[Skip to Content]

Provider staff training: Close the treatment gap on health inequities

People with mental illness have a hard time accessing mental health care, especially compared to physical health care. In fact, worldwide, more than 70 percent of individuals with mental illness do not receive any mental health treatment.

Stigma and discrimination contribute to that treatment gap, according to one study. What may surprise some people is that such stigma sometimes comes from within the healthcare system itself, preventing individuals with mental illness from seeking treatment. It also can result in subpar physical health care.

Feelings of dismissal

The study reveals that individuals with mental illness sometimes feel “devalued, dismissed, and dehumanized” when receiving care. Specifically, they report experiencing the following:

  • Exclusion from decisions
  • Receiving subtle or overt threats of coercive treatment
  • Being made to wait too long for treatment 
  • Receiving insufficient information about one’s condition or treatment options •
  • Being treated in a paternalistic or demeaning manner
  • Being told they would never get well 
  • Being spoken to or about using stigmatizing language

For people who do not have mental illness, such feelings are not the norm in most healthcare experiences. What, then, explains this dynamic coming from an industry whose very mission is to make people better, normally living up to that standard, as evidenced by today’s pandemic?

A problem from within

Healthcare professionals have a strenuous job with very high stakes. After all, what’s more important than one’s health?

Understandably, burnout and compassion fatigue can contribute to this stigma, according to the study, but there are other concerns as well, such as:

  • Lack of awareness and unconscious bias 
  • Pessimistic views about the likelihood of recovery, which contributes to a sense of provider helplessness 
  • Inadequate skills and training
  • A culture of mental illness-related stigma, even for healthcare professionals’ own mental health

Such views act as barriers to care in multiple ways, continues the study. For example, they can lead to “delays in help-seeking, discontinuation of treatment, suboptimal therapeutic relationships, patient safety concerns, and poorer quality mental and physical care”.

A second study confirms similar findings, identifying four issues that contribute to individuals not seeking care. In brief, those four issues include lack of knowledge about the treatability of mental illnesses; inexperience around accessing mental health treatment; prejudice against people with mental illness; and expectations of discrimination against people with mental illness.

Culture change, leadership support drive change

Research conducted in Canada suggests there are encouraging strategies for reducing stigma in healthcare settings, including organizational culture change and strong leadership support, according to the first study referenced above.

Culture change is never easy, but training is essential to that effort and should teach healthcare providers to know “what to say” and “what to do”. Ideally, those training efforts would also include “first-voice testimonies” from people with lived experience of mental illness where they are the educators and not the patients.

Culture change is never easy, but training is essential to that effort and should teach healthcare providers to know “what to say” and “what to do”.

Additionally, training should require “myth-busting” learning to help healthcare professionals overcome unconscious bias that could be affecting their delivery of care. It should also show how healthcare professionals have a role to play in the process of recovery to help mitigate that sense of professional helplessness.

Organizations, of course, need to be sure that such trainings are effective. Researchers suggest that one successful tactic would be to develop stigma-reduction metrics that target health and safety and accreditation standards. In other words, address the problem from a quality-of-care perspective, an approach that healthcare professionals know well.

A win-win: Improved care, improved lives

Improved care delivery for people with mental illness benefits everybody. Of course, better care improves the health and quality of life for the patients themselves. Staff’s improved competence and confidence in delivering that care helps them to overcome personal bias about mental illness. Finally, as these two factors align, healthcare organizations can potentially improve their financial outlook through the delivery of more effective care.

It’s not easy to be a healthcare professional, and we don’t have to be one to recognize that. However, research indicates that focused training and a general consciousness about the true nature of mental illness will go a long way in improving lives. Beacon Health Options calls upon all healthcare organizations and their leadership to help staff be even better at their jobs by raising awareness and competence around mental illness, regardless of staff role.

14 Comments. Leave new

As a Licensed Clinical Social Worker in Florida since 2009, it is apparent that mental health concerns have escalated with the COVID-19 pandemic. My agency has a total of 4 therapists working overload schedules in trying to cope with various problems that were not evident in years past. We can get through this stigma by being vigilant to mental health stressors that were non-existent before the coronavirus took over with additional training opportunities. Telehealth and telemedicine are good–however, face to face with CDC guidelines is preferred by our agency.

James F. Pierce
October 7, 2020 7:02 pm

Exellent article on a very timely topic. Addressing our own mental health attitudes and issues is always helpful in insuring tht we treat the person, not just the diagonis. Our job begins a depends on empathy and a belief in the benefits that we provide. Thank you for the reminder.


Society needs to be aware that mental illness and mental toughness do not contradict each other.


I am pleased that you have paid attention to the notion that mental health contributes to physical well being. I hope that this emphasis can be attended to by physicians and nurses. I know that they have a lot to contend with these days, but it is shocking how little mental health services are available. I understand that in our county, Sonoma, Health and Human services has lost its accreditation for Medicare, so it is starving for funds. Hence the proposal on the ballot. While really this inadequacy needs to be eliminated.
Thank you for asking.


What is needed are more Mental Health Providers. How to encourage students to consider entering the field?I think when science improves treatment and stabilization and recovery , mental health as a discipline will become more appealing as one’s life’s work.

Susan Holland
October 7, 2020 9:40 pm

Not only do we need more mental health providers, we need more providers of color. If an African American wants an African American therapist in my area (the coast of California), it is very difficult to find one who has openings. The same for Spanish speaking therapists. PCPs who take time with their patients are the ones who get the highest scores from my patients. Unfortunately, many PCPs feel stretched very thin, especially since COVID. Perhaps teaching in med school that a behavioral health alliance can make their practice flow more smoothly. This is an excellent topic for more discussion!


Excellent article offered to therapists working with fragile families at this time . Thank you Lynda Hiatt LC SW California and Utah

Marilyn Green
October 8, 2020 3:27 pm

Thanks for the topic. I work in the State of New York and I feel that we as social workers are not as valued as we should be in the mental health field. We do a lot for a little. I get satisfaction from seeing growth and improvement in my clients because the money limited. I take medicaid and medicare clients who often have difficulty finding a provider to take their insurance because of what their reimbursement rate is . So it is not just stigma.


The Covid 19 challenge has been a challenge. I am an LCSW in private practice and we never closed. We are doing virtual as well as in person. It is sad that some many people still fall through the cracks.

October 8, 2020 8:09 pm

Thank you for this article. I also want to emphasize the issue of physical conditions such as severe anemia , undiagnosed diabetes , and other autoimmune diseases such as Hashimotos, Sjogrens. When depressed people are not getting better with proper mental health medication and counseling, which are given over time, without sufficient improvement, perhaps we overlooked some of these physical issues.

Louise Santana
October 9, 2020 2:54 pm

Thank you for your important article highlighting salient issues in the delivery of mental health services. I have practiced for over three decades in a variety of settings and learned that:
1. Training needs to be updated to include current relevancies, with more extensive, methodical, and experiential components.
2. Supervision by seasoned professionals is of utmost importance in the early working years.
3. The society as a whole is poorly educated re mental illness and only seems to value providers when it hits them personally in some way.
4. The schools that provide training on the Master’s level need to rethink their curriculums as well as how to address the perception of Social Work by the larger society.


Education is the key! I sometimes relate diabetic medication to mental health education. If you need medication for diabetes, would you for go the pill or shot? No, b/c there isn’t a stigma attached to diabetes.

October 11, 2020 11:17 pm

thank you


As a therapist myself, I am seeing a slow but steady acceptance of the reality of mental health issues by the older generation when talking with my younger clients. For the longest time, younger patients commonly felt like outcasts because the older generation would say things like “you’re soft” or “back in my day people dealt with their issues” and such. It was tough for the younger crowd to even accept that they could have something real happening to them. With COVID, this massive isolation is actually changing the perspective for many older people to see that mental health CAN be a real thing and it can affect anyone! So now it’s up to the providers and teachers to recognize and implement better solutions when things like depression and anxiety are being recognized!


Leave a Reply

Your email address will not be published. Required fields are marked *
Comments that are inappropriate and/or not pertaining to the immediate topic at hand will not be published.

Top Link