One of my consistently most popular posts is “8 Reasons Why People Don’t Get Treatment for Mental Illness.” In it, I described several common obstacles and barriers which often keep people from seeking or obtaining treatment for mental illness.
This post clearly struck a chord with a lot of people, including those who have had negative experiences with treatment and family members trying to persuade their loved ones to seek help. You can read the original post here.
I thought it might be interesting to go back through this same list and outline some of the common thoughts which underlie each of the reasons why people don’t get treatment. These thoughts can range from totally factual and real concerns to unrealistic or even irrational beliefs.
After each group of thoughts, I’ll suggest alternative ways to think about the issue, which may help you be better equipped to work through these barriers to seeking treatment.
1) Fear and shame – common thoughts:
“I’m afraid to ask for help.”
“I’m embarrassed and ashamed to talk about my problems.”
“I’m scared of getting labeled as ‘crazy.’”
“I don’t want to know if I’m sick or that something bad is happening to me.”
Instead, consider this: It’s completely ok to have these feelings. But know that 1 in 4 adults has a mental illness; you are definitely not alone. While the negative stigma surrounding mental illness is still strong and undeniable, more and more people are feeling comfortable about being open and stepping forward to ask for help.
2) Lack of insight – common thoughts:
“Nothing is wrong with me.”
“My friends and family are worrying about me for no reason; I’m fine.”
Instead, consider this: Maybe there is nothing wrong, but if people who truly care about you are concerned, humor them and go for a check-up. If they’re wrong, make them buy you dinner. If, however, a professional also expresses concern about your mental health, at least listen and be open-minded about their recommendations.
3) Limited awareness – common thoughts:
“Things really aren’t that bad.”
“Everyone has issues.”
Instead, consider this: Sometimes you may recognize you are struggling but you try to minimize or deny your difficulties, hoping they aren’t that serous or they will go away. But there are times when you do need professional help for significant mental health concerns. Since you aren’t trained to formally diagnose yourself, you need a professional opinion to gauge the nature of your problems and to determine which effective treatment options are available.
4) Feelings of inadequacy – common thoughts:
“I hate to admit my flaws and shortcomings.”
“Asking for help means I’m inadequate or a loser.”
“I should be able to cope better with things.”
“I blame myself for my problems.”
Instead, consider this: Would you consider yourself inadequate or a loser if you had cancer or diabetes? Asking for and receiving professional help for an illness does not mean you are an inferior person or that you are to blame for your current challenges.
5) Distrust – common thoughts:
“It’s hard to trust someone with my deepest secrets.”
“I’m afraid my personal information won’t be kept confidential.”
“I don’t want anyone to know I’m in treatment.”
Instead, consider this: Health care providers are trained and required to respect and honor the privacy and confidentiality of the personal information you disclose to them in treatment. Other than some rare and extreme situations involving threats of harm to yourself or others or certain court-related circumstances, the information you provide is very secure and cannot be released to anyone else without your permission.
6) Hopelessness – common thoughts:
“Nothing will help me.”
“I’ve tried treatment before and it didn’t help.”
“I messed up before so I might as well give up.”
“My last episode of treatment was horrible and made me worse.”
“I saw a therapist and they were incompetent. I’ll never go back.”
Instead, consider this: There are many medications and psychotherapy-based treatments for mental illnesses with solid research evidence for their effectiveness. Also, just because a previous therapist or treatment was not effective or even stressful, trying a different approach or a new provider could be very helpful.
7) Unavailabillity – common thoughts:
“There are no therapists or treatment programs near me.”
“I don’t know how to find a therapist or treatment program.”
Instead, consider this: Lack of availability of appropriate mental health treatment or a lack of understanding about how to locate a competent professional can be real problems. If so, reach out to your family medical providers and local mental health organizations for information on how to find care and for suggestions of recommended professionals.
8) Practical barriers – common thoughts:
“I don’t have transportation to get to treatment or child care during my appointments.”
“I can’t afford to pay for treatment.”
“I’m too busy; I don’t have time for treatment.”
Instead, consider this: These practical obstacles are real and often difficult to overcome. Start by talking with friends and care providers about options to reduce or remove some of these roadblocks. Ask directly for assistance with transportation or child care. Explore public assistance programs or lower-cost treatment services to reduce the financial burden associated with treatment. Make time to get help; it’s just as important as anything else on your schedule.
I hope these suggestions for managing these common barriers to treatment will be helpful as you or a loved one consider getting help for a mental health concern. Just remember that treatment is available, it is effective and you don’t have to suffer in silence. But you do have to take the first step and ask for help.
Here’s a question: What have you found helpful in removing one of the barriers to seeking help for mental illness? Please leave a comment. Also, please subscribe to my blog and feel free to follow me on X (formerly Twitter), “like” my Facebook page, or connect on LinkedIn. Finally, if you enjoyed this article, please share it with a friend. Thanks!
1 and 4 jump out to me, that’s ironic given I run a popular blog and website called EndTheStigma !!
With 1. It’s more fear than shame
I have a particular aspect to my condition which is embarrassing/very unusual
There’s also an element of “what label might I get now”
With 4, I have a family who are anti psychiatry, anti psychology, anti psychopharmacology ++++
This is where I can tell you what’s been helpful, my folks won’t change their minds, but I find being a Mental Heath Advocate and giving some help (even, take kind words to another person)helpful to them and therapeutic to me!
Outstanding article. Will share today.
Aidan
Aidan, thanks as always for your comments and support!
Is it not true that addictions are a major part of mental health issues? Yet they seem subsumed or ignored. They may be discrete or co-morbid. Many who suffer diagnosed mh condition also experience substance or behavioural dependence/addiction. Thinking of just one, gambling addiction – which carries high suicide rates and major depression – just what treatment is available? Could you point me towards successful/effective treatment by public health? Playing devil’s advocate., maybe people don’t seek help because they are capable of knowing that whatever ‘help’ they receive may be useless.
I have been treated in various types of therapy for the last 25 years (since I was 22 when I realized I had always had chronic depression and anxiety problems). I have not had issues with any of the points mentioned except for 4, feeling inadequate, which I have problem with still. I know so much about my condition that’s have learned over the last 25 years and yet I have no tools and no ability to make myself feel better. So naturally point 7 is relevant. After 25 years with little results, except that I am still reluctantly alive, hopelessness is a prevailing feeling and starting over with therapy over and over again takes its toll. Availability is of course also a problem when you have tested what you at least imagine is everything. So, I am afraid I have no helpful tools to make me feel better. I continue to suffer without much hope for any change. Maybe it is time to just accept that feeling well was not for me. At least my illness is helping my children to cope better in the world. Maybe I should not ask for more than that?
Anders, thank you for sharing your thoughts. Even though you have tried many therapies and health care providers, sometimes it’s helpful to consider trying a new program or provider to see if there could be any benefit for you, since new treatment approaches are always developing over time. Also, I don’t know where you live, but there may be some local mental health organizations with peer support staff or support groups that could also be a resource for you to provide a community to connect with for extra support. Thank you again for your comments and I hope you can find greater comfort and peace of mind.
Adrian, yes, addictions only further complicate mental health issues. There are many treatment resources for addictions and it’s often best to consult with knowledgeable mental health providers in your area to find out about local options. I agree that many assume treatment won’t be effective, but given that there are many proven treatment approaches, I’m an advocate of at least giving treatment a chance rather than not trying it at all. Thanks for your comments.
Dear David,
Thank you for your response! To give you som context, I was brought up innSweden and was treated with talk therapy with a psychologist combined with the first SSRIs in my early 20s until I turned 30 and moved to the US. In the US I continued to be treated with various doses of SSRIs together with talk therapy in Birmingham, AL and Boston, MA during my pistdos studies there. After moving to Buffalo, NY I was first treated with SNRIs that were new about 10 years ago. Being labeled gifted the idea of me potentially benefitting from ADHD medication was tested and made it possible for me to concentrate somewhat better but only at doses of 2 x 40 or 50 mg daily that left me with bad side effects. And it was not recommended with my anxiety medication. I then entered a 6 years phase of psychoanalysis together with CBT, which taught me more about how I worked but I never reached s stage where I obtained any useful tools I could apply agains debilitating anxiety and my low grade depression or dysthymia that have been my constant companion since early childhood. After moving back to Sweden, my diagnosis has been attributed to giftedness and I have tried the latest medications, all in all approximately 20 substances including MAO inhibitors and lithium for augmentation, without results. I am currently trying compassion therapy, which makes sense but I cannot succeed to improve my mental healt. Besides this I have tried EMDR and other newer techniques without success over the years. So I am currently located in southern Sweden but travel
Often to the US as my children live there. -A
Anders, thanks for sharing your journey with me. I hope you will continue to explore treatment options as they become available and that you will find some that will be helpful to you.
Thanks for reply, David. Regarding gambling addiction there is only ONE NHS clinic in the UK. Research shows only 5% of gambling addicts seek help, only 1% receive help – and there is no research on effectiveness of latter that is conclusive. Perhaps in addition to the individual sufferer’s ‘responsibility’ there is a need for greater resourcing of research, treatment provision, training for health professionals etc?
Adrian, I’m certainly no expert on problem gambling or on UK resources. Thanks for the information, albeit discouraging. I do agree greater training, research and education would be terrific.
This minimizes the reality of the practical barriers. If CBT costs 120$ and hour min, how on earth can someone afford that if their depression is impacting their ability to work, care for a family and themselves. You have to be incredibly wealthy to be able to afford good mental health care. Otherwise you are on waitlists for months and even years. Most places have a limited number of spots for lower cost services. Until proper mental health care gets rolled into the canadian medicare system children and youth as well as adults will continue to die from mental illness
Sarah, I know how huge the cost barrier can be and for many people that’s the only barrier. I’m not familiar withe the Canadian healthcare system, but we struggle with the cost issue here in the US as well. I don’t know where you live, but you might explore the option of a university-based training clinic for lower cost care. You can find a directory of these clinics at http://aptc.org/?module=Members&event=Clinics. Thanks for your feedback!