What’s holding back mental healthcare access? There is a lot of information on the general issues that bar people from seeking help to treat their mental illnesses. Sure, there are people that have managed to access successful treatment, but a good number of those battling mental illnesses aren’t getting the help they need. This gap between patients and treatment trickles down to multiple factors.
Ideally, knowing all the reasons that are keeping you from accessing treatment could change your life. If you would like to know some of the reasons why accessing mental healthcare is tough, this is the post for you. It includes five of these barriers.
The points included in this post are not only an inside view of the mental healthcare industry but also evidence-based insights into why accessing treatment options have been a problem. It will answer the many questions in your mind right now.
Table of Contents
1. Structural Barriers
Mental health issues are common all over America. While all states have been working on creating an environment favorable for mental health treatment, there still exists a large gap between access to healthcare treatment and the prevalence of the illnesses.
The Treatment Gap
The treatment gap is used to refer to the difference between the number of patients who need specific treatment and those who actually receive the care. Among the primary reasons for this large gap is the availability of unpredictable and insufficient data on the American population. This is exacerbated by the scarcity of resources for collecting this data.
According to the survey:
- America’s weighted mean for the treatment gap for mental illnesses stands at 71.2%
- The mean for the treatment gap stands at 57.6% for severe disorders
- The mean for the treatment gap stands at 65.7% for critical to moderate disorders
In the case of severe mental disorders, the treatment gap is as follows:
- 5% in North America
- 9% in Latin America
- 4% in Mesoamerica
- 8% in South America
For severe to moderate mental disorders, the treatment gap increases substantially:
- 2% in North America
- 7% in Latin America
- 7% in Mesoamerica
- 1% in South America
Tackling the treatment gap that exists among alcohol and substance abusers is the biggest challenge for first-world countries such as America. The treatment gap among American adults is also exceptionally high, further adding to the global mental health disorder burden.
Poor Mental Health Policies
Policies are supposed to aid in meeting the needs of the population. Historically, America has been more than adamant in creating mental health policies aimed at helping people with war-related chronic mental health problems. This includes a centralized system of procedures that have been around since 1960. Services might no longer be available to the seriously ill citizens because the centralized approach didn’t factor this target demographic.
The present situation concerning public health policies isn’t that different from the post-war one. Instead of targeting the population that needs them, today’s health policies are aimed at therapeutic services for outpatient settings. As such, this scenario results in inadequate resource allocation for the mental health sector.
Here are a few trends recorded in 2020, according to Mental Health America’s published article:
- There has been an increase in the prevalence of depression and anxiety from 8.66% to 13.01%
- More adults are attempting suicide than ever
- While most American have insurance, they lack treatment
- The youth and adults lack treatment requirements
- There is still a large proportion of the youth that goes unidentified despite struggling with mental health illnesses
Mental Health Professional Shortage
In general, America doesn’t have enough health professionals, but this inadequacy can be felt most in the mental healthcare sector. According to mental health resources, a good number of Americans, 89.3 million, live in federally designated areas of mental health shortage.
These statistics can be tied back to a variety of factors. Other than rural areas being highly deprived of diagnostic and treatment services, they typically lack access to mental health professionals. On the flip side, while urban areas have more health professionals, most have long waiting lists. Patients often have to wait for months before accessing these services.
This matter is further aggravated by government-sponsored and private insurance plans. Also, doctors often shy away from taking up mental healthcare careers.
The Organization of Mental Healthcare Services Is Fragmented
The fragmentation of mental health services makes accessing mental healthcare tougher for most people. Mental health services are referred to as ‘de facto’ in many areas. While people do report their problems, they often find themselves stuck in a maze of disorganization before they can get any help. This increases the urgency of having an efficient service system to facilitate direct contact with the community.
Some of the reasons for the disorganization of mental health services include:
- Desperate administrative resources
- Historical reforms
- Variation in eligibility criteria rules
- Misconducted funding streams
When combined, these factors have created widespread artificial boundaries between the patients and access to treatment. It is rare for popular communities to offer their past and present medical histories for assessment. When these communities actually present this data, processing the examinations usually takes months.
A severe lack of mental health services is also common among large minority communities, which is why people who dwell in rural areas are known to commit suicide at a rate that’s higher than their urban counterparts.
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Ignorance of the High-Risk Population’s Treatment
Whenever reform and guidelines are being designed, the high-risk population is often neglected. Mental healthcare isn’t advanced enough to ensure that all aspects that require consideration are addressed. However, the leaders in advancement also use outdated and general approaches when making decisions on mental healthcare.
Here is some of the high-risk population that is often ignored during mental healthcare reforms:
Mental health disorders and suicide are highly prevalent among the older generations, so providing this age group with treatment is necessary. For older people, ‘Medicare’ is their primary financer for health issues. The sad truth is that Medicare offers limited services and options for the mental healthcare sector. This inadequacy is linked to:
- Limits to hospitalization
- Limited coverage of office visits
- Little to no coverage of prescription drugs
Around 25% of this demographic claim that these Medicare restrictions bar them from seeking healthcare. Since the treatment offered to older people isn’t as receptive as that offered to other adults, most resist seeking treatment. Under Medicare, general outpatient medical services require a 20 percent copayment, while most outpatient mental health services require a 50 percent copayment. It also rigidly limits the lifetime hospitalizations to 190 days.
Suggested Citation: “9 Barriers to Effective Treatment and Intervention.” Institute of Medicine. 2002. Reducing Suicide: A National Imperative. Washington, DC: The National Academies Press. DOI: 10.17226/10398.
The under-diagnosis and under-treatment of the older generation also pose a greater risk to access to treatment. Since a good number of physicians’ view depression and mental illnesses as part of growing old arising from anatomical, physiological, and psychological changes, special treatment considerations do not seem necessary for this group. However, this mindset can negatively impact the importance of seeking mental healthcare.
The reasons behind poor mental healthcare access are the same for the adolescent population; low utilization, limited access to care, low help-seeking behavior, and diagnosis problems have all contributed to the limited access to mental health treatment.
Another significant factor is that the unemployed status of most adolescents makes affording treatment expenses an uphill task. This age group also doesn’t adhere to appointments and follow-ups as required.
2. Limited Awareness/Education About Mental Health
The lack of mental healthcare awareness can be quite consequential. Stories about mental health complications can be found everywhere, including in newspapers, media, and TV. The responsibility of spreading and understanding mental health awareness falls on the government, treatment providers, and family members. Why aren’t people that struggle with bipolar disorder or chronic depressive disorder or schizophrenia getting the treatment they deserve? For those who do, why are treatment rates quite high?
The best excuse for this situation would be ‘Anosognosia’ – an inadequacy in self-awareness. If the person suffering from a mental disorder isn’t well-educated about their condition, they will have a lot of questions about their wellbeing. ‘Broken brain’ is a term commonly used to refer to people struggling with mental illnesses who have to deal with the continuous change in their brain or its damage without sensing that they have a mental illness.
50% of patients who are suffering from mental illness often don’t accept the fact that they have a mental disorder. While their health providers, friends, or family might try to inform them of their condition, it can be tough for them to understand or be mindful of their mental wellbeing. Addressing anosognosia is challenging since it is also a symptom of mental illness. Those who aren’t at home with their mental illnesses might react differently, including through:
Other than being uncomfortable to deal with at first, mental disorders do get worse with age and time. Those struggling with these illnesses may face pressure in the form of work, financial burden, memory loss, a decline in cognitive skills, and stigma, which can breed anxiety while socializing.
Fear and Anger
The experience of being told that you have a mental disorder is typically painful and terrifying. People react towards fear in a completely unpredictable way. For those with psychiatric disorders, it can be tough to take things positively.
The language used to address the different disorders could also be an issue to the point where people suffering from mental illnesses become susceptible to specific words. For instance, calling such people’ mentally disturbed’ can be humiliating and cause anger reactions.
Why Mental Health Awareness Matters
Mental health awareness and the awareness of existing healthcare choices are necessary for early diagnosis and for spotting red flags within a specific demographic. This awareness also speeds up recovery from mental disorders.
Knowledge of all things mental health-related could help those in need figure out how to access healthcare resources. In fact, half of Americans might not access healthcare resources due to not knowing how to go about it.
They may not be aware of the resources that exist for their specific disorder; non-profit organizations, insurance policies, government-sponsored low-budget insurance coverage, and funding all offer great opportunities for improved mental health for the population. However, the lack of education, cultural and language barriers, superstitions, and conservative mindsets hold back people from leveraging healthcare options and treatments.
Awareness offers both hope and a large recovery window. Attention to the possibilities of mental illnesses creates the perfect environment for decreasing comorbidities and improving how people approach life.
In the United States of America, a variety of organizations is working overtime to improve mental health awareness in their communities. These initiatives are targeted at improving the mental health of the population as well as increasing awareness of available treatment options. Some of these initiatives include:
- Helpful Educational Resource for Mental Disorders and Healthcare In The U.S
- CDC (Center for Disease Control and Prevention)
The CDC offers a rich source of data concerning mental health disorders. It has databases that are broadly based on public data and statistics. In recent years, the organization has been a huge advocate for mental health awareness. It has been promoting this cause by describing mental health to the public and outlining the benefits of mental health awareness as well as the available treatment options.
MedlinePlus is the service behind the most extensive medical library in the world, the ‘National Library of Medicine.’ The organization’s main goal is to offer high-quality information concerning health and wellness. By using English and Spanish, it achieves its goals of spreading healthcare awareness through all possible mediums. As an online resource, MedlinePlus is among the most trusted sources of information for individuals and their friends and family.
The U.S government uses this website as a one-step access door for a wide variety of mental health resources. Visitors can learn all things related to mental health by visiting the site. It targets a number of areas, including:
- The general public
- School systems
- Health and emergency preparedness professionals
- Local communities
- Government and business leaders
National Center For PTSD
This organization’s target demographic is American veterans, both men, and women. It claims to offer all employees of the VA respect, excellence, and a baseline of standards.
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National Institute of Mental Health (NIMH)
NIMH has been one of the greatest champions of establishing evidence-based research on mental illnesses. As a leading federal agency in the mental health field, it falls under the 27 institutes of the National Institute of Health, which has been acclaimed as the world’s largest biomedical research agency.
In the coming five years, NIMH has created a strategic plan on how it wants to push mental health awareness forward. The plan includes (2020 updated):
- Highlighting efforts aimed at improving therapeutic and preventive mental health interventions
- Monitoring the trajectory of mental illnesses to establish the perfect way to intervene
- Advancing the basic science of the brain, behavior, and genomics to understand mental illnesses better
- Ensuring that people suffering from mental disorders can benefit from improved services and outcomes, and better knowledge to practice
3. Racial Barriers and Social Stigma (Social Barriers)
The disorder isn’t the only complication that people struggling with mental illness have to deal with. While the disorder itself can be daunting to deal with, the whole experience is worsened by social stereotypes and prejudice.
Victims of mental illnesses are often robbed of both a healthy, happy life and access to mental healthcare facilities. They end up being deprived of adequate healthcare, good jobs, and access to freely available resources.
Why Mental Health Stigma Is Prevalent?
Stigma arises whenever the society or those closest to the victim term them as less desirable. It can be manifested in a variety of ways, including negative attitudes, ignorance, or discrimination. The victim is often referred to as ‘other.’
This stigma could easily be fueled by society’s negative attitudes and lack of awareness. In other cases, people struggling with mental illnesses often become society’s soft targets of violence in a variety of ways. For instance, people who have schizophrenia are often regarded as violent and a danger to others.
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Five Common Societal Misconceptions About Mental Illness
1. Mental Disorders Are A Weakness
It is common for the mentally ill to receive a lot of backlash for their mental health status. Their condition often raises questions about their abilities, intelligence, and physical output. Such perceptions about them often lead victims towards a path of anxiety, depression, and hopelessness, which is often a big hurdle to their motivation to seek mental healthcare.
Also, seeking treatment for mental disorders is often regarded as a lack of mental strength. The truth is that mental strength isn’t affected by mental illnesses. In fact, many people dealing with mental health disorders are quite influential and are known to handle their condition incredibly well.
2. It Is Impossible to Overcome Mental Health Problems
Some contributing factors are non-modifiable, such as age, genetics, sex, and family history. However, it is quite possible for people struggling with mental illnesses to manage and recover from their conditions. A lot can be done to their daily living to lead them on the road of recovery. This includes:
- Eating a healthy diet
- Embracing psychotherapy
- Practicing good sleep hygiene
- Taking FDA-approved medication
- Engaging in regular physical activity and exercise
3. Violence Is Normal for People with Mental Disorders
The media has made a significant contribution to the negative portrayal of the mentally ill. Mental illnesses have been tied to ghost possessions, domestic violence, spooky mental asylums, serial killers, and more.
Hollywood movies, news, and documentaries have easily earned the mentally ill a ‘crazy’ label. In reality, people struggling with mental illnesses tend to be innocent and polite and are often not the perpetrators of violence, but victims of it.
The ensuing backlash, false portrayal by the media, constant label, and linkage of mental illness to criminality have all contributed to creating an unsuitable environment for those with mental illnesses to recover or open up about their struggles.
4. Seeking Mental Healthcare Is Considered as a Sign of Failure and a Source of Embarrassment
Around 50% of Americans are embarrassed and hesitant to seek help, regardless of their mental condition. This can be linked to the myths, baseless opinions, and stereotypes that are constantly exchanged within society. Mental health disorders are far from being a choice. Seeking mental healthcare should be seen in the same light as getting help for other health conditions. It should be viewed as a choice to prioritize your health enough to seek treatment and enjoy a better life. Owning up to your mental disorder and seeking help is, in fact, a sign of strength, which shows you have the spiritual power and will to design a happier life for yourself.
5. Mental Health Practitioners Aren’t Doctors
Studies in the field of psychiatry and psychology are of great importance. These health professionals play a key role in diagnosing mental disorders, treating them, and coming up with advanced ways of managing mental illnesses. Psychologists cannot be called doctors until they earn their PhD. in their fields and get authorized licensure. Attending medical schools isn’t a requirement for them. On the other hand, psychiatrists have to attend medical school to completion and take licensing exams before reaching their degree. In both cases, these professionals are referred to as doctors after fulfilling the required criteria.
While there is a significant difference in salary and education, this difference neither takes away their title nor questions their expertise. The fact is that both professions have a significant role to play in decreasing mental health stigma and improving healthcare accessibility with an excellent prognosis.
Stigma Can Be Divided into Two:
- Public stigma
Stereotype: The mentally ill are negatively perceived by society. (violent, different, weak, dangerous)
Prejudice: Rigidity towards these negative beliefs.
Discrimination: Often, this leads to the avoidance and withholding of common living opportunities.
On average, the American and European population has a very negative perception of people with mental health disorders. Even professionals in the mental health sector do practice some form of stigmatization.
Some of the general thoughts about mental health within the public domain are:
- People struggling with mental illness should be isolated from society
- The mentally ill are immature
- Others should make the life decision of the mentally ill since they are incapable of making these decisions themselves
Double standards and discrimination in thoughts and opinions around the mentally ill are quite common. Family members might shy away from socializing with the mentally ill. An above-average portion of society will also have negative thoughts concerning marriages with the mentally ill. This public stigma hurts the chances of the mentally ill to access good jobs, free treatment options, safe housing, social club memberships, public parks, etc.
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Stereotypes: Having a negative perception about oneself (feeling helpless, weak, and crazy, etc.)
Prejudice: Agreeing with and settling to the false beliefs of society
Discrimination: Failing to seek help and missing out on treatment opportunities
It is common for people living within a society that stigmatizes against them to endorse this backlash. With time, a mentally ill person might find themselves thinking that they inherently deserve less, and often lose hope for their future. Low self-esteem and dignity are significant contributors to the low rates of the mentally ill seeking resources and screening.
Moving onto this chapter’s last section
Unlike in the case of general health, there are petty differences among the public regarding accessing quality mental healthcare. The minorities in the United States, such as African Americans, access poor quality mental healthcare, whereas the situation is much better for accessing general healthcare.
Studies show that the prevalence of mental health issues among African Americans is less than or equal to that of the other American ethnic groups. However, the outcomes for blacks aren’t anywhere close to being as good as those of the whites.
4. Barriers in Primary Healthcare and Suicidal Detection
Globally, mental health problems are quite common. In fact, the morbidity and mortality rate has seen a steady increase recently due to inadequate primary care and screening for the mentally ill. Primary care plays a pivotal role in the detection, diagnosis, treatment, and prognosis of mental illnesses. Most people struggling with mental disorders complain about inadequacies in primary healthcare facilities and limited access to the available ones. According to a study conducted by De Hert and colleagues, the poor management of mental illnesses can be tied back to several barriers, which include:
Low Socioeconomic Background:
The unavailability of resources like aids, funding, family support, and insurance coverage hold back people from affording mental healthcare. One of the most significant problems for people with low socioeconomic backgrounds is that the mentally ill are often regarded as disabled and problematic. As such, these individuals have to primarily depend on their own financial abilities due to inequality, social stigma, and low self-confidence.
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Poor Mental Health Experience:
Some of the social experiences people have had with mental health make patients shy away from opening up to society and health experts. For instance, the media has been painting a terrorizing picture of common mental healthcare resources such as doctors and hospitals. Famous Hollywood movies have created the perception of the mentally ill being victimized through experimentation, torture, bloodshed, and violence. This negative image makes it tough for people with mental illnesses to believe that the real world is any different.
Service Provider Barriers:
Three factors drive the quality and capacity to address and treat mental health disorders:
Inadequate knowledge about the different mental health conditions among healthcare providers complicates access to mental healthcare. While there are diverse mental health disorders, a single disorder could affect two people in varying ways. Lacking the knowledge of the multiple aspects of the different disorders makes managing patients an uphill task. Education is necessary among doctors and nurses for them to deal with mental health emergencies with efficiency.
Scope of Practice
The scope of practice of a good number of healthcare providers excludes mental illnesses. While a physician will claim that they have a license to treat the body, they may emphasize that they don’t treat the brain. Such individuals believe that dealing with mental health issues is outside their scope.
Attitudes and Values:
A lot of people find dealing with new primary healthcare workers tough. Making a connection with them and opening up can be a challenge for most people. This especially holds true for people with a history of alcohol and drug abuse as they experience rejection from primary healthcare workers who might see them as “drug-seeking.”
Barriers to Suicide Detection and Management:
In the United States, suicide has grown into a significant concern. Mental health disorders and suicide attempts often go hand in hand.
What Are the Mental Health Disorders Associated with The Risk Of Suicide?
Some of the mental health disorders that result in suicide include:
- Major depression
- Substance abuse
- Emotional stress
- Bipolar disorder
- Personal disorders
- Post-traumatic stress disorder
Here are some of the problems that hold back suicide detection:
Most countries have embraced a grim suicide detection strategy. In most cases, this involves conducting primary health surveys on depression and assessing the probability of suicide occurring among the target audience.
While there are a variety of tools that can help screen suicide, their applicability is often questionable. Having conversations with the patient about their condition as well as their family and medical history is often the best alternative.
People who fit the following description often have a high risk of suicide:
- People facing fatigue
- Clients with chronic pain
- People struggling with financial burdens
- People going through sudden changes in their life
- People who are socially isolated
- People going through postpartum depression
- People who are sleep-deprived
- People with a history of substance abuse
- People struggling with more than one chronic disease
- People whose first-degrees biological relatives have a history of depression
- People living in impoverished home environments
- The geriatric population that lives alone
Often the sensitivity and availability of the screening tools aren’t always at 100%. Picking the ideal screening tools trickles down to a variety of factors, including personal preferences, availability, time consumption, and other factors.
The fact that screening tools are also known to lead to false-positive results is also a major drawback. This can lead to high medical care costs, which could complicate the lives of people who lack private insurance.
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5. Financial Barriers
The adverse effects of economic and psychological issues have had a significant role to play in the increasing burden of mental health disorders around the world. According to recent research, about 56% of the population with depression and 86% of people struggling with alcohol abuse go untreated due to the high cost of accessing treatment.
Globally, the inability to afford mental healthcare treatment is the main cause of treatment denial. Many of America’s insurance companies, especially Medicare, either allocate inadequate resources or completely fail to cover mental healthcare services. Reversing this is largely in the hands of authorities, caretakers, and the policymakers.
WHO has already confirmed the significant threat that lies with mental illnesses? Millions of Americans find accessing psychiatric healthcare challenging. Often, those who access the care often have to go through a maze of fragmentation and financial obstacles.
Some of the main reasons behind these financial issues include:
- Insurance companies’ high rate of denial of care
- Health insurance networks lacking mental health experts
- Mental healthcare facilities demanding high out-of-pocket costs
These issues will exist, whether the person seeking mental healthcare has private or public insurance coverage. Here is a list of the opportunities for healthcare treatment offered in the United States and the financial aspect that hold them back:
Ideally, having insurance coverage is meant to make accessing treatment easier. There is a scheme under the American health system that allows all deserving populations to access treatment under a specific insurance plan.
Many insurance sources under this scheme do cover mental health treatments. For instance, employers can provide insurance to their employees. As for young people (those below the age of 26), they can always rely on the coverage provided by their parent’s employer. On the other hand, college students can enjoy low-cost insurance provided by the school’s state.
The Financial Drawbacks of These Insurance Options
A good number of these plans might exclude mental health conditions from their coverage. Despite the government trying its best to be strict, many insurers could exclude previously diagnosed illnesses from their coverage. In other cases, the mentally ill might struggle to afford common insurance plans, with some working under employers who don’t offer insurance!
For people who can’t access insurance through family support, school, or work, there is always the option to access government-sponsored plans through:
- Affordable Care Act Marketplace
Medicare And Medicaid
The U.S government sponsors Medicaid and Medicare. These services are provided based on qualifications, disability status, income, and age. For you to gain access to the service, you will need to work with a social service agency to fill social security disability applications.
The Limitations of Medicare:
Limited Providence of Facilities
Other than the popular Medicare plans to have a variety of financial restrictions, the services that you can access under the insurance are limited to a specific budget. For a majority of these plans, you will need to pay higher fees if you can only access out-of-network healthcare providers. While other plans can give more choices, they often come with a high price tag that is difficult to afford.
State-Specific Limitations on Coverage
Although Medicare services can be accessed throughout America, the advantage plans will often be strictly restricted to specific areas or states. This will prove to be disadvantageous to the demographic that travels frequently; their health insurance might not work outside their residential area.
The Additional Cost of Healthcare Coverage
At face value, Medicare looks like a reasonable plan that comes with premium charges that are automatically deducted throughout the project’s many parts. However, it might have user-specific hidden charges. These charges could include specialist visit copays, add ups on the advantage plans, and drug deductibles.
Free Clinic and Health Services
While insurance will cater to most parts of healthcare, there exist a couple of cost-free options. These options are easy to obtain through Federally Qualified Health Centers (FQHC). However, you need to meet stringent requirements to gain access to these services.
Another popular option is to reach out to local non-profit organizations. While some therapists under these organizations can offer their services at no cost, such opportunities are often luck-dependent.
What Are the Possible Issues?
Cost-free options are often offered by healthcare candidates like part-time workers, observers, and trainees. These candidates might fail to match the quality services and treatment regimens offered by experts. People seeking treatment for their mental health disorders could easily experience a lack of professionalism and malpractice.
Funding for The Mentally Ill Working Population
Finding employment as a mental health patient is often a struggle. However, job seekers can always leverage the disability quota for a chance at landing minimum role jobs. The government also provides supported employment options and vocational rehabilitation services. The former offers people with mental illnesses an excellent opportunity to make enough money and afford their treatment.
In order to get supported employment, you might have to contact mental health agencies. Your employment could be restricted to specific sectors, such as teaching the mentally ill. Once you are employed, your employer will take the responsibility of eliminating any barriers to how you work. Often, this involves stringent supervision to ensure high levels of quality and create an ideal corruption-free environment.
The Difficulty of Maintaining Jobs With Mental Disorders
It is often difficult to find and maintain jobs with mental illness. While 60% of Americans suffering from mental illnesses are ready to work, it can be surprising to learn that their unemployment rate lies at 80%. Sure, seeking a job with a mental illness can be a great idea, but the underlying illness could complicate relating with others in the workplace.
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There is a diversity of barriers to healthcare to accessing ample care for mental health disorders, with most of the above-listed obstacles having several contributing factors. The ensuing stigma and lack of healthcare access could arise from both the society or the patient himself. The ultimate goal is to work on ways for breaking these stereotypes and barriers to eventually allow victims to enjoy a healthy and functional life like the rest of the population.
Now that you have learned enough about lack of access to mental health care aspects, you can do your part to change this narrative. Whether you or your loved one have a mental illness or not, you are always welcome to seek care at Mango Clinic. Feel free to leave a comment and visit this site anytime for more knowledge.