Employers may offer benefits. Leaders may say the right things. But when someone actually needs care, the real barriers to mental health tend to be practical:
It takes too long to find careIt costs too muchIt’s not safe or privateIt’s hard to know where to start
And those barriers are not the same for everyone.
As part of our research for Spring Health’s 2026 Workplace Mental Health Annual Report, we surveyed 1,500+ full-time employees across five different countries (the United States, Canada, Mexico, India, and the United Kingdom). Employees pointed to a familiar set of obstacles to accessing care.
And while the overall group surveyed clearly identified their top barriers, the leading barriers are more nuanced when you factor in age, income, and other factors.
What are the biggest barriers to mental health care?
When employees are asked what gets in the way of mental health support, the answers are strikingly practical.
Across Spring Health’s research, employees said the top barriers are:
Lack of time: 43%Cost: 42%Work schedule and job demands: 30%Concerns about privacy: 30%Long wait times: 29%Stigma: 28%Lack of trust you’ll get better: 25%
That matters because when support is hard to find, hard to trust, or hard to use, the benefit may exist on paper without making a real difference in people’s lives.
How income levels influence barriers to care
Income levels significantly influenced responses to top barriers to care. While our research was global, we did ask U.S. respondents for their household income levels (within a range of options). What we learned about income-influenced barriers was compelling.
Among U.S. respondents, for lower-income employees, cost was the defining barrier. Slowly, as you moved to higher income brackets within the research, lack of time became the prevailing barrier.
For those with household incomes of less than $75,000, cost was the top barrier at 53%. Lack of time was a distant second at 33%. For those with household incomes of at least $75,000 but less than $150,000, cost was at 46% and lack of time was at 45%. For those with household incomes of at least $150,000, lack of time emerges as the top barrier at 50%, followed by privacy concerns at 37% and cost at 34%.
Privacy concerns is another important nuance. Just 15.6% of employees earning less than $25,000 cited privacy concerns, compared with 37.8% of those earning $150,000-$249,999 and 40.9% of those earning $250,000 or more, again with the small-base caveat.
That suggests that more senior or highly compensated employees may need something more than broad reassurance. They may need concrete proof that using mental health support is confidential, discreet, and safe.
Perceived access also tracks with income
Before employees can use a benefit, they have to know it exists.
Our research also shows that awareness of employer-sponsored mental health benefits tracks strongly with income. Among employees earning under $50,000, just 47% said their employer offers mental health benefits. Among employees earning $150,000-$249,999, 82% said their employer offers mental or behavioral health benefits.
Spring Health’s research within the 2026 Workplace Mental Health Annual Report also found that 34% of employees say they are either not offered mental health benefits or are unsure whether they are, which indicates the possibility that many employees are simply unaware of the care available to them. For example, according to Mental Health America, 98% of mid-to-large U.S. companies offer an Employee Assistance Program (EAP).
For lower-income employees especially, the barrier may begin even earlier than cost or wait times. If the benefit is poorly explained, rarely mentioned, or buried in HR materials, access breaks down before care becomes a possibility.
Age influences barriers, too
Among global employees ages 18-34, the top barriers were:
Lack of time: 52%Cost: 37%Availability due to job demands: 33%Privacy concerns: 32%
However, as populations within the survey got older, cost emerged as the top concern. But the percentage impacted by cost didn’t change much due to age; it’s simply that lack of time and availability declined as barriers.
Among employees 55 years of age and older, the top barriers were:
Cost: 39%Privacy concerns: 26%Stigma: 26%Lack of time: 25%
Younger employees may face more time pressure at work, or feel less able to make time for care. Older employees may still face affordability challenges.
Barriers to care are practical, structural, and cumulative
Mental health equity requires recognizing that employees do not all start from the same place. There’s a distinction between equality and equity. Equity means recognizing that barriers differ across circumstances and ensuring people receive support that reflects those realities.
For one employee, the barrier is cost. For another, it is the fear that seeking support will not stay private. For another, it is not being able to take a call during the workday. For another, it is long wait times for therapy. For another, it is not knowing whether the employer offers anything at all.
That is why removing barriers to mental health services has to go beyond awareness campaigns or one open enrollment mention per year. The support itself has to be easier to start.
What removing barriers to mental health care looks like
If employers want to improve access to mental health care, they need to design around the barriers employees actually face.
That includes:
Employees should have a single point of entry for any mental healthcare. They shouldn’t have to navigate a list of multiple phone numbers or determine on their own what specialist they really need. If cost is the leading barrier for lower-income populations, employers need to explain what support is available, what it costs, and what happens next. And they need to do so in plain language.Getting them to the right care quickly is highly important. Fast access matters, but fast access to the wrong provider can become a barrier or reinforce existing barriers. If someone is matched to the first available appointment rather than a provider who can actually support their needs, they are less likely to stay engaged. Data-driven provider matching is vital.Employers also need to address privacy concerns around therapy explicitly. Employees should not have to guess what information is shared, what stays confidential, or whether using a mental health benefit could affect how they are perceived.Employers should also acknowledge that time is not a side issue. Employees cannot access care that only works during business hours or assumes they have room in their day. Flexible scheduling, virtual options, and a simple path into support matter because convenience is often what determines whether care happens at all.How Spring Health helps remove barriers to care
Spring Health members begin their care journeys with a short, clinically validated assessment that helps identify what kind of support may fit best. From there, members receive a personalized care plan and can be connected to the right level of care, whether that is self-guided support, coaching, therapy, medication management, or specialty care. Spring Health’s model is designed to reduce trial and error, lower friction, and help people move into care with more confidence.
Spring Health’s AI-native experience, Guide, adds an important layer for adherence to care. Rather than treating care as a series of disconnected appointments, Guide helps carry context forward across the member journey so support does not reset every time life changes, coverage changes, or someone moves between moments of care. Spring Health is built to reduce friction in getting started and staying in care. Members can access provider appointments in less than a day, compared with a 48-day average with traditional EAPs, and Spring Health members recover 5.9 weeks faster than our leading competitor.
It also matters when provider fit is the barrier. Spring Health supports a diverse provider network, offers care in more than 100 languages, and allows members to filter for characteristics that may matter to them, including language, race, ethnicity, gender identity, and sexual identity. That creates a more personal path into care for employees who may otherwise assume the system will not understand their needs or lived experience.
And it matters when equitable access is the issue. Spring Health’s published outcomes research shows that Spring Health can reduce socioeconomic equity gaps in mental healthcare. In peer-reviewed research (Baum et al., 2026), Spring Health saw a 36% increase in care utilization when introduced. And, more importantly, Spring Health achieved equivalent clinical improvement for everyone, regardless of their zip code.