He’d left a voicemail on the office machine asking for a callback as soon as possible. When a therapist returned his call, his words came out in a rush. He needed ADHD-specific support, but he couldn’t pay anything out of pocket; he was barely keeping himself afloat between rent and groceries. Although she gave him referrals to services that accepted Medicaid, she hung up wondering whether he was just on a fast track to a miles-long waitlist, with no guarantee of specialized care at the end of it.
Unfortunately, that call was not unusual. For mental health practitioners across the country, conversations that end without a clear path to care happen every day.
The solution might seem obvious: take him on pro bono, or connect him with a colleague who can if the initial referrals don’t work out. But free or reduced-fee therapy only goes so far. A mental health system that relies on the goodwill of individual clinicians to compensate for policy failures isn’t a solution.
It’s a stopgap.
As a therapist-in-training, this tension sits at the heart of my work. Nearly every day I sit across from people who are struggling in large part because of the crushing weight of circumstances that no amount of coping skills can fix. Naturally, these limitations of the work sometimes make me feel despondent as a clinician. As someone once told me, trying to help people with their mental health separate from the many other factors that could be affecting their emotional and physical wellbeing is like “trying to fix the radio in a car when the engine doesn’t work.”
Acknowledging this severe gap in care while offering accessible and actionable mental health resources is the driving force behind From Clinical to Community, a new monthly column on mental health news, emerging research, and the people and practices actually moving the needle.
The people least likely to receive treatment are often the ones who need it most. Young adults ages 18 to 29 report the highest prevalence of mental health crises, while Black and Hispanic adults report disproportionately higher rates of distress. People experiencing housing instability face the highest crisis prevalence of all, at nearly 40%.
This isn’t a coincidence. It is the predictable result of systems that fail to provide stable housing, living wages, and accessible healthcare, including consistent mental health support. Yet instead of addressing these root causes, we’ve made the therapy room — and AI bots for the many who can’t afford therapy — the default safety net for society’s structural inequalities.
The demand for therapy has scaled at an unprecedented rate: in 2024, U.S. behavioral health visits reached 66.4 million and outnumbered primary care visits for the first time. But the current method is neither sustainable nor as effective as it could be. Worldwide, only 9% of people living with depression receive even minimally adequate treatment. Despite decades of advances, global rates of mental illness have remained stagnant since 1990, while U.S. depressive disorders surged by nearly 60%. We may be talking about mental health more than ever, but we’re not successfully treating it.
This isn’t a failure of therapy; rather it’s a condition of the disempowering conditions people are forced to live in.
To look at this landscape and only focus on its shortcomings, however, is to miss the substantial shifts quietly happening on the ground. The field is at a profound inflection point, and there are some reasons for genuine optimism. Psilocybin and other psychedelic treatments are showing promising results for depression and PTSD and may even become FDA-approved treatments, and peer support models and community health workers are reaching people that traditional clinical care struggles to. Even the American Psychiatric Association is considering formally integrating social determinants like housing, employment, discrimination into psychiatric diagnoses, a shift that would finally reflect in official medical language what clinicians see every day. The conversation is clearly expanding. The question is whether the systems meant to support mental health can keep up.
From Clinical to Community will track that question every month. It won’t minimize the scale of the crisis, nor offer superficial self-care tips as a band-aid for systems neglect. Instead, each installment will cover mental health through three lenses: the news and research shaping the field, the structural forces that determine who gets to heal, and what’s actually working when it comes to bolstering our collective mental health.
As a clinician, I wholeheartedly believe therapy is an invaluable experience that can help you understand your patterns, build resilience, and be a healing container for your emotional pain. Yet as worthwhile it is, it cannot pay your rent, fix a broken healthcare system, or undo decades of disinvestment in marginalized communities.
The man on the voicemail deserved more than a referral, and so does everyone who comes after him.
Join the Conversation: From Clinical to Community is meant to be a shared exploration, and I want to hear from you. What systemic barriers are impacting your mental health? What community-led healing models should we investigate? Let me know what you want to see covered in future installments by reaching out at gwen.avilesurl@gmail.com
