Barriers to Mental Health Care: The Harm Caused by Independent Medical Examinations

One of the most frustrating and painful barriers to mental health care I’ve seen up close is the way insurance companies use independent medical evaluations (IMEs) to block people from getting the care they need. The person I care for has been battling chronic nerve pain for nearly a decade. Even with a confirmed diagnosis of Complex Regional Pain Syndrome (CRPS), they’ve repeatedly been denied treatment because workers’ compensation insurers bring in IMEs whose reports contradict treating doctors. These IME doctors are not part of the patient’s care team. They’re hired by the insurance companies and often seem more focused on protecting the company’s money than supporting the person in pain.

What makes this even worse is that the delay in getting proper treatment has caused their condition to get significantly worse. This isn’t just a physical issue—there’s been a major toll on their mental health, too. At one point, they lost their insurance completely, which made it nearly impossible to find affordable mental health support. This meant dealing with severe chronic pain while also managing depression and anxiety, without access to the kinds of therapy or medications that could have helped.

The ethical concerns around IMEs are well documented. Ebrahim et al. (2014) explain that IMEs are not about treating patients—they’re about providing a report to whoever is paying for it, usually an insurance company. These doctors don’t have the same responsibility to act in the patient’s best interest. That creates a huge conflict of interest. Sometimes, they withhold critical medical information or make decisions that go directly against what the patient’s real care team recommends. According to the article, although there is a general agreement that IMEs should avoid causing harm, the legal definitions around what counts as harm are vague, which means patients often suffer with no accountability for the evaluators (Ebrahim et al., 2014).

To help someone facing this kind of barrier, mental health professionals must take a big-picture approach. It’s not just about treating symptoms—it's about understanding how the healthcare system itself may be hurting the client. Therapists can help by listening without judgment, validating the client’s frustration, and working to connect them with any available resources. Advocacy can also be part of the work, helping clients understand their rights and navigate these systems more effectively.

One of the core ethical principles that matters here is Beneficence and Nonmaleficence. We’re supposed to do good and avoid doing harm. But when a therapist isn’t aware of these systemic issues, or ignores them, that principle can’t really be upheld. We must look beyond what’s going on in the therapy room and understand the structural barriers affecting the client’s ability to heal (American Psychological Association, 2017).

The reality is that people can’t just “get better” if the systems around them are working against them. A good mental health provider must recognize that and do whatever they can to help break down those barriers, especially for people who’ve already been fighting for care for years.

References

American Psychological Association. (2017). Ethical principles of psychologists and code of conduct. https://www.apa.org/ethics/code

Ebrahim, S., Sava, H., Kunz, R., & Busse, J. W. (2014). Ethics and legalities associated with independent medical evaluations. Canadian Medical Association Journal, 186(4), 248–249. https://doi.org/10.1503/cmaj.131509