One myth that I have occasionally heard is that if someone gives up on getting mental health care, it means they did not really want to get better. This is, obviously, cruel and unempathetic, but it also ignores a stark reality. The mental health care system has several barriers in place that often prevent patients from accessing care. Primary among these is administrative burden.

Administrative burdens are the pieces of red tape between a patient and their health care. Sometimes it is extra paperwork, or other times additional knowledge that most people do not have. These lead a patient to spend more time and effort to find and receive the care they need. Here are some examples of administrative burdens in mental health care.

• Needing to get prior approval before insurance will pay for therapy sessions.
• Insurance not paying for a visit to a psychiatrist because the psychiatrist is not in the insurance company’s network. This means the psychiatrist did not sign a contract with the insurance company agreeing to a certain pay rate.
• Directories that list therapists and psychiatrists as in-network but the person does not actually accept that insurance. The patient may waste hours calling potential therapists and psychiatrists only to find they would have to pay for the care themselves instead of being able to use their health insurance.
• Needing a referral from their primary doctor to see a therapist or psychiatrist.
• Complicated processes for logging into a portal to make appointments.
• Receiving confusing paperwork on what care was paid for by the health insurance company. This can lead to stress for the patient if it is not clear how much they have to pay.
• Having to pay for mental health care in advance and then send a request form to their insurance company with a receipt from their therapist to get reimbursement.
• Complicated and confusing workplace policies about paid time off and processes for requesting time off.
• Need for additional documents from their therapist or psychiatrist to gain assistance at school or work to support their mental health.

While not every patient will encounter every type of administrative burden, most will encounter at least one, if not multiple. I also want to emphasize that this is not an exhaustive list of administrative barriers to getting mental health care. These examples are some of the most common that I hear about from patients, fellow psychologists, and in the press.

Administrative burdens are particularly harmful for people with mental health conditions because the symptoms of their conditions can make it harder to hurdle these barriers. Fatigue and trouble with motivation are common symptoms of depression. Trouble focusing and concentrating is a hallmark of anxiety and attention deficit hyperactivity disorder. All of these symptoms can make it more difficult to push past these barriers and figure out a solution.

So the next time someone is talking about having trouble finding a therapist or psychiatrist, please keep these points in mind. A common saying in the mental health field is that admitting you need help is 50% of the work. I would argue it is actually 25% of the work, with 50% of the work hurdling administrative burdens and the remaining 25% being the actual work of therapy and taking medication.