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Overcoming the Hurdles: Accessing Mental Health Care in America

I would love to tell you all that starting therapy is as simple as deciding you’re ready, making an appointment, and showing up. However, that is nowhere even close to the reality that most people in America experience when they realize that they need therapy. For most people, there is obstacle after obstacle that needs to be navigated around before even finding themselves on a therapist’s couch. For most people, therapy is looked at as a luxury, rather than the invaluable resource that it is meant to be. And that’s due to a whole host of reasons and broken systems in this country. I often hear people say “the mental health stigma” is getting better. 9 times out of 10 my response is, “is it though?” If we as a society do not come up with some solid solutions for helping people ACTUALLY obtain mental health care, the stigma will remain. While the struggle to find childcare, the rising cost of living, transportation, a provider shortage, and the general population not understanding what mental health symptoms actually are, there are all very real barriers that people face regularly that prevent them from obtaining care. I'm choosing to focus on three other barriers; insurance, time off from work/scheduling, and stigma.

Let's start with one of the more frequent obstacles I see for people trying to find care, insurance. You can take a look at August's blog post, A Fresh Take on the Mental Health Parity and Addiction Equity Act, for some systemic issues I address with insurance companies, for now, let's look at the frequent roadblocks someone seeking care might come across. Most people don't know that it is most beneficial, before even calling a therapist's office, to contact their insurance company and ask about their benefits for mental health services. I personally had to learn the hard way what a deductible, coinsurance, and copay were, because no one ever taught me how insurance works. When people don't ask these questions they are often surprised with a bill from their therapist that they weren't anticipating "because they have insurance." Having insurance just gives you benefits, it doesn't necessarily mean that all the services in your plan are paid for in full initially. When people do get to the point of contacting therapists, one of the first questions people often ask is, "do you take insurance?" (You can also ask your insurance provider for a list of therapists that are considered in-network, but again, a lot of people don't know that.) Often, for people who have insurance, paying privately isn't a feasible option. So they have to try with another therapist until they find someone in-network. They will repeat that pattern until they reach a therapist who can take their insurance. Then, if they are lucky enough to find someone with openings (or a reasonable waitlist), who accepts their insurance they will schedule an intake. During an intake session insurance companies require that certain pieces of information are collected, dictating to some extent how a session may be run as a result. After the initial session, some insurance plans tell the client that they are only allotted a certain number of therapy sessions in a calendar year. Again, this dictates the therapist's actions. So with insurance as a barrier, a person must be able to afford whatever payment they will be responsible for (deductible, coinsurance, or copay), find a therapist who is in-network, find a therapist with current openings, that treats their presenting issue, and be able to reach their therapy goals in the specific time frame that insurance decides. It's a lot of factors that need to come together to make getting therapy using your insurance benefits possible.

Next, let's look at the time someone needs for therapy. More often than not, in my experience, when someone reaches out to me for therapy, they often request appointment times outside of their work day. Typically 5 pm or later. While in theory, this is fine and sensible, it's important to remember that therapists also have families and lives outside of their office that they want to be able to participate in. Some therapists offer appointments outside of the typically 9am - 5pm work day (weekends, evenings) because it works for their lifestyle, but most want to be able to have a life outside of their job, just like everyone else. This leaves people trying to make appointments work over lunch breaks or using PTO for appointments during the day. In theory, that's fine, right? Just take your hour lunch break or put in for an hour of PTO and hop on a virtual call with your therapist to make the most of your time. This becomes problematic in schedules that aren't fixed everyday, or for people who only get 30-minute breaks in their day. It then comes down to looking at each individual day and evaluating if that person can "sneak away" for an hour or if they will be needed by a boss or team member. Let's take the PTO angle here for a minute. PTO is not always an option for people to use, especially if they have children or other responsibilities that they typically need to use their PTO. This is just my opinion, so take it for what it is, people should be using their PTO to relax and revitalize themselves so that they can produce the best work possible for their employer. So while PTO and lunch breaks sound good in theory, for many people, scheduling is still a very real barrier that gets hard to work around unless they find a therapist with non-traditional hours of operation. I'll give you another one of my opinions which will lead us to the third barrier that I want to address; employers should be ENCOURAGING and doing whatever they can to make therapy as accessible as possible to their employees without requiring them to use PTO or be penalized for needing time away.

The stigma around mental health symptoms/diagnoses is still very real. While I understand what people mean when they say the stigma is getting better, it's still there. Sure, more people are opening up about their experiences. Sure, insurance has to include mental health benefits in their plans. Sure, there are more therapists out there. And yet, depression, anxiety, and other mental health-related diagnoses are still not understood by the majority of the population. I can't tell you how many times people will sit in front of me during a session and say something along the lines of "I know other people have it worse than me and I know I don't really need to be here." THAT IS STIGMA! If you are experiencing symptoms of any kind that are impacting your ability to function, that is enough of a reason to see a therapist. You don't have to be on the verge of hurting yourself to seek help. You don't need to reach a certain severity before you can address your symptoms. I also hear stories of shame or fear as reasons that people avoid seeking help or even acknowledging that they might be managing a lot. Those are also forms of stigma. General education about how different diagnoses present and how we as a society support someone managing those symptoms is incredibly needed. Human well-being needs to be the priority over profit, business growth, appearance, and whatever else. I truly believe that if we placed a greater emphasis on caring for people as a whole, our society would dramatically change for the better as a direct result.

These barriers that are preventing members of our society from getting help are systemic issues. They aren't going to be fixed by a few therapists reducing their fees or changing their hours to better accommodate client needs. Society as a whole needs to be better about making the health and well-being of its members the top priority. In the meantime, I will continue to try to provide as much education and anecdotal accounts as I can to do my part in dismantling these barriers that I'm seeing. I have hope that things will change. That we will move towards a more connected society rather than one that values individuality above all else. For those of you who really want to get help but are facing these barriers, my heart is with you. I know it's not the same as professional care but consider things you can find access to; online courses, books, your own support network, QUALITY self-care, and more.

Brooke Halliday, MA, LPCC (she/her)

Licensed Professional Clinical Counselor

Certified EMDR Therapist

Owner of Redbird Counseling

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