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Why is it so hard to get mental health care and support?

By Nora Dennis, MD MSPH | May 3, 2021 | Industry Perspectives, Behavioral Health, Transforming Healthcare

Over and over I have heard the complaint from friends: they have insurance but can’t find a therapist or psychiatrist. Everyone they call is full. With the weight of their depression or anxiety making it difficult to initiate activity, they face the additional barrier of lack of appointment availability.

The behavioral health crisis in the United States has never been more apparent. The COVID-19 public health emergency laid bare the intensity of need for behavioral health services. In a recent survey, 23.8% of Americans with symptoms of anxiety or a depressive disorder had unmet mental health needs. That’s an increase of 2.8% from August 2020.1

The five barriers to care

In many ways, there are multiple gates between people with behavioral health disorders and access to appropriate care.

First, stigma surrounding behavioral health disorders prevents many people from recognizing that they are suffering and seeking care.2

Second, there is the disorder itself. In many cases behavioral health disorders impair energy, concentration or executive functioning. These boundaries can make it difficult for a person to organize themselves to sit down and call providers to find someone who is able to see them.

The third gate is the appointment availability, which may be extremely limited.

Fourth is affordability. The percentage of psychiatrists who accept insurance is significantly lower than physicians of other specialties.3 That means even people with health insurance might be unable to afford behavioral health care.

Fifth is time. Unlike some other chronic medical conditions, behavioral health disorders are best treated by a combination of both medications and therapy. High quality psychotherapy may require weekly treatment for multiple months, which can be a challenge for many people to fit into already busy schedules.

What can we do about it?

At Blue Cross and Blue Shield of North Carolina (Blue Cross NC), our behavioral health team is committed to the vision that behavioral health services should be accessible, high-quality, and stigma-free. To this end, we have enacted a variety of programs to change our members’ experience as they seek behavioral health services.

Blue Cross NC pays for behavioral health services received via telehealth at the same rates as those paid for in-office visits, making it easier for our members to receive care from the comfort and privacy of their own homes. Our team is working with Quartet, a technology platform that matches members with a behavioral health provider who can care for their presenting condition, accepts their insurance, and can see them in a timely manner.

This platform is available to most Blue Cross NC customers. Check with your employer to see if it applies to your plan.

Graphic explains how to get started with Quartet: Sign up on, answer a few questions about yourself, and someone will reach out to you to welcome you and help you match with a behavioral health provider.

Using Quartet, behavioral health providers can track their patients’ symptoms and communicate with their primary care provider. We believe that our members should not have to make multiple phone calls to find a provider who can see them. Quartet makes it possible for members to simply enter their contact information, and then they will receive outreach from a care navigator and a behavioral health provider. In addition, members who use Quartet have access to free digital cognitive behavioral therapy tools through Silvercloud.

Behavioral health disorders are some of the most common health problems. Globally, the disease burden of depression is tremendous. Among those ages 10-24, three of the top five burdens of disease are behavioral health disorders.4

The pervasive and highly impactful nature of these illnesses coupled with our increasingly sophisticated understanding of their mechanism and biological origins compels us to stop treating them as individual failings and start acknowledging them as treatable illnesses.

Our Blue Cross NC behavioral health team will continue innovating and striving to improve care for every one of our members. We won’t stop until healthcare is better for all.


[1] Vahratian A, Blumberg SJ, Terlizzi EP, Schiller JS. Symptoms of Anxiety or Depressive Disorder and Use of Mental Health Care Among Adults During the COVID-19 Pandemic — United States, August 2020–February 2021. MMWR Morb Mortal Wkly Rep 2021;70:490–494. DOI: icon.

[2] Thornicroft, G., Mehta, N., Clement, S., Evans-Lacko, S., Doherty, M., Rose, D., Koschorke, M., Shidhaye, R., O’Reilly, C., & Henderson, C. (2016). Evidence for effective interventions to reduce mental-health-related stigma and discrimination. Lancet (London, England), 387(10023), 1123–1132.

[3] Bishop, T. F., Press, M. J., Keyhani, S., & Pincus, H. A. (2014). Acceptance of insurance by psychiatrists and the implications for access to mental health care. JAMA psychiatry71(2), 176–181.

[4] GBD 2019 Diseases and Injuries Collaborators (2020). Global burden of 369 diseases and injuries in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet (London, England)396(10258), 1204–1222.

Quartet Health is an independent company providing behavioral health support services on behalf of Blue Cross NC. Quartet Health does not offer Blue Cross or Blue Shield products or services.