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Mental health care access in the U.S. is plagued by challenges, including a lack of providers. This issue is not new, and the situation becomes more alarming when you consider that in 2020, 53 million adults, or 21% of the population, were affected by a mental health condition, with 14 million adults, or 5.6%, experiencing a severe mental illness. Mental health advocacy groups highlight that many individuals can't get the care they need in times of crisis and emphasize that millions go without necessary treatment each year.
A U.S. Government Accountability Office report released in March found that even when people attempt to seek care, they often face barriers like mental health providers not accepting new patients or long waiting times. These hurdles can result in higher healthcare costs, delays in receiving treatment, and challenges in finding local providers. In light of this, what can someone do when they are struggling and unable to access professional support?
What should you do when mental health services are out of reach?
"I believe that skills are extremely valuable because therapy often offers a chance to process emotions, have someone listen, and hopefully provide reflections and insights that encourage personal breakthroughs," said Kathryn Gordon, a clinical psychologist and author of The Suicidal Thoughts Workbook: CBT Skills to Reduce Emotional Pain, Increase Hope, and Prevent Suicide. "However, it's equally beneficial to have practical tools that individuals can use on their own, either when they are not in therapy or during the gaps between sessions."
Gordon noted that many skills can be learned outside the therapy room, especially when access to care is limited. These can be found in self-help books, free apps like Virtual Hope Box and COVID Coach, YouTube videos, and podcasts. These resources can help you develop healthier habits, soothe yourself in stressful moments, and improve your self-talk with kindness.
Learn to identify your emotions
Gordon explains that one of the most essential skills is being able to recognize your emotions. Though this may seem simple, many people don’t pause to consider their feelings. They may only know if they feel good or bad. But when someone identifies their emotions, they often experience a sense of relief or clarity, which can help them validate their feelings and gain deeper self-awareness.
For example, if someone recognizes they are angry after a particular event, they can begin to understand the reason behind their anger and take steps to resolve it.
"The first step is recognizing what it is that I need," Gordon shared. "For example, if I feel angry, do I need to express myself? If I feel isolated, should I reach out to connect with someone? Identifying emotions is the key to understanding what actions are necessary to address them in the moment."
Engage in mindfulness
Mindfulness, a practice commonly taught in dialectical behavioral therapy (DBT), can be incredibly helpful. Dialectical behavioral therapist Britt Rathbone, founder and director of Rathbone & Associates in Maryland, explained that mindfulness is all about awareness. Without understanding what triggers emotions that might lead to harmful behaviors, it’s hard to make changes.
Mindfulness involves observing thoughts and feelings, and this can be practiced by changing the way we use language, according to Rathbone. For instance, instead of saying, "I hate that person" or "That person hates me," try reframing it as, "I’m noticing the thought that I hate that person" or "I’m noticing the thought that that person hates me."
"What we’re doing here is shifting from identifying with your thoughts to observing them from a distance," Rathbone noted. "Because thoughts aren’t facts. When you step outside of them, you can observe them and decide how to respond in a way that’s different from being caught up in the thought itself."
By becoming aware of your thoughts, emotions, or impulses, a therapist can help you recognize that you have the opportunity to pause and choose how to respond, rather than simply acting on autopilot, which is often driven by outdated patterns of behavior. While autopilot can be useful most of the time, as Rathbone explains, it can sometimes lead to trouble when relying on learned responses that no longer serve you effectively.
Act against your emotions
One approach taught in DBT is known as opposite action. Rathbone describes opposite action as a technique for when emotions evolve into moods. He emphasized that emotions are a natural part of being human, but when we engage with and nurture those emotions, they can turn into moods that shape our behavior.
Opposite action is particularly helpful when emotions turn into moods that don't align with reality and prompt actions that may ultimately be unproductive or damaging. Rathbone encourages people to assess the situation and take actions contrary to what their emotions may be urging them to do in those moments.
For instance, imagine someone feeling sorrow after a setback and wanting to remain in bed all day. While grief is a typical response in such circumstances, the question remains: does staying in bed for an extended period truly help in coping with the situation?
Rathbone explained, “If we listen to [the emotion] and remain in bed, avoiding any action or interaction, it will eventually lead to depression. The longer this continues, the deeper we fall into the hole.” He added that practicing opposite action helps break this cycle by encouraging movement, socializing, and re-engaging with life, ultimately helping to lift one's mood.
Keep track of your self-criticism and inner dialogue
In challenging times, negative self-talk and critical thoughts are counterproductive, particularly when striving for improvement. Clinical psychologist Valentina Stoycheva, who owns Stress & Trauma Evaluation and Psychological Services (STEPS) in Huntington, N.Y., emphasized that people don’t change their behavior by shaming themselves into action.
Stoycheva highlighted the importance of self-compassion in learning to observe one’s thoughts and feelings without harsh judgment. She noted that many patients, after learning this skill, realize just how negative and self-critical they had been without recognizing it before.
“This is crucial because constant self-criticism makes change more difficult,” she said. “One helpful approach is to ask yourself, ‘What would you say to a friend in the same situation, feeling the way you feel now?’”
Prevent a crisis through self-soothing
For those facing particularly tough moments, self-soothing can be a helpful tool, a distress tolerance skill used in DBT. Rathbone points out that many of his clients, during these challenging times, might engage in harmful behaviors, like drug use, which could have long-lasting negative effects. In these situations, it’s essential to reduce the emotional intensity they’re experiencing.
Rathbone explains, “If you imagine your mood on a scale from 0 to 100, once you surpass 80, your thinking becomes clouded. At that point, emotions dominate, and you’re more likely to make impulsive, rash decisions.”
Self-soothing is a technique aimed at helping individuals in those high-intensity moments to avoid crisis. Rathbone notes that self-soothing activities can vary from person to person. Some people find comfort in petting their dogs, listening to music, watching a movie, going for a run, or even playing video games.
While self-soothing is a popular and useful technique, Rathbone cautions that it’s not a permanent fix. The feelings that led to the crisis will likely return, and once calm, it’s important to begin problem-solving. Otherwise, there’s a risk of falling into a cycle of avoidance as a coping mechanism.
Direct your attention to what you can change through the practice of radical acceptance
Radical acceptance, another distress tolerance skill introduced in DBT, can be challenging for some, as noted by Rathbone. While its name is easy to remember, the concept can be difficult to grasp. Radical acceptance involves recognizing that things are as they are, and resisting this reality will only lead to further distress. Accepting reality, even when it's painful, allows us to find peace in the present moment.
When people experience distress, they often struggle against reality, Rathbone pointed out. However, once we accept reality, we can focus on what we are truly able to change. For example, imagine someone upset because they want it to rain to water their garden. Though they can’t control the weather, they could explore alternatives like manually watering the plants or selecting drought-tolerant plants. If they don’t accept that the rain isn’t coming, they may miss out on these other solutions and continue to suffer.
Make self-care an essential part of your daily routine
Although self-care has become a popular term, Stoycheva highlights that its true meaning, especially in relation to mental health, is often misunderstood. Self-care isn't just about occasional indulgences like massages. Rather, it's about making consistent efforts to maintain your well-being. This might include regular exercise, daily walks, carving out time for reading, or connecting with a friend who provides comfort.
“Some of these things that help you should become a regular part of your routine,” Stoycheva emphasized. “[You need to carve out time] for them, not just in times of crisis.”
She also noted that these self-care activities are often the first to be neglected when people experience burnout—which is ironic, as these activities are actually key to preventing burnout.
Establish healthy personal and emotional boundaries
Mastering the art of setting boundaries is essential for maintaining good mental health. According to Stoycheva, this involves not absorbing others' emotions as your own or trying to fix the problems of those around you. These behaviors often lead to unnecessary stress.
When Stoycheva meets with patients, she occasionally asks them what changes they wish to see in an ideal scenario. If a person expresses a desire for a loved one to change their behavior, she stops them and gently explains that while she shares their wish, those changes are out of their control. She then shifts their perspective and encourages them to focus on what they can control, helping them to set emotional boundaries.
Consider categorizing the challenges you're facing into two groups: those you can influence and those beyond your control. Once that’s done, Stoycheva advises, concentrate on the issues you can control.
Recognize your triggers
While the term “trigger” is commonly used, it can refer to a variety of things in mental health. Stoycheva clarifies that triggers may include alarming situations, specific people, certain locations, or even particular ideas. It could also be a TV show depicting something upsetting that mirrors issues in your life. Understanding your triggers is vital so that you can either limit your exposure to them or mentally prepare for them if they’re unavoidable.
If someone is triggered, they shouldn’t ignore it, as it’s likely they will have a reaction.
“It’s better to expect it and take extra care,” she said. “So, this happened, I’m triggered. Let me take a moment to read a book or calm myself down.”
Examine the evidence behind negative thoughts
Anyone who has struggled with persistent negative thoughts understands how they can feel relentless, like a game of whack-a-mole. While these thoughts may never completely fade away, there's a useful skill to keep them in check. Gordon suggests one way to deal with negative thoughts is to search for evidence supporting and contradicting those thoughts to assess their validity.
For instance, if the thought is that you're a terrible person, she said, you should ask yourself a few questions. What evidence supports this thought? What evidence contradicts it? Is there a way to rephrase this thought that would lessen the intensity of the negative emotions?
“If I think I’m a terrible person because I made a mistake or something like that, the evidence for it might be, ‘Well, I made a mistake.’ The counter-evidence is that this doesn’t define me as a person,” Gordon explained. “I might think about the positive actions I’ve taken that are far from 'horrible person' behavior. So, I may come to a more accurate conclusion like, ‘I’m not pleased with the mistake I made, but overall, the evidence points to me being a good person who’s trying, and everyone makes mistakes.’”
Remember that this too shall pass
Clinical psychologist Gordon emphasized that when facing distress, people can benefit from engaging in activities that are physically stimulating or provide a sense of positivity. She also highlighted the importance of recognizing the role time plays in alleviating distress in such situations.
"Sometimes, just knowing that your mood will shift, even if you don't actively use any self-soothing techniques, can help you push through distress," Gordon mentioned. "Realizing that even though it’s tough now, in a little while, it might feel better," she added.
When to seek professional help
Rathbone, a dialectical behavioral therapist, points out that mastering any skill requires practice. Some may expect immediate results with mental health techniques, but that’s not the case – it’s about continuously working to improve through repetition and practice.
Moreover, Rathbone clarified that mental health care isn’t a one-time fix. It’s like physical fitness – regular effort leads to results, but if you stop, you lose progress. Most crucially, if you’re dealing with suicidal thoughts or ongoing distress, professional help should be sought right away.
Stoycheva recommends picturing yourself as a thermometer. At the bottom, the thermometer is green, which signals that you're doing well – you're feeling content, relatively calm, and managing any challenges that come your way. Moving upward, yellow represents mild stressors – you're not feeling your best, but you're still coping and can see the light at the end of the tunnel. It may be tough, but you're pushing through.
Above yellow is the orange zone, where things start to get more worrisome, according to Stoycheva. People in this stage often feel out of control and helpless. They may have been feeling down for weeks or struggling to manage their anxiety. At this point, they realize they're not OK and might start withdrawing from others. It's overwhelming to talk to people or leave the house. Some might even turn to substances or engage in unhealthy behaviors they wouldn’t normally do. In some cases, their eating habits may become irregular.
"That's typically when you should reach out," said Stoycheva. "Your nervous system has been under strain, and you've tried to handle it by yourself. Even if you think, 'I can do this alone,' your body is signaling that you shouldn't have to. You could be the strongest person, able to lift 300 pounds, but this one challenge is 350 pounds. You can't lift it alone."
