Mental Health Barriers, Identity, And Intersectionality: Finding Help

Human identity—shaped by race, gender, sexuality, socioeconomic status, disability, and more—profoundly affects how we experience mental health. Like other areas of the health care system, mental health care has historically been viewed through a clinical or individualistic lens, yet the living realities of many people show a more complex picture. With current efforts in advocacy and understanding, these limitations seem to be diminishing, offering more culturally competent and accessible mental health resources. This article explores how multiple social identities can create unique challenges and disparities in accessing and experiencing mental health care.

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What is intersectionality? 

According to the Merriam-Webster dictionary, intersectionality refers to “the complex, cumulative way in which the effects of multiple forms of discrimination (such as racism, sexism, and classism) combine, overlap, or intersect, especially in the experiences of marginalized individuals or groups.” Legal scholar Kimberlé Crenshaw first presented the concept to describe the complex layers of discrimination some populations experience. For example, a Black transgender woman may face racial discrimination, gender-based violence, and transphobia—each amplifying the risk of psychological distress in ways that are not captured by focusing on just one identity. 

The concept of intersectionality in mental health care

Social identity and mental health services disparities

Access to quality health care can be deeply influenced by an individual’s identities. People from historically marginalized communities often face greater mental health burdens while having less access to appropriate care. Race and ethnicity can play a major role, and gender and sexual orientation may present a unique set of variables that create barriers. Each country views mental wellness differently and prioritizes it in different ways. According to BetterHelp’s State of Stigma report, respondents across the globe believe that societal expectation can discourage people from seeking mental health resources.

Race and ethnicity 

Black, Indigenous, and People of Color (BIPOC) individuals typically encounter higher levels of racial bias and structural racism in mental health services than their White counterparts. This may come in the form of disrespect or dismissal by mental health care providers, as well as diagnostic bias. Additionally, cultural misunderstandings between health care providers and clients can lead to mistrust and disengagement from care. For many communities, intergenerational trauma, immigration stress, and experiences of racism add complexities to mental health struggles that traditional models may overlook.

Challenges in treatment regarding gender and sexual orientation 

LGBTQIA+ individuals, particularly transgender and nonbinary people, tend to face significantly higher rates of depression, anxiety, and suicide. These disparities may result from factors like social rejection, discrimination, and violence. When services lack affirming, knowledgeable mental health providers, this can lead to experiences of harm or erasure. Similarly, women may face gendered expectations, trauma, and care models that pathologize their responses to oppression.

Socioeconomic status and access to mental health care

Income, education, and employment can be major determinants of mental health. The relationship between poverty and mental health conditions is often bi-directional, with poverty both increasing the risk of mental health conditions and potentially resulting from them. Not only are people living in poverty more likely to experience mental health challenges, but they are also less likely to receive care. High therapy costs, inadequate insurance coverage, and long waitlists can further exacerbate inequality.

Housing, employment, and chronic stress

Individuals experiencing unstable housing, employment insecurity, and food insecurity may be more likely to experience severe and chronic stress that takes a significant toll on mental health and leads to more serious mental illness. These stressors may be causes of mental health concerns, but they can also create barriers to adequate care, potentially leading to a cycle of mental illness and poverty. Without addressing the underlying social elements, mental health care risks being out of reach for the people who need support the most.

Stigma, discrimination, and cultural taboos

Stigma can be a considerable barrier to mental health support. In some cultures, mental illness is misunderstood as a type of “weakness” or a flaw in temperament. This can deter individuals from acknowledging symptoms and seeking care. Discrimination within mental health systems, such as language barriers or bias against non-Western beliefs, can further isolate individuals. Internalized stigma can also lead people to believe they are undeserving of help, especially if they've been marginalized across multiple identities.

Systemic barriers in mental health services

Health care institutions often mirror the broader inequities of society. For example, intake forms may assume heteronormativity, or clinicians may overlook cultural practices and beliefs when devising treatment strategies. While these oversights may not be intentional, they can cause harm. A lack of diversity among mental health professionals can aggravate the disconnect, with many patients unable to find providers who understand their perspectives and lived experiences. 

Gaps in treatment research and policy

Another concern regarding intersectionality and quality of care lies within the lack of mental health research and policy-making around individuals in marginalized groups. This lack of representation can create gaps in data that lead to diminished understanding and, ultimately, substandard care. Without accurate, fully representative data, disparities often remain unaddressed in conventional care models.

The importance of culturally competent treatment

The therapeutic bond between therapist and client can be critical for favorable treatment outcomes. When therapists demonstrate cultural sensitivity and understanding, clients may sense that they are validated, increasing the likelihood of establishing a strong therapeutic bond. Culturally competent therapists can build trust in a safe, supportive environment by respecting their clients’ unique backgrounds and experiences. 

Additionally, by understanding and addressing intersectionality, therapists can tailor interventions to better meet clients' mental health needs, leading to improved outcomes. 

Culturally competent therapists can help clients feel comfortable seeking help by acknowledging and addressing cultural beliefs and stigma surrounding mental health. Culturally sensitive therapists may also help clients access mental health services that are relevant and effective for them.

Key elements of culturally competent mental health care

The American Psychological Association (APA) outlines cultural competency training guidelines that therapists must follow to provide the best care possible for their clients. The training requires therapists to be aware of and respect cultural differences, understand the impact of culture on mental health, and adapt their therapeutic approaches to be culturally responsive.

Making mental health care accessible and inclusive

Improving the accessibility and inclusivity of mental health care means addressing various barriers, including affordability, stigma, and a lack of culturally competent services. For example, broader insurance coverage for mental health services may increase mental health benefits and remove finances as an obstacle to treatment. Organizations like SAMHSA (the Substance Abuse and Mental Health Services Administration) may also offer access to free community resources or referrals for financial assistance programs to help individuals access care if they can’t afford it. 

Various organizations may promote public education and launch public awareness campaigns to reduce stigma and encourage individuals to seek help. Schools, workplaces, and communities can also foster inclusive environments in which individuals are supported to openly discuss their mental health. 

Promoting cultural competence might involve training mental health care professionals to recognize and understand the specific needs of different populations. Diversifying the mental health workforce can also ensure that providers represent the diversity in the communities they serve. Finally, providers may offer services tailored to different cultural groups' specific needs and preferences. 

Mental health is vital for overall well-being

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Accessibility to online mental health care 

Some people don’t seek therapy because they may have disabilities that make them physically unable to attend sessions. Meanwhile, people living in rural or underserved areas might not have access to treatment providers in their local areas. Many other barriers to in-person care exist as well. In such cases, many people find online therapy an excellent solution. 

Therapy platforms like BetterHelp offer access to a broad pool of mental health professionals from diverse backgrounds, experience, and expertise. Users may receive culturally competent mental health treatment from the comfort of home, eliminating the need to visit an office and speak to a therapist in person—which may be advantageous not only to those with accessibility challenges but also for those experiencing mental health stigma. Online therapy is often more affordable than individual treatment without insurance, and BetterHelp offers financial assistance to those who qualify. 

Research offers considerable evidence that internet-delivered treatments are as effective as traditional treatments for a wide range of mental health disorders. For example, a 2024 review indicated that online interventions were routinely successful in reducing public stigma and could be delivered effectively thanks to their cost-effectiveness and widespread availability. In addition, according to a 2021 study, online cognitive behavioral therapy can be an effective way to support people with a range of identities and unique needs.