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One in five people in the United States face mental health challenges every year, with effects that ripple across every area of their lives. Although high-quality treatment can help mitigate those effects, less than half of people who need care actually get it due to persistent barriers to mental health treatment.
This low utilization of mental health services means many people are left untreated, raising the risk that their symptoms will get worse and their quality of life will diminish. Untreated mental health conditions can have far-reaching effects, including:
When employees lack access to needed mental health care, they’re less likely to work effectively and more likely to seek pricey medical care that may not address their needs. Employers bear the financial weight of inadequately treated mental health conditions, often without realizing it. For example, NAMI reports that depression is a leading cause of disability worldwide, and one in eight visits to U.S. emergency departments are related to mental health disorders.
One important step toward a mentally healthy workforce is understanding the barriers to mental health. Identifying and addressing challenges early on helps people feel better faster, with less negative impact on their lives. Here are some common barriers to treatment for mental health:
Mental health care is often hard to get. In a recent study of over 50,000 people, 95 percent reported at least one barrier to accessing mental health services. Challenges with access to mental health care can include:
Long wait times
One study found that 94 million Americans have had to wait longer than one week for mental health services. One week may not sound bad at first, but for every one day of wait time, 1 percent of patients give up seeking care altogether. And for many, wait times are much longer.
Shortage of providers
Another challenge is finding a provider that specializes in the right type of care for their needs and takes their insurance. There is an escalating shortage of mental health professionals, especially since there aren’t enough new providers replacing the number who retire every year.
Finding a culturally responsive provider is even harder. Racial and ethnic populations only represent one-sixth of psychologists, even though these communities represent closer to 40 percent of the U.S. population.
The United States’ relatively lax attitude toward multilingual learning means it also can be difficult for non-English speakers to find providers who are fluent in their language. Since mental health care relies heavily on verbal communication, this barrier to accessing mental health services can lead to treatment delays, misdiagnosis, and inadequate care.
Lack of transportation
Transportation can be a logistical barrier to therapy. When people can’t physically get to a mental health appointment, they’re less likely to get timely care or access needed medications, and more likely to miss appointments. Lack of transportation disproportionately impacts those with lower incomes and who lack insurance.
Accessing mental health services is hard, but finding high-quality care is even harder. Only 20 percent of mental health treatments have been proven effective in research, according to the American Psychological Association (APA). In addition, traditional mental health care services don’t often measure or provide insight into the outcomes of various care types for different conditions. High-quality mental health care exists, but it requires knowledge and persistence to find it.
Stigma—the fear, embarrassment, or shame associated with needing mental health support—is a major barrier to receiving mental health care. As a result of stigma, eight out of 10 workers won’t reach out for support, often for fear that their reputation, relationships, or job status could be in jeopardy if they disclose having a mental health condition. This can worsen their symptoms and make them less likely to get treatment and recover. Former U.S. Surgeon General Jerome Adams, MD, called stigma “the biggest killer out there.”
Navigating insurance coverage and the health care system can be confusing and time-consuming. Research suggests that many Americans lack access to information that builds mental health literacy, which makes it difficult to engage in treatment or know when, where, or how to seek it.
Research shows some people don’t seek care because they lack confidence in mental health treatment or feel it won’t help. Others are afraid they’ll have to take medication or be placed in a psychiatric hospital. Concerns about confidentiality are also a barrier to treatment for mental health for some.
Black, indigenous, and people of color (BIPOC) may have additional feelings of distrust toward the mental health system that make it difficult to seek care. Research shows the majority of psychologists in the United States (86 percent) are white. Paired with historical and contemporary instances of systemic oppression, this results in an understandable fear of being vulnerable to white people.
In one survey, people voiced a preference for managing mental health challenges on their own as well as thinking they didn’t need treatment. Self-help can reduce stigma and help address some mental health concerns, but is not a replacement for professional mental health services.
Some people report feeling more comfortable asking for mental health support from friends or family, or turning to prayer or pastoral counseling as a replacement for therapy.
Even if someone has access to mental health care and wants treatment, financial considerations might prevent them from seeking help. One study found that lack of affordability was one of the most prevalent barriers to mental health care access, and one that caused considerable worry among those who need these services.
Many people lack health insurance. Even among those with health insurance, many are forced to use out-of-network benefits to cover mental health care, which leads to higher out-of-pocket costs compared to other types of care. In spite of legislation created to prevent financial barriers to mental health care, insurers often pay lower rates to mental health providers than other medical professionals, so fewer therapists and psychiatrists can afford to accept insurance. One study found that only 20 percent of mental health practitioners accept insurance.
Financial barriers to mental health care are especially pronounced among low-income workers. One survey found that nearly half of people making less than $30,000 annually say they have access to affordable mental health support, compared to 76 percent of those making more than $150,000. In that survey, low-income workers were twice as likely to put off mental health care because of the cost, and nearly a third turned to self-medicating to cope with stress.
Mental health has received increased attention in recent years, but this hasn’t translated into an increase in quality services, according to the World Health Organization’s (WHO) Mental Health Atlas report on worldwide mental health services. The WHO added there is a shortfall in terms of leadership, governance, and financing for more promotion and prevention efforts.
Documented abuses, inequities, and oppression—past and present—have led some people of color to lose trust in health care providers, including mental health professionals. Studies show people of color more often receive lower quality mental health care than white people. As a result, BIPOC individuals often don’t receive the mental health support they need.
Another barrier to receiving mental health care for underrepresented communities is a lack of cultural competence among mental health providers. These are skills that lead to effective and appropriate communication with people of other cultures. Cultural competence allows people to feel comfortable with their provider, which encourages them to continue receiving care.
While several barriers to mental health treatment are outside employers’ control, there is a great deal organizations can do to support workforce mental health. Here are a few ways to demonstrate your commitment to improving access to mental health care and breaking down barriers:
In today’s workplace, a baseline investment in an EAP, health plan, or mental health app isn’t enough. With these approaches, low utilization, long wait times, and other barriers keep people from accessing mental health services. Instead, companies are choosing more comprehensive mental health solutions that include:
Investing in mental health pays off. Most employees (84 percent) say that when considering a new job, it’s at least somewhat important that the prospective employer offer mental health benefits. When employees feel their companies support their mental health, they’re less likely to experience symptoms of mental illness, miss work, or underperform. They’re also more likely to talk about mental health concerns, feel satisfied with their job, and feel proud to work at their company.
Be intentional about how you design your team’s work and your workplace culture, so you can create an environment that supports mental well-being. For example:
Employers play an important role in destigmatizing mental illness. Some of the steps you can take include:
Many employees assume their managers are receiving training on identifying mental health issues and providing referrals to helpful resources. However, surveys suggest that just 25 percent of managers have actually received this type of education. Consider providing training in:
Barriers to mental health treatment have existed for decades, but through concerted efforts to destigmatize and address mental health conditions, change is happening. Employers play an essential role in improving mental health accessibility and breaking down barriers. And the rewards are well worth the effort when employees are able to thrive in both their personal and professional lives.