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Mental Health Accessibility and Psychology in Practice: Home

This research guide was created by the 2019-20 Library Research Fellow Gabby Collins in partnership with the Undergraduate Library Fellows Program.

Understanding Mental Health

Mental health for many folks extends beyond diagnoses; mental health is often talked about in the context of diagnosable disorders with specific criteria that must be met for diagnosis, such as generalized anxiety disorder, clinical depression, schizophrenia, PTSD, depersonalization, etc., but this is limiting for a number of reasons (Cohen, 2016).

Many folks experience mental health in a much more complex way, with subclinical or sub-threshold presentations (e.g. depression symptoms that don't meet enough of the diagnostic criteria to be considered clinical depression as defined by the DSM), comorbidities, or experiencing more than one mental illness at a time (the average person in the U.S. struggling with their mental health experiences 2.1 disorders), and highly contextualized causal and perpetuating factors that are often dismissed (e.g. trauma from institutionalized biases or discrimination, etc.) (Boorsboom, 2017; Cohen, 2016).

Diagnoses are important for some reasons, including ensuring that psychiatrists are administering medications appropriately and that psychologists and therapists are utilizing evidence based treatments in the correct manner and dosage. Additionally, diagnoses are one of the only ways for many folks to insure that their insurance covers their therapy sessions in our current healthcare system. At the same time, a transdiagnostic model and understanding that accounts for subclinical presentations, comorbidities, and multiple causal and perpetuating factors may be more informative (Boorsboom, 2017).

"Mental illnesses" and their related symptoms are often not abnormal, pathological, or some kind of inherently faulty biology, but are often rather normal responses to distressing or disturbing circumstances. These normal responses to distressing or disturbing circumstances may have biological correlates (e.g. measurable markers of stress in the blood like heightened levels of pro-inflammatory cytokines such as interleukin-6), physiological responses (e.g. sweating, heavy breathing, heightened heart rate), and mental or emotional states and experiences (e.g. anxiety, fear, anger, etc.), and these normal responses may be unwanted or no longer serving folks in a helpful manner. This might help explain why folks in marginalized communities face higher incidence of mental illness; there's no inherent aggregate difference in their genetics with respect to mental health, but rather these folks might have responses to trauma, bias, and discrimination that manifest as anxiety, depression, or some other mental illness. 

Mental Health Resources and Accessibility

Access to mental healthcare, particularly in the United States, can be difficult to obtain. There are many barriers to mental healthcare accessibility, which can include:

  • lack of affordability of mental healthcare: 25-60 million Americans are uninsured, many more are underinsured (many insurance plans lack mental health benefits because they are seen as less important) (McAlpine & Mechanic, 2000). 
  • lack of universal healthcare, which limits the number of providers folks can see, even if they do have insurance (McAlpine & Mechanic, 2000).
  • being able to find a mental healthcare provider; few people know where to look for a therapist or how to narrow their search, even if they want to seek out mental healthcare.
  • lack of access to childcare, so that folks with kids are able to see a mental healthcare provider.
  • lack of transportation.
  • stigma of accessing help with respect to mental health.
  • availability of mental healthcare providers; many mental healthcare providers work 9am-5pm, which are the same hours most people go to school and work, and many mental healthcare providers may have full caseloads of clients already.

Additionally, for folks belonging to marginalized or minority groups, these accessibility concerns may be especially likely to represent their experiences, and they may have other addednaccessibility concerns that white, wealthy, cisgender, heterosexual, able-bodied folks don't have to worry about, such as:

  • finding a mental healthcare provider that will be affirming of their identities and that will understand how their experiences of bias, prejudice, and discrimination might impact their mental health; there's a lack of diversity amongst mental healthcare providers (most are white, cisgender, heterosexual, able-bodied) (Algería, Alvarez, & Falgas-Bague, 2017).
  • facing a mental healthcare system that caters to dominant norms and values, and creates little room for differing experiences (Algería et al., 2017).
  • bias, prejudice, or discrimination in explicit or implicit forms directly from mental healthcare providers (Algería et al., 2017).

Thus, addressing accessibility in mental healthcare is crucial, and many structural changes clearly need to be implemented to fix many of these issues and barriers. At the same time, if you are struggling with any of the accessibility concerns above and want to seek mental healthcare, here are some resources that might be helpful:

  • Many therapists will take a certain number of sliding-scale patients, which means that if you don't have insurance or are underinsured and can't afford your co-pay, the therapist will work with you to adjust their hourly fee and find an amount per session that will be more affordable for you.
  • There may be community mental health clinics near you that provide a certain number of sessions with a mental healthcare provider at little to no cost. One of these in the Berkeley area is the Pacific Center, which focuses on providing free or low cost individual or group therapy to LGBTQ+ folks in the Bay Area. Their services can be found here.
  • Psychology Today's "Find a Therapist" search function, which allows you to search for therapists based on where they're located, what kind of insurance they take, what kinds of clients they have worked with (e.g. have experience working with LGBTQ+ clients, etc.), what kinds of therapies they use, and much more. You can also read bios that each therapist has put up about themselves and access their contact information. This search function can be found here.
  • Databases that list therapists that hold specific identities or that meet certain criteria, such as Therapy for Black Girls, which highlights therapists who are black women.
  • If meditation is something you find helpful or something you would like to try, there are many free meditations available on YouTube with a quick search. Search terms like "mindfulness meditation", "body scan", "meditation for anxiety", etc., and a length of time that works for you (5 minutes, 10 minutes, 30 minutes, etc.) to narrow your results! An eight minute body scan meditation will be linked at the bottom of this page.
  • Following therapists via social media. There is a huge movement amongst therapists to make their knowledge more accessible through social media platforms such as Instagram. Of course, this is not therapy, but many of these therapists are providing free resources and tools to their followers that may be useful. Thus, here's a list of Instagram usernames of just some of the many therapists on Instagram: @nedratawwab, @lisaoliveratherapy, @lizlistens, @alyssamariewellness, @therapyforlatinx, @therapyforblackgirls, @drlaurenfogelmersy, @decolonizingtherapy, @marielbuque, @themindgeek, @the.wellness.therapist, and so many more.

  • The UC Berkeley Library has many books written by psychologists that may be interesting or helpful that you can access for free with your student ID. Here are just a few, and many more can be found via Oskicat:

Bibliography / Papers on Transdiagnostics and Research Applicability

Alegría, M., Alvarez, K., Falgas-Bague, I. (2017). Clinical Care Across Cultures: What Helps, What Hinders, What to Do. JAMA Psychiatry, 74(9), 865–866.

Borsboom, D. (2017). A network theory of mental disorders. World Psychiatry, 16, 5-13.

Cohen, B. (2016). Embracing Complexity in Psychiatric Diagnosis, Treatment, and Research. JAMA Psychiatry, 73(12), 1211-1212.

Heneghan, C., Goldacre, B. & Mahtani, K.R. (2017). Why clinical trial outcomes fail to translate into benefits for patients. Trials, 18, 122.

McAlpine, D. D., & Mechanic, D. (2000). Utilization of specialty mental health care among persons with severe mental illness: the roles of demographics, need, insurance, and risk. Health Services Research, 35(1 Pt 2), 277.

Bridging Research and Practice

For those of us interested in either being literate in psychological research or in doing research in the field of psychology or mental health ourselves, real-world applicability might be a feature we hope our research possesses, but that may actually be difficult to achieve. For example, research on behavioral treatments for DSM-defined anxiety may have a high level of control and a strong design, thus producing high internal validity, but lack external validity, or its applicability outside the lab, due to numerous factors, from the low caseload of researching psychologists compared with that of practicing LCSW or MFT therapists allowing for more preparation for each client, to the exclusion of folks with comorbidities (necessary to establish causation) despite comorbidity being the norm (Heneghan, Goldacre, & Mahtani, 2017). Thus, there are some ways to potentially increase applicability and some highly applicable areas that need further study:

  • Look for / include multiple studies; those in the lab, as necessary to establish causality and internal validity, and those in practice, to establish external validity and real-world applicability
  • Look for / create study designs that examine, allow for, or at least address comorbidities
  • Look for / design studies that account for or directly examine barriers to mental healthcare access (e.g. poor healthcare access, no transportation, stigma, lack of affirming therapists) and that allow for cultural adaptation and analysis of effectiveness across cultural groups so treatments can be improved
  • Look for / design studies that examine bias, prejudice, or discrimination, which may give an increased scientific understanding of causes behind disparate mental health struggles for those in marginalized communities

Below are some databases and other resources that Berkeley students have access to through the UC Berkeley Library system, that may be helpful if you're interested in psychological research, are working on an honors thesis, etc.:

If you need help learning how to access the databases, how to navigate the databases, or how to find search terms to use to generate results that match what you're looking for, these links will take you to other Psychology LibGuides that go into these topics in more depth.

Psychology: Find Articles

Psychology: more on PsycINFO

Psychology: eJournals & Open Access

The UC Berkeley Library System also has many books that can help with research in psychology, in addition to the databases. Here's a list of a few books available through the UC Berkeley Library system that may be helpful in summarizing and conceptualizing psychological research that maintains a high degree of applicability:

If you want to find more books on psychological research available through the UC Berkeley Libraries and Oskicat, check out this Psychology LibGuide on finding books:

Psychology: Find Books

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