The Scope of the Problem
Barriers to mental health treatment abound in the United States. The nature of these barriers is varied. Some involve people seeking but unable to obtain services. Others involve a failure to seek services. In combination, these obstacles result in a large proportion of those in need of mental healthcare not getting it.
For example, a 2008 study examined mental health problems in a large sample of military members who served in Iraq and Afghanistan. The study found that only around half of those veterans with depression and PTSD sought help for these problems. Unfortunately, the corresponding statistics for non-veterans are no better. Why is that?
Examples of Barriers to Mental Health Treatment
Mental health stigma
Mental health concerns are stigmatized in the United States. This means that many people view emotional difficulties more negatively than they would a medical condition, despite the lack of basis for this. These negative attitudes can lead to discrimination. They can also become internalized and thereby lead some to feel unduly embarrassed about their emotional difficulties. This creates an additional obstacle to seeking help.
Some people believe that the problems they are experiencing are their own fault. For that reason, it seems wrong to them to seek help. This is unfortunate; even if someone has contributed to their own problems, that doesn’t mean that seeking help would be a cop-out.
For example, let’s say that you had a close friend who started to drink too much. Let’s say this drinking became a problem in their lives and affected their relationships and their job. Fortunately, your friend recognized that the drinking had become problematic, and insisted that cutting back on drinking was the only answer to their problems – “simple as that.” However, they blamed themselves for “letting things get to this point” and were convinced that asking for help was a crutch. Wouldn’t you want your friend to at least try to seek help, even if they ultimately decided that it wasn’t for them?
Let’s be honest. Seeking healthcare in the United States can be expensive, whether it’s medical care or mental health care. For most people, whether they can get services is dependent on which insurance they have as well as their personal financial situation. This is an unfair and damaging system, as has been well documented in the national discourse. Unfortunately, it is one of the most prominent obstacles to people seeking help for mental health difficulties at present.
Sometimes we get in our own way. Many people believe that getting mental health help is undesirable. For example, the notion that you should be able to handle whatever life throws at you. Or that seeking help is like cheating. Seeking help is admitting defeat. These beliefs are damaging in that they prolong the person’s suffering, and for little reason. We don’t think of seeing a physical therapist for a knee problem as an opportunity to judge ourselves. Why do we think that way about emotional problems?
Privacy Concerns Related to the Workplace
Another factor that plays into reluctance to seek help has to do with the link in the United States between health insurance and work. The fear of one’s employer finding out about one’s mental healthcare is an understandable obstacle to seeking services. Can a company’s human resources department obtain personal health information from the health insurer with whom they contract? Fortunately, the Health Insurance Portability and Accountability Act of 1996 provides some protections against health information being disclosed without your consent. Unfortunately, there is not great clarity to be found on the question of whether and how health information can be shared by insurers to employers.
Despite this unsettling lack of clarity for those who obtain health insurance through their employer, the potential benefits from addressing mental health issues often outweigh concerns about employers finding out for many Americans. One suggestion for those concerned about their employers’ access to personal health information is to inquire with your employer’s human resource department. They will be able to provide an answer to this very reasonable question.
Unfamiliarity with the Mental Healthcare System
If you have never seen someone for emotional difficulties before, it can be daunting. Where to start? What’s the difference between psychiatrists, psychologists, and therapists? Our guide on how to find a therapist is one place to get started. Primary care doctors can also be a good source of advice and referrals. Friends or loved ones can recommend someone, but many people are reluctant to ask them for a recommendation.
Making Change Happen is an Accomplishment
Ultimately, whatever change does happen in psychotherapy occurs because of changes made by the person themselves, regardless of any guidance from a therapist. Consider someone with a drinking problem — reducing drinking is something that no one else can do for you. Many problems are similar in that they require work to address. This work can only be done by you, and if you can do it, you should be proud of that accomplishment.
The same holds true for those who take medication. Seeking out and taking that medication is a choice. If you need that help, seek it out, and make it happen, you can take pride in having proactively done something to improve your life.
Seeking mental health services is challenging for many of us. Sometimes, the biggest barriers to mental health treatment have to do with our own attitudes about mental health. Other times, it’s about mental health stigma or who will find out. These obstacles are all real. This author’s hope is that over time, these obstacles will be problems for fewer and fewer people.
Subscribe to the Manhattan Center for Cognitive-Behavioral Therapy blog!