Access to Mental Health Services

With mental health conditions on the rise in the United States and around the world, access to care is more important than ever. Experiences with these conditions can differ significantly, and the type of support someone needs often depends on their personal situation. While many people still go without treatment, often for reasons beyond their control, there is growing awareness of how valuable mental health support can be.

The Current State of Mental Illness

Mental health conditions are generally grouped into two broad categories: any mental illness (AMI) and serious mental illness (SMI). AMI includes a wide range of mental, behavioral, or emotional disorders. In contrast, SMI refers to conditions that can significantly disrupt daily life, such as schizophrenia, bipolar disorder, PTSD, OCD, and major depression.

These challenges are far more common than many people realize. In 2022 alone, an estimated 59.3 million U.S. adults experienced AMI. Despite this high number, only about half of those people (around 50.6%) received mental health treatment.

Access to care isn’t consistent across all groups. Gender played a notable role: 56.9% of women with AMI received treatment, compared to just 41.6% of men. Age differences also stood out. Young adults between 18 and 25 experienced the highest rates of SMI at 11.6%, with the rate gradually decreasing among older age groups ^[1].

Racial and ethnic disparities were equally significant. People identifying as multiracial and American Indian or Alaska Native reported the highest rates of both AMI and SMI. Among multiracial adults, 11.8% experienced SMI, followed by 7.3% of American Indian/Alaska Native adults. On the other end of the spectrum, Native Hawaiian and Pacific Islander adults reported the lowest rate, at 3.5% ^[1].

Barriers to Accessing Mental Health Care

While some people actively choose not to seek treatment for their mental illnesses, treatment is not always available to them due to several barriers.

Common barriers to mental health services in the United States include: 

• Financial constraints
• Healthcare provider shortages
• Living far away from care
• Fear or shame around mental health 
• Confusing healthcare rules and paperwork
• Lack of internet or technological skills 

Although less of a challenge in countries with universal healthcare, many people in the United States struggle to meet the financial requirements of mental health care ^[2]. Therapy sessions, psychiatric evaluations, and medications can be expensive, and not all providers accept insurance. Even when they do, high deductibles, costly co-pays, and out-of-network fees can make treatment unaffordable. Adding financial stress to an already challenging situation can feel overwhelming for many people. 

Another significant issue is provider shortages ^[2]. Whether in countries with universal healthcare or not, the demand for mental health services far exceeds the supply of professionals. Long waitlists, sometimes stretching weeks or months, are common, with some areas reporting provider-to-patient ratios in the thousands. While big cities may have more providers, they also serve denser populations, which can still result in lengthy delays.

People in rural or remote areas often need to travel long distances to receive care, assuming they can access transportation. Without reliable options, consistent in-person support may feel out of reach. 

Stigma and cultural barriers can further prevent people from seeking help. In many communities, mental health problems are a sign of weakness and a source of shame. Fears of judgment, misunderstanding, or rejection, especially related to race, religion, gender identity, or immigration status, can make it even harder to ask for support ^[3].

Even when someone is ready to seek help, the system is hard to navigate. Insurance requirements, confusing eligibility rules, delays in paperwork, and miscommunications between providers and insurers often create frustrating roadblocks. 

While telehealth has expanded access in recent years, it is not an option for everyone. Those without reliable internet access or digital literacy may have difficulty using virtual care ^[4]. This can be especially true for older adults, people with disabilities, or those in lower-income households. 

The Rise in Telehealth Improves Access

The COVID-19 pandemic significantly accelerated the adoption of telehealth services, especially in mental health care. When in-person therapy sessions were no longer possible at the start of the pandemic, many practitioners and patients quickly embraced virtual sessions. Video calls became the primary means of connection, offering a safe space for patients to speak face-to-face with their doctors and therapists.

Telehealth helped remove several barriers to care. It made treatment more accessible for people living far from providers. It also reduced the stigma for those who felt shy or hesitant about visiting a therapist’s office in person. The virtual format often felt more discreet and private for many patients ^[4].

However, telehealth has its limitations. Not everyone has reliable internet or the right devices, which tends to be less of an issue for younger people but can be a significant challenge for older adults and those with lower incomes. While telehealth solved some privacy concerns, it also introduced new ones, such as data security risks. Additionally, some patients may not have a quiet, private space at home for virtual sessions and may worry about being overheard.

Policy changes during the pandemic helped support the growth of telehealth. Many insurers expanded coverage to include virtual visits, and regulations around cross-state provider licensing were relaxed. These shifts have generally been positive, allowing more people to access care regardless of location.

Access to Mental Health Care at School

Schools play a vital role in providing mental health support for children and teenagers, especially since many mental health conditions first appear during these pivotal developmental years. However, many schools face challenges, including a shortage of mental health professionals.

Although the American School Counselor Association recommends a ratio of one counselor for every 250 students, the actual ratio is often much higher. Some schools have one counselor for every 400 students or more ^[5]. This shortage frequently leads to staff overwhelm and burnout, and students not receiving the care they need.

On a more positive note, some schools are working to bring mental health services into the educational environment. This can include on-site therapy and support groups. Many schools are also taking a proactive approach to handling extreme emergencies such as suicidal ideation or traumatic events. These systems create a safer environment for both students and faculty ^[6].

Workplace Employee Assistance Programs 

In recent years, mental health has become an increasingly recognized part of overall employee happiness and well-being. Many employers offer programs to support mental wellness, such as Employee Assistance Programs (EAPs) that provide counseling and access to other resources. These are typically free, confidential services available for short-term therapy or guidance. Some companies also offer therapy reimbursement as part of their employee benefits.

That said, sometimes a toxic work environment or the stress of working for a difficult manager can contribute to mental health difficulties. Building a workplace culture that encourages flexible working hours to accommodate therapy sessions, along with managers who value and normalize discussions about mental health, is essential ^[7].

Another critical factor is that not all healthcare coverage plans offer comprehensive mental health services. Employers can select plans that provide mental health benefits comparable to other medical coverage, ensuring employees don’t have to worry about paying for sessions out of pocket or budgeting for co-pays.

Creating More Inclusive Access

While mental health is becoming less stigmatized and telehealth has made treatment more accessible, significant disparities still affect marginalized and underserved groups.

Research shows that people from Black, Indigenous, and people of color (BIPOC) communities often face greater obstacles in accessing mental health care. Provider bias is a common barrier that can lead to misdiagnosis or a lack of understanding of their unique experiences ^[3].

Marginalized groups also frequently have a higher need for mental health services. For example, members of LGBTQ+ communities experience higher rates of depression, anxiety, and trauma due to discrimination and social stigma. Transgender people, in particular, report high levels of psychological distress and often require specialized care ^[8].

People from immigrant communities also face challenges such as language barriers and fears related to their legal status or possible deportation. These concerns frequently discourage them from seeking the treatment they need.

Creating more inclusive access to mental health care means addressing these disparities head-on. Efforts to train providers in cultural competency, expand language services, and develop affirming, trauma-informed care models are gaining momentum. By continuing to prioritize equity and inclusion, the mental health system can become more responsive and accessible to everyone.

Improving Mental Health Care Access

Access to mental health services can make a world of difference in a person’s life. Yet many people still encounter barriers to care, whether financial constraints, stigma, judgment, or living in remote areas that make attending appointments difficult. 

The rise of telehealth has made mental health support more accessible than ever, allowing people to connect with providers from the comfort and privacy of their own homes. At the same time, schools and workplaces are increasingly recognizing mental health as a vital part of overall health and are working to provide more supportive environments.

Ultimately, improving access to mental health care is a shared responsibility that requires commitment from communities, employers, and policymakers. Communities can work to reduce stigma, while employers can offer comprehensive and inclusive benefits for employees. For policymakers, enacting laws that protect access and affordability is key.