Breaking Down Barriers to Access, No Matter Where People Live

The drive from San Juan, Puerto Rico, to the mountain town of Aibonito provides breathtaking views. With every turn during the steep ascent, Puerto Rico’s beautiful green valleys and hilltops reveal themselves.

But the journey to the remote town reinforces the barriers to access that so many people face, whether they’re in a remote mountain town on a beautiful island or in a major American city. That’s because we haven’t solved our nation’s problems surrounding access to care.

Nearly 30 million people across the U.S. don’t have access to the comprehensive, high-quality, affordable mental health and substance use care when they need. Daunting barriers to access prevent many Americans from seeking care, especially Black, Hispanic, Asian, Native American and LGBTQ+ individuals – nearly half of whom say they have personally experienced increased mental health challenges over the past 12 months. But few received treatment, according to a poll by the National Council for Mental Wellbeing.

Too often people in need of care (for themselves or a family member) don’t know where to turn for help. Even if they do know where to turn, the cost of treatment prevents many Black, Hispanic, Asian, Native American and LGBTQ+ individuals from seeking help.

Acacia Network, a mental health and substance use treatment organization based in Bronx, New York, is working in partnership with Puerto Rico’s clinics to find ways to overcome barriers in Aibonito and throughout the island for all Puerto Ricans.

Acacia Network, which is a member of the National Council, was founded in the 1970s to provide substance use treatment to members of the Puerto Rican community in a culturally and linguistically appropriate manner. Now Acacia Network is the largest health and social services provider in the Bronx. It also has a presence throughout New York State. And in Puerto Rico.

With leaders like National Council board member Yaberci Perez-Cubillan, Acacia Network is trying to find ways to support and supplement the health and social services network in Puerto Rico. This work is beyond high quality mental health and substance use care. It includes access to food, childcare and hurricane-proof housing.

But Acacia Network faces considerable challenges on the island. The delivery of physical health and mental health care is fragmented and underfunded. Many people lack access to the entire health care continuum. And tragically, these conditions are still stigmatized and viewed as a moral failing by too many in the community.

There are also practical hurdles. Puerto Rico continues to overcome devastation from Hurricane Maria, which struck in September 2017 and caused billions of dollars in damage. Power wasn’t fully restored until August 2018. A 6.4 magnitude earthquake struck the island in January 2021. And don’t forget COVID-19. The pandemic forced people to make hard decisions. Because the hurricane and earthquake ravaged so many homes, families often congregated under a single roof. But then the pandemic meant they could no longer live together.

And there are political hurdles. The government has declared bankruptcy.

Despite the physical and political barriers, Acacia Network is connecting people to service and amplifying the incredible work being done by providers on the island.

After our scenic drive from San Juan to Aibonito two weeks ago, I had a chance to meet with the leadership and staff at Sistema de Salud Menonita, a psychiatric hospital in the mountain town. Their passion and commitment were evident during our long discussion. They shared that Sistema de Salud Menonita has the lowest re-admission rate on the island. They described how they deliver culturally competent care in the community.

They talked about their plans for the future, which include applying for a federal grant to start a Certified Community Behavioral Health Clinic and how that would help them transform care in their community.

The work Acacia Network does in Puerto Rico and the Bronx to help people with mental health and substance use challenges is nothing short of awe inspiring. So many of our 3,500 National Council members are engaged in equally inspiring work to help mental illness or substance use challenges.

They all share a common goal to eliminate barriers to access to people and ensuring that mental wellbeing – recovery from mental health or substance use challenges – is within reach for everyone. No matter where they live.


Charles Ingoglia, MSW
(he/him/his) President and CEO
National Council for Mental Wellbeing
See bio