A young person can have a counselor's number saved in her phone, a clinic ten minutes from campus, and an insurance card that covers the visit — and still not go. Some young people go to counseling or therapy once, sit across from someone who doesn't understand their language, culture, or lived experience, and never return.

That gap between a service being available and a young person being willing to use it is a part of "access" that is frequently overlooked.

We tend to measure access by supply: how many providers, how many appointment slots, how short the waitlist. Those things matter. But for young people, especially those from underserved and under-resourced communities, access is also a feeling. It's whether they feel or believe the person across from them can be trusted. Whether the space feels like it was built with them in mind. Whether reaching out will be met with understanding rather than judgment. A service you don't feel safe using is not, in any meaningful sense, accessible.

More than 7.5 million young people from underserved and under-resourced communities in the United States are struggling with their mental health and emotional wellbeing, which amounts to more than one in five. Three-quarters of mental health conditions emerge by age 24, during the period when young people move through the transitions that shape the rest of their lives: adolescence into higher education, college into the workforce. The care that could help isn't reaching them evenly. Black and Latinx youth are 14 percent less likely than their white peers to receive treatment for depression. Just 8 percent of the lowest-income communities have a mental health specialist at all.

That gap between a service being available and a young person being willing to use it is a part of "access" that is frequently overlooked.

These disparities reflect a set of systems that were never designed for underserved or under-resourced patients. Cost and logistics put care physically out of reach, while a shortage of professionals who share their communities' language and lived experience makes it harder to trust the care that does exist. Stigma — a major barrier to care — makes the first step towards help seem harder. Too often, the models that mental health care is based on feel disconnected from the realities young people actually live. When care doesn't reflect who someone is, "available" and "usable" turn out to be very different things.

Belonging is a protective factor in its own right. Research points to a consistent set of protective factors: a strong sense of self, supportive relationships, and, above all, a sense of belonging that help young people stay well and navigate challenges as they arise. Culturally responsive care is what activates protective factors. It's the difference between a young person being treated as a case and being seen as a whole person in the full context of their family, culture, and community.

What does that look like in practice? It starts with mental health professionals who come from the communities they serve and bring cultural fluency into the room. Quality mental health care treats identity and community as strengths to draw upon. It means meeting young people where they already are in peer communities, on campuses, in the spaces they already trust, so the first conversation doesn't require a leap of faith into an unfamiliar system.

For colleges, employers, funders, and community organizations, these expectations reframe the work. The goal is to add capacity and more counselors and to build an environment that young people will trust enough to use. That means investing in a workforce that reflects the communities it serves and designing programs alongside the young people and their families. It also means treating belonging as a real outcome of care.

When care is built around trust and grounded in culture, young people show up, stay in care, and achieve better healthcare outcomes. The challenge is to build services in a way that makes them worth walking into.

This work requires collective action from schools, providers, families, funders, and young people themselves committed to the same vision: that every young person is supported by people and places that understand them.

Access is the door. Trust is what gets someone to walk through it.

If you or a young person you know is struggling, support is available. Text STEVE to 741741 to reach a crisis counselor, or call or text 988 for the Suicide & Crisis Lifeline.

Dr. Annelle Primm is senior medical director of The Steve Fund, a leading nonprofit dedicated to promoting the mental health and emotional wellbeing of young people from underserved and under-resourced communities.