In the U.S., mental health issues are far more common than many realize. According to the U.S. Department of Health and Human Services, one in five American adults have experienced a mental health issue, and one in 20 Americans live with a serious mental illness, such as schizophrenia, bipolar disorder, or major depression.
For many, mental illness can be challenging to manage on one’s own. Access to mental health care is crucial to helping individuals receive the necessary support to address their illnesses. However, today, more than half of adults with mental illness in the U.S. (a total of 27 million people) do not receive the mental health treatment they need.
For the majority of these untreated or under-treated individuals, the main barriers to mental health treatment and access are:
When mental health issues and illnesses go untreated, they affect a person’s ability to live a fulfilling life and carry on with school, work, or family responsibilities.
Ensuring that individuals have access to mental health care can improve lives and communities. For many, removing these barriers to mental health treatment can dramatically reduce or eliminate the risk of suicide, legal issues, family conflict, unemployment, and substance abuse.
Let’s look at the top five barriers to mental health care and how we can begin to surpass them.
Although the Affordable Care Act required medical insurers to provide coverage for behavioral and mental healthcare, the cost of treatment still often limits access to mental health services. Even with insurance or financial assistance, mental healthcare services can be costly. Copays and deductibles add up quickly when a diagnosis requires regular therapy, complicated medication management, or intensive treatment programs.
For many individuals, insured or not, a lack of financial resources prevents them from seeking help or leads to inconsistent or inadequate treatment. For instance, a traditional 60-minute therapy session can range from $100 to $200 depending on the state and whether the provider is considered in-network. Moreover, treating severe diagnoses can carry even heavier lifetime cost burdens. For example, a patient with major depression can spend an average of $10,836 a year on treatment.
One of the main barriers to mental health treatment is simply a lack of available services caused by a combination of a high demand for treatment and a low supply of trained professionals.
While the U.S. is facing an overall shortage of doctors, the shortage of mental health professionals is steeper than any other category. According to the Health Resources and Services Administration, 149 million Americans (nearly half the U.S. population!) live in federally-designated Mental Health Professional Shortage Areas. For comparison, 93 million Americans live in similarly-designated primary-care shortage areas, and 67 million live in dental health shortage areas.
Rural areas often have few to no mental healthcare providers, let alone providers with specific specialties. On the other hand, urban clinics and providers often have long waiting lists, and patients can suffer for months before they get a basic intake appointment. Finally, while virtual therapy today is much more common and accessible to many, this option requires a reliable internet connection and can limit care if a person isn’t in a safe, trusted environment.
As a result, this barrier can make it difficult for someone to find affordable and accessible mental health care services in their area to get reliable and consistent treatment.
Another common barrier to mental health treatment is the general lack of mental health education and awareness. Often, those who have the greatest need for mental health treatment haven’t been taught the signs of mental illness and how treatment can help.
With a physical injury or illness, the signs are typically apparent—you feel sick, something hurts, or a clinical test shows an abnormality. Mental illnesses, however, can be harder to recognize. Symptoms are often subtle and sometimes dismissed as “personality” or “attitude” issues. For example, clinical anxiety may be dismissed as “worrying too much,” and depression can often present as “laziness” or “fatigue.”
Serious conditions may not even be obvious to the person suffering or those around them, especially if they don’t share their inner thoughts and feelings. Other times, people may assume that their emotional or mental status is normal, not realizing that they are suffering from disordered thinking or clinical symptoms. Ultimately, if a person doesn’t know something is wrong, they’re unlikely to seek treatment.
Studies have found that the stigmas associated with mental illness—defined as the “devaluing, disgracing, and disfavoring by the general public”—often prevent people from accessing treatment.
On the one hand, a person’s own beliefs about mental illness can prevent them from acknowledging their illness, seeking help, or sticking with treatment.
On the other hand, the risk of facing discrimination in cultural, social, and professional circles also creates a huge barrier to seeking treatment. People may fear that family and friends will avoid them or treat them differently or that disclosing a mental health condition will lead to adverse treatment and perceptions at work.
While these stigmas won’t disappear overnight, encouraging awareness and education through national and local campaigns can help change public perceptions of mental health illness and dissolve those barriers to treatment.
There are significant disparities in mental health care accessibility among different racial and ethnic groups. One survey finds that white adults (23%) are more likely than Black (13.6%) and Hispanic (12.9%) adults to seek and receive mental health treatment. In addition to the barriers discussed above, these disparities stem from a lack of diverse representation in the mental health field, language barriers, and implicit bias.
According to research from the American Psychological Association and the Bureau of Labor Statistics, 84% of psychologists, 67% of social workers, and 88% of mental health counselors are white. People are less likely to seek help if they think their doctor can’t understand or empathize with their background or cultural differences and experiences.
Luckily, the American Psychological Association (APA) is seeing more people of color earning psychology degrees, a trend that is enhancing the diversity of the psychology workforce and will help break down barriers to more equitable access and treatment.
While these barriers to mental health treatment can seem disheartening, it’s essential to take the time to understand how these issues apply to the communities and individuals you serve. Understanding what prevents mental healthcare access opens the door to improving access with better programs and policies.
As the first step in this process, we recommend leveraging your case management software to collect meaningful data, assess your community’s needs, amplify your mental health programs, empower your community, and, ultimately, improve your impact.
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