Getting in to see a therapist or psychologist can be a confusing and expensive experience. Here’s how the system is broken—and ways to cope.BY LORA SHINNPUBLISHED: JUN 1, 2023SAVE ARTICLE

Maybe you can only imagine the scenario, or perhaps you’ve experienced it. At night in bed, you hope sleep will obliterate the despairing emptiness that’s been looming all day. Or that you’ll finally escape the disembodied whispers saying no one loves you and you don’t deserve to live.

In the morning, a sick swirl of anxiety descends, and your chest tightens after yet another night plagued by racing thoughts. Placing one foot on the floor seems improbable. Calling a list of therapists feels impossible.

This story is part of our Year of Making Noise, Prevention’s series dedicated to helping you speak up for your health and change your life. We’re taking a close look at health issues that are ignored and overlooked and making sure every person is heard. It’s time to get the health care you deserve.

But in the U.S.—despite pressing hopelessness, spiraling anxiety, or other tangled symptoms of a mental health crisis—you’re required to figure out how to get help. Whom do you call within a system that’s complex and scattershot, low on providers and high in cost?

This situation may be familiar to you or someone you love, because legions struggle with mental health issues, especially since COVID-19. The numbers show in stark relief how the pandemic upended America’s mental health and increased pressure on stressed systems: In 2019, fewer than one in 10 adults reported symptoms of anxiety or depressive disorders; during the pandemic, that number increased to three in 10, according to the Centers for Disease Control and Prevention.

And the situation doesn’t seem to be improving: In December 2022, a survey by the American Psychiatric Association (APA) showed that the percentage of Americans who rated their mental health as only “fair” or “poor” increased to 37% from 31% the previous year.

Navigating a path toward support and help is, at best, a challenge. “It feels like the mental health care system by design is meant to be confusing,” says Theresa Nguyen, a licensed clinical social worker for 20 years and now chief research officer at Mental Health America (MHA).

The biggest issue in the U.S. may not even be the system but a lack of one, according to Jennifer Snow, national director of Government Relations, Policy and Advocacy at the National Alliance on Mental Illness (NAMI). She points to a patchwork of individual providers, systems, and approaches that vary by state or county. “People with mental health conditions get the short end of the stick,” she says. Compared with those with physical conditions, she adds, “it takes longer to get care, and people have to pay more to get care, with fewer choices of providers. It’s a sad state of mental health care in America.”

How access to care got to be such a problem

In 2021, 35% of adults who needed and didn’t receive mental health services said it was because they didn’t know where to go, according to a large Substance Abuse and Mental Health Services Administration (SAMHSA) survey.

In 2022, a Kaiser Family Foundation survey found that 50% of women surveyed (ages 18 to 64) needed mental health services in the previous two years—but only half made an appointment. Among those who tried to get an appointment but were unable, a third said they couldn’t find a provider accepting new patients, and another third said they couldn’t afford the care.

When a person’s crisis hits a stage needing inpatient treatment, things can become more dire. There are two main ways in which most people interface with mental health treatment, says licensed psychologist Hani Talebi, chief clinical officer at the Meadows Mental Health Policy Institute: “One is through law enforcement, and the other is through a hospital’s emergency department because crisis symptoms have worsened and they have no place to go.”

A big reason: There’s an overall shortage of inpatient beds for those experiencing an acute crisis. This partially stems from a laudable mid-20th-century goal of closing harmful psychiatric institutions and instead opening more community-centered facilities. The problem is, the latter never really happened.

Those same mid-century requirements mean Medicaid coverage for low-income Americans won’t pay for psychiatric care at a facility with more than 16 beds, and Medicare limits inpatient psychiatric stays to 190 days over a person’s entire lifetime. “There’s no similar prohibition on any other type of health care facility for medically necessary care,” Snow points out. “Can you imagine something similar for cancer?”

We all pay the price at the societal level—inadequately treated or lifelong mental illness can lead to increased homelessness, incarceration, and premature death, according to a 2022 White House brief. The brief notes that nearly one-third of those who receive Social Security Disability Insurance fall within the “mental disorder” category. That’s more than the number of people who are unable to work due to injuries, cancer, and diseases of the circulatory and nervous systems combined.