Knowing what services exist and how to reach them is a substantial barrier in itself, and the structure is broadly similar across health systems even where funding differs.
The stepped model
Most systems organise provision by intensity, offering the least intensive appropriate option first and escalating if it does not work.
Which is efficient, since most people improve at lower intensities, and it produces delay for those who need more from the start.
Understanding this explains why an initial offer may be guided self-help rather than therapy.
Primary care
The general practitioner or family doctor is the usual entry point.
Which means they assess, treat where appropriate, and refer onward.
They can prescribe, arrange sick leave, refer to psychological services and, in more serious cases, to specialist teams.
A substantial proportion of mental health care is delivered entirely in primary care.
Psychological therapy services
Provide talking therapies for common conditions.
Which operate through referral in some systems and accept self-referral in others, and knowing which applies locally saves considerable time.
Waiting times vary enormously, and services generally publish them.
Specialist teams
Community mental health teams for more severe or complex conditions, generally multidisciplinary.
Which include psychiatrists, nurses, psychologists, occupational therapists and social workers.
Access is generally by referral rather than self-referral, and thresholds are set by service capacity as much as by need.
Crisis services
Provide urgent assessment and support outside routine hours.
Which vary by area and generally include a crisis line, a crisis team and, in some places, safe havens or crisis cafes offering somewhere to go.
Emergency departments remain the route when nothing else is accessible, which is widely acknowledged as unsuitable and is what capacity permits.
Inpatient care
Admission where risk or need cannot be managed in the community.
Which can be voluntary or, where legal criteria are met, compulsory under mental health legislation.
Legislation sets out criteria, safeguards, rights to appeal and access to advocacy, and these differ substantially between jurisdictions.
The voluntary sector
Charities and community organisations provide substantial support, including helplines, peer support, counselling and practical help.
Which is frequently faster to access than statutory services and varies in what is available locally.
Many people find these easier to approach initially, and reputable organisations support people into clinical care where needed.
Employer provision
Employee assistance programmes offer counselling and support, generally confidential and separate from the employer.
Which is widely available and widely unused, largely because people do not know it exists or doubt the confidentiality.
What to do
Contact a doctor as the general route, and check whether local psychological services accept self-referral.
In crisis, use the crisis line or emergency services — this is what they are for.
This describes how systems are generally structured and is not clinical advice.
Thresholds and the gap
Specialist teams operate thresholds determining who is accepted, and those thresholds are set partly by capacity.
Which produces a group whose difficulties are too severe for primary care psychological services and not severe enough for specialist teams.
This gap is widely acknowledged in service reviews and is rarely resolved, since resolving it requires capacity that does not exist.
People in it are frequently referred repeatedly between services, which is exhausting and is not anyone's intention.
Children and young people
Provision is generally separate from adult services with its own referral routes and thresholds.
Which creates a transition problem at the age boundary, since young people move between services with different models at a point in life when disruption is unhelpful.
Transition protocols exist and are inconsistently applied, and the boundary age varies between systems.
Schools are a substantial route into support, with mental health support teams established in education settings in several countries.
Records and information sharing
What is recorded and who can see it is a common concern and worth understanding.
Which generally means the record is shared between clinicians involved in care and is not accessible to employers or others without consent.
Rights to access your own records exist in most jurisdictions, and requesting them is straightforward.
Advocacy
Independent advocates support people to express their views and understand their options.
Which is a statutory entitlement in defined circumstances in several systems and available voluntarily more widely.
People frequently do not know it exists, and it is particularly useful where someone finds it difficult to be heard.
Complaints and feedback
Every system has a complaints process, and patient advice services exist in many to help navigate it.
Which is worth using where care has gone wrong, since complaints feed into service review.
Raising a concern informally with the service first frequently resolves matters faster than a formal process.
Continuity
Seeing the same clinician over time is associated with better outcomes in primary care research.
Which is increasingly difficult to achieve given workforce pressure and appointment systems.
Requesting a specific clinician is generally possible and involves waiting longer for an appointment.
Knowing the local picture
Provision varies substantially between areas within the same country.
Which means general descriptions only take you so far, and local directories are the practical source.
A doctors' surgery, a local authority website or a national charity's local page will list what actually exists where you are.