In Ep 66 : Challenges to Latin American Mental Health, our guest, counselor Clara Rosenzweig, describes the work she oversees as the Director of Vecino Health Centers. Her comments highlight one of the major problems in preventing suicide: accessing mental health care. In our podcast, we have frequently spoken about how stigma and shame regarding mental health serve as obstacles to seeking help. In this blog we want to discuss some of the other impediments that make it difficult for people to obtain help for mental health concerns.
Financial Obstacles
Treatment for mental health issues is often expensive. Many mental health conditions are chronic, meaning that a person may require ongoing or periodic treatment, significantly increasing the costs of treatment. While health insurance companies are generally required to provide coverage for mental health conditions, that coverage may not be sufficient to make the care affordable. Even when a person is insured, they must still meet deductibles and manage co-pays. Furthermore, for people who are unemployed or underemployed, sometimes because of conditions such as depression, they are less likely to be insured. Finally, more seasoned mental health providers may not take insurance because of the low reimbursement rates paid by insurance companies.
Lack of Access to Care
In many places there are few mental health services available. Rural areas and less affluent urban neighborhoods generally have few mental health resources or providers. Most mental health professionals are located in relatively affluent sectors of the community. This is not because there are more needs in those areas, but rather because people in those areas are more able to pay. For a person who is potentially suicidal this lack of access can mean delays in receiving help for a life-threatening condition. To some extent the advent of telemedicine services can address the scarcity of resources in a given area; however, not everyone has access to stable internet access which is crucial for this kind of care.
Shortage of Mental Health Professionals
There are simply not enough trained mental health providers to meet the need for services. (This is in spite of the stigma against seeking such services!) Any person who has sought counseling or psychotherapy has likely encountered either long waiting lists or unavailability. People who seek to find a provider on their insurance panel often learn that few, if any, have openings to see them. When a person needs specialized care (e.g., for suicidal thoughts, obsessive-compulsive behavior, intellectual disability), it is even more difficult to find a professional with such specialized expertise.
Cultural/Racial Barriers
The vast majority of mental health professionals are white, non-Hispanic. Most are fluent only in English. Although many mental health professionals try to be culturally sensitive to those from different backgrounds and are required to attend continuing education to improve their cross-cultural awareness, effective mental health care is often contingent on nuances in language and cultural familiarity. Unfortunately, there are not nearly enough mental health professionals who grew up in other cultural traditions, fewer still who have the skills to communicate comfortably in languages other than English. There are some therapists who are fluent in Spanish, but far fewer who can speak Vietnamese, Urdu, Mandarin, or Arabic. Professional groups such as the American Psychological Association are trying to attract more students to improve access to care. Admittedly there is a long road to go. It takes years of study beyond a Bachelor’s degree to become a licensed mental health provider.
In Conclusion
This is a hurting world with much more need for mental health care than resources to meet those needs. Obstacles to care include not only the social stigma against seeking help, but also the cost of services, the lack of accessible resources for care, and cultural and language mismatches between clients and professionals. There is some promise of greater accessibility through the use of telehealth services and by increasing the numbers of mental health professionals from other cultural backgrounds. Presently, though, there is a long way to go in removing these obstacles to seeking help.