In the US, you can't be turned away from an emergency department, but doctors, psychiatrists included, don't have to treat you if you can't pay. Usually, you pay, whether it's copay with insurance or cash for the whole bill before you even see a doctor. The doctor doesn't see you, doesn't know you have been turned away, and doesn't turn you away, the receptionist does. As for meds, you pay for meds or copays when you pick them up. Just like any store, if you can't pay you can't play.