7 Hard Truths About Mental Health Care No One is Talking About
Written by Oksana Chabot, Founder, Executive Director
Oksana Chabot, MA, LMFT-A, ADC-IP, is a trauma-informed family therapist and founder of Katherine’s Healing Nest™, pioneering a nature-based, scalable model for mental health healing that integrates clinical care, community, and land.
A couple of months ago, I started noticing something that didn’t make sense. Clients I had been working with consistently, people who were showing up, opening up, doing the work, began to disappear. Not all at once, but gradually. A missed session here, a reschedule there, and then, silence.
At first, I did what most therapists do. I turned inward. I questioned my approach, my presence, my effectiveness. Was I missing something? Were they disengaging? Was this resistance? But the truth, when it came, was much simpler, and much heavier. They couldn’t afford to keep coming. That realization forced me to sit with something uncomfortable. Not just as a therapist, but as a human being working inside a system that, in many ways, is not designed for the people who need it most. The more I paid attention, the clearer it became. These were not isolated situations. They were patterns. And behind those patterns are truths we don’t talk about enough.
Access is conditional
We often say that therapy is accessible, especially with insurance. It sounds reassuring, even responsible, as if we’ve created a system that works.
But what I’ve come to see is that this kind of access is fragile. It only exists as long as someone’s financial situation remains stable. The moment life shifts, and it always does, therapy becomes negotiable. I’ve had clients quietly admit that they were stretching their budgets just to make it to sessions.
Others would space out appointments, not because they were ready, but because they had to make it work financially. And eventually, many of them stopped altogether. Not because they didn’t value the work. But because they could no longer afford to prioritize it.
Progress gets interrupted
What we don’t always see from the outside is how much it takes for someone to begin therapy in the first place. To trust. To open up. To sit with things they’ve spent years avoiding. When that process is interrupted, not by choice, but by circumstance, it doesn’t just pause. It unravels. I’ve seen clients who were beginning to feel safe suddenly pull back.
Not because they wanted to, but because consistency was no longer possible. And when they return, if they return, they often have to start from a different place, rebuilding trust, re-establishing safety, re-entering a process that was never meant to be fragmented.
Co-pays are a barrier
There is a quiet assumption in mental health care that co-pays are manageable. But for many people, they’re not. A $100 co-pay, week after week, becomes a real and pressing decision.
Especially for those already carrying financial stress, supporting families, or navigating instability. I’ve had clients apologize for canceling sessions, as if they were letting me down. When in reality, they were choosing between therapy and something essential. That’s not a choice anyone should have to make.
Time limits restrict healing
There is also something about the structure of therapy that we rarely question. Forty-five minutes. Fifty minutes. An hour, if there’s space. And within that time, we try to hold everything, trauma, relationships, nervous system regulation, meaning-making. Of course, meaningful work can happen in that space.
It does, every day. But there are moments when the depth of what is emerging doesn’t fit neatly into a time slot. When someone is just beginning to access something important, and we have to gently bring it to a close. Healing doesn’t follow a schedule. But the system often requires it to.
Environment matters more than we admit
Over time, I began to notice something else. It wasn’t just what we were doing in sessions, it was where it was happening. Traditional clinical settings are designed for efficiency. Neutral walls, controlled environments, back-to-back sessions. But the nervous system doesn’t respond to efficiency.
It responds to safety. I started to imagine what healing might look like in a different environment. One where there is space to breathe. Where the body can soften. Where connection happens not just through words, but through presence, nature, and shared experience. And I realized how much we’ve underestimated the role of environment in the healing process.
The system rewards volume
As therapists, many of us enter this field because we care deeply about people. But the structure we work within often pushes us toward volume. More sessions. Full caseloads. Limited time between clients. Not because we want to rush, but because sustainability depends on it.
And over time, that pressure builds. It becomes harder to hold the same level of presence. Harder to create the kind of spaciousness that healing sometimes requires. Not because the intention isn’t there, but because the system doesn’t always support it.
Healing is treated as a service, not a human need
At some point, I had to confront a deeper truth. Mental health care, in many ways, is treated like a service. Something you access if you can afford it. Something that fits into a billing code. Something that is measured in sessions and reimbursements.
But healing doesn’t operate that way. It is not optional. It is not transactional. It is not something that should be reserved for those who can sustain it financially. It is a fundamental part of being human. And when we treat it as anything less, we create gaps that continue to widen.
A different approach is possible
Sitting with these realities has not led me to frustration as much as it has led me to clarity. Because once you see the gaps, you can no longer unsee them. And once you understand the impact, you begin to ask different questions.
What would it look like to create a model that doesn’t rely solely on insurance? What would it feel like to offer healing in environments that support the nervous system, not just the conversation? What becomes possible when community, nature, and sustainability are part of the equation? This is the vision behind Katherine’s Healing Nest™.
Not as an alternative to therapy, but as an expansion of what healing can look like. A place where retreats, workshops, and community experiences help generate the resources needed to provide access for those who otherwise could not afford it. A system that sustains itself while making healing more accessible, not less.
Start the conversation
I don’t believe these truths are meant to discourage us. I believe they are meant to wake us up. Because behind every canceled session is a story. Behind every pause in therapy is a person trying to hold it all together. Behind every gap in the system is an opportunity to do better.
The question is not whether change is needed. The question is whether we are willing to be part of creating it. And whether we are ready to imagine something different, together.
Read more from Oksana Chabot
Oksana Chabot, Founder, Executive Director
Oksana Chabot, MA, LMFT-A, ADC-IP, is a trauma-informed family therapist and founder of Katherine’s Healing Nest™, pioneering a nature-based model for mental health healing. Her work integrates clinical care, nervous system regulation, and environment to create lasting transformation.
