Jim Sliney at Patients Rising asked me to write my perspective about the barriers of patient access to healthcare.
There are three big barriers, in my experience. These barriers to healthcare access keep people from getting the mental healthcare services they need.
The superficial answer is cost, distance, and stigma. But the complete answer is a combination of those in conjunction with low self-esteem and inertia. You can use your health advocate to develop a sense of presence in your environment (including a sense of personal power) and persistence.
Seeking Help is Being Strong
Mental Health Treatment has carried a stigma in most cultures. Self-reliant American culture associates it with weakness. Certain faith communities believe that the afflicted have a spiritual deficit. Nancy Reagan dismissed drug abuse as willful misbehavior. Her “Just Say No” promotion changed the model of care and legitimized re-allocating resources away from treatment. These cultural factors can contribute to the weight of hopelessness that you feel as you seek help.
Managing your feelings means changing how you think about the other barriers that exist within the structure of service delivery. Insurance plans often have a different co-pay or additional deductible for mental health care. Plans emphasize the briefest modes of treatment, usually pharmacotherapy, while ignoring the evidence-based research that shows that medication and counseling combined are more effective for the client.
Large scale programs such as Kaiser Permanente and the Department of Veterans Affairs introduce evaluation protocols with the intent of assuring equal access and standardized treatment methods. Ironically, they assure the opposite. Even smaller County-run clinics share these types of bureaucratic-structured barrier problems.
Getting What You Deserve
One veteran explained that negotiating the requirements to get the VA mental health services required jumping through numerous hoops. By the time he had dealt with the frustrations, the delays, and obfuscation in the system, he had developed coping strategies to manage his feelings to the point that he didn’t need help anymore. He got better. Even so, this is a poor excuse for care.
I work with patients regularly, helping them demand a second opinion when dealing with the barriers to healthcare access. Often that happens to be an option within their plan, but they feel they aren’t entitled to access it. If you are one of those who have been turned down once, you need a boost to get over the barrier. Low self-esteem makes for a slippery climb.
Change of Mindset
If you’re struggling with depressive feelings, your self-esteem bucket is likely near empty. Don’t despair. Many people walking through life feeling bad about the person they see in the mirror each day. The task for you in navigating the care system is to use the advocacy assistance available and prepare psychologically to interact with the system to get the right care. As you do that, your self-esteem will improve, too.
The first step is simple. First, disregard the MSRP. New car price stickers shock your system. But a salesperson will tell you that he can make the car “affordable.” In healthcare, the MSRP is the rules that govern who gets care, where, for how long, and from whom. If you are told that what you need is “not covered,” psychologically, disregard the rules.
Move Out of Your Comfort Zone and Change The Game
My recommendation goes against all the social prescriptions you have learned growing up. These can be recognized in familiar sayings. “Pull yourself up by your own bootstraps.” One that I particularly like and seems relevant for our discussion is, “Do unto others what you would have them do to you.” Only flip it around in your mind: “Expect from others what you would have done for them.”
This serves to legitimize your request. Without that sense of compassionate entitlement, you will have difficulty accessing all the available advocacy resources. I work with patients regularly who can’t ask to be referred to a specialist. If it involved a family member, they would be the first to stand up! But in some way, for themselves, they feel they might be expecting too much. Have you ever felt this way? Consider asking for an exception.
Tackling the health care monster might feel overwhelming. So don’t give them that power. Even the largest corporation has an individual at the top. And as you negotiate your care, you only have to deal with the doctor, nurse, technician, or clerk in front of you. You can overcome the barriers to healthcare access.
Initiate. They can’t read your mind. If you approach them with the changed attitude that what you are requesting is reasonable, you are setting the stage for the discussion. Be ready to feel frustrated. That’s the system’s defense against your reasonable request. If they can poke you to escalate into expressing anger, they get to dismiss you as irrational. Keep your cool. Believe in yourself. Use your advocate.
Persist. Return to ask again. Ask to be referred to someone else who might be able to help you. In many cases, systems are like mazes. You have to find your way around inside them. Your advocate can help with that. My input focuses on how you contain your feelings in order to maximize your results.
Take Up Space
A client once told me that her physical size was her psychological armor. She displayed confidence as she moved through the world. She had no fear even though she lived in a bad neighborhood. She was not trained in martial arts, but she conveyed the message, “don’t mess with me.” You probably have met someone like this.
You have a place in the world. You have a right to be where you are at. I’ve had clients who will defer to others in line waiting to register for a visit. I am not suggesting you push to the front of the cue, but claim your place. You’ll feel better, and you’ll work with your advocate in a more assured way. In the end, express gratitude for what you receive. It will smooth the way for you and others the next time. We’re all in this together.
I hope my advice on how to overcome the barriers to healthcare access provides you with the guidance needed.
Dr. Dennis Lewis, is a practicing psychologist specializing in the treatment of trauma and family dysfunction. 📚For more than twenty-five years, he has been on the clinical faculty of the University of California San Francisco. He serves as a national consultant, expert witness, and media spokesperson. He divides his time between his clinical practice, professional writing, and forensic consultation.
Specialist in Addictions 💊 Dr. Lewis led the development of substance abuse programs across multiple institutions during his active career. He developed the PATHS Program, a perinatal treatment facility for substance-abusing women. This unique program combined gender-specific treatment and an early child development program for the women’s children ages zero-to-five. The goal was to break the cycle of dependency in the family by engaging multiple generations in recovery.
Current Activities 🏥 He is retired from both the Veterans Administration and Kaiser Permanente. He continues to consult with mental health training programs in California’s central valley and supervise psychiatric residents in group and individual psychotherapy. Dr. Lewis has published research in the area of neurobehavioral problems with alcoholics.