spoiler alert, it wasn’t.

The truth is, I hit some bumps, big ones. And while I wouldn’t trade the lessons I learned, I wish someone had warned me about a few things. So if you’re standing where I once was, thinking about leaving community mental health for private practice, here’s what I want you to know.

1. The therapeutic relationship starts earlier than you think

Back when I worked in community mental health, I didn’t really talk to clients until our first session. They called a receptionist, got scheduled, filled out their intake paperwork, and then showed up in front of me. My role started when they sat down in my office.

So when I opened my private practice, I carried that same assumption. I thought my first real interaction with clients would also be in a session. But I quickly learned that when you’re in private practice, you’re also the receptionist, the scheduler, and the admin. The very first phone call is where the relationship begins.

And here’s another thing I didn’t expect: many clients in private practice are coming to therapy for the very first time. They’re brand new to the process. Unlike in community mental health, where I often worked with people who’d already been through the system and knew how it worked, private practice clients often need me to explain the frame of therapy.

Now, when someone calls, I slow down. I say things like, “It’s really important you find the right fit therapist for you. If it’s not me, I’ll help you figure it out.” That small change communicates safety and sets the stage for trust from the very first interaction.

2. State your fee with confidence (and let the pause do the work)

In community mental health, I never once had to talk about money. Fees were handled through insurance or benefits, and clients usually sorted that out with staff before I even saw them.

So when I started my own practice and had to tell clients my fee directly, I panicked. I overexplained. I’d say things like, “Oh, my fee is $250, but I can slide… I don’t take insurance, but here’s why… maybe we can work something out…” I ended up discounting sessions I didn’t need to discount, and honestly, I sounded unsure of myself.

What I’ve learned now is simple: state your fee clearly, then pause. The pause is the key. It keeps me from rushing in to assume the client is uncomfortable, and it lets them take in the information without me muddying the waters.

These days, I say: “My fee is $250 per session. If you have any questions, let me know and I’ll send over my intake paperwork.” And then I stop talking. It’s clean, it’s confident, and it respects both my work and the client’s process.

If you’ve been thinking about raising your fee, I put together a free guide that walks you through exactly how to do it, step by step. It’s the resource I wish I had when I was fumbling through those early conversations.

3. Boundaries are only as strong as your policies

When I left community mental health, I figured clients just “knew” there was a 24-hour cancellation window. I mean, didn’t everyone know that? I pulled some boilerplate intake paperwork from who-knows-where and thought it would be fine. It wasn’t.

The reality is, in community mental health and treatment centers, the agency sets policies. They tell you what to do with no-shows, late cancellations, or outstanding balances. But in private practice, it’s on you. And if you don’t set clear policies from the beginning, you’ll end up with clients confused about expectations, and your boundaries will take the hit.

I had to learn the hard way that everything needs to be spelled out. Your fee policy. Your no-show policy. Your social media policy (yes, even what happens if a client sees you on Instagram or a dating app). All of it.

Now, I take the time to write policies that reflect how I want my practice to run, and I include them in my intake paperwork. Having clear policies hasn’t scared clients away; it’s made the whole process smoother and more respectful.

4. Private practice can feel lonely (and that’s normal)

When I worked in community mental health, I had a team. We met every week, celebrated birthdays, and leaned on each other through hard cases. I underestimated how much those little moments mattered until they were gone.

When I moved into private practice, I thought, “How could I possibly feel lonely? I’ll be seeing clients all day.” But sitting with clients isn’t the same as being on a team. Pretty quickly, I realized how isolating it could feel to work alone.

That’s why one of the best decisions I made was to join a consultation group. Having other therapists to talk with about cases, share resources, and just connect with has been a lifesaver. It’s not just good for marketing, it’s good for your mental health too.

Final Thoughts

If you’re thinking about leaving community mental health for private practice, here’s what I want you to take with you from my story:

• The therapeutic relationship starts with the very first call, not the first session.

• Say your fee with confidence, and don’t overexplain. (And if you’re planning to raise it soon, grab my free guide; it’ll make the process so much easier.)

• Your practice runs on the strength of your policies; get clear and write them down.

• And yes, private practice can feel lonely, but building community will keep you grounded.

You don’t have to figure it all out perfectly right away. I didn’t. Small steps really do add up, and you’re doing better than you think.

I built my Private Practice Roadmap course for the therapist I used to be, the one who loved community mental health but was stumbling her way through private practice. If that’s where you are right now, know this: you’re not behind. You’re building something real.

Until next time, I’m cheering you on every step of the way.