Why Is Mental Health Care So Hard to Access?
If you’ve tried to find a therapist lately, you already know the drill. You search. You call. You leave voicemails. You fill out forms. You wait. Or you finally get an appointment, weeks out, only to learn they don’t take your insurance. They’re not accepting new clients. The “next available” time is 2:15 p.m. on a Tuesday when you’re at work. Many people assume they’re doing something wrong when it is hard to find care. That assumption makes an already difficult process even heavier. It’s exhausting, and it can start to feel personal. At Tactical Counseling, I want to be clear about something up front: access is hard because the system is hard, not because you’re failing.
Barrier #1: There Aren’t Enough Appointment Slots
Even as more clinicians enter the field, more are leaving, taking jobs at agencies and closing up their private practice. Demand is outpacing availability slots. People are seeking help for stress, trauma, anxiety, depression, substance use, grief, relationship strain, and burnout, often all at once. A therapist may be “available,” but not available at the frequency, times, or pace you actually need. The counselor only sees one client at a time for an hour in individual therapy. Existing clients often take priority, further widening the gap in access to initial clients. The widening gap creates long waitlists and limited scheduling options, especially in smaller communities and rural areas where mental health needs are rising, and resources are limited.
Barrier #2: Insurance Coverage Isn’t the Same as Access
Having insurance doesn’t automatically mean you can get care. Many plans have limited networks. Some providers are “in-network” on paper but aren’t taking new clients. Others are credentialed but only offer a few insurance slots. Then there’s the practical reality of copays, deductibles, session limits, prior authorizations, and paperwork.
This is one reason some practices operate private-pay: it reduces administrative burden and allows more consistent scheduling. Unfortunately, it can also create a cost barrier for many clients. When people feel stuck between “can’t find someone who takes my insurance” and “can’t afford private-pay,” it’s easy to give up. That discouragement is a rational response to a frustrating system.
Barrier #3: Geography and Logistics Still Matter
Even with telehealth, not everyone has a private space for sessions, reliable internet, or a schedule that supports consistent appointments. Shift work, overtime, childcare, and unpredictable demands, especially for first responders and health care professionals, can make therapy feel impossible, even when motivation is high.
Barrier #4: Stigma and Burnout Don’t Help
Sometimes the barrier isn’t only external. People delay care because they feel like they “should be able to handle it,” or because previous experiences made them feel judged, misunderstood, or dismissed. For high-performing people, the hardest part can be admitting, “I don’t want to keep living like this.” When access is already difficult, stigma becomes the final weight that keeps someone from trying again.
What’s Changing (And What Still Isn’t)
There are signs of progress. Medicare has expanded who can provide covered outpatient mental health services, including marriage and family therapists and mental health counselors. Starting in 2024, Medicare began allowing mental health counselors and marriage and family therapists to bill independently for covered services under Part B. These are meaningful steps toward expanding capacity and reducing bottlenecks.
But policy changes don’t instantly create more appointment slots, reduce administrative friction, or solve workforce shortages. Access improves when the system supports sustainable practice models and when people can realistically afford care on a timeline that matches the urgency of their lives.
What You Can Do When the System Feels Like a Wall
If you’re stuck, here are a few strategies that are actually practical:
- • Widen the search radius, especially for telehealth options.
- • Ask about waitlists and cancellation lists.
- • Request a current in-network provider list from your insurer.
- • Ask about superbills for possible out-of-network reimbursement.
- • Explore sliding-scale or community resources while you continue searching.
None of these are perfect solutions. They don't guarantee immediate access, but they increase the odds, and that matters when persistence is already costing you energy. They can turn “stuck” into “moving,” and momentum matters.
Strategize Your Success
If finding care has been discouraging, you’re not alone, and you’re not doing it wrong.
At Tactical Counseling, I try to be transparent about availability, fit, and options. I offer services in person and via telehealth. I keep a robust schedule that provides as many opportunities as possible during both peak and off-peak times to match your schedule. I provide superbills through the client portal and can help you learn how to submit them to your insurance provider to apply toward your deductible or for reimbursement directly to you. And I offer sliding-scale options to Open Path Psychotherapy Collective members. I’m happy to help you think through a strategy that matches your schedule, needs, and resources, even if the best next step is connecting you to a different level of care.
Resources for Further Reading
- • Centers for Medicare & Medicaid Services. (2025). Marriage and family therapists & mental health counselors. https://www.cms.gov/medicare/payment/fee-schedules/physician-fee-schedule/marriage-and-family-therapists-mental-health-counselors
- • Medicare.gov. Mental health care (outpatient). https://www.medicare.gov/coverage/mental-health-care-outpatient
- • Health Resources & Services Administration. (2019). Behavioral health workforce projections. https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/bh-workforce-projections-fact-sheet.pdf