Sandra N. Crespo, LICSW, is the Clinic Director at Columbia Mental Health’s North Bethesda office. She is a licensed clinical social worker, professor, public speaker, and advocate for diversity in social work leadership and wellness.
In this conversation, Sandra shares her perspective on how accessible mental health care can shape families, schools, workplaces, and entire communities.
How access to care changes community life
When access to mental health care improves, what kinds of changes would you expect to see in communities?
Sandra: When I thought about this topic, the first thing that came up for me is that there is no silver bullet. When we’re dealing with multiple systems, like education, government, and health care, solutions depend on how those systems integrate or don’t integrate. So everything I say here is simply my opinion, and there are many ways to approach questions like this.
Right now, a lot feels chaotic and isolating. In Western culture, we tend to individualize pain. When we’re in pain, we retreat instead of sharing it. And when a whole community is doing that, it looks like a lack of trust in government, in services, and in each other.
If access were easier, I think we’d see safety and connection replacing some of that chaos and isolation. Early access is key. When people can receive care early, they’re more engaged in their lives. You’d see parents showing up to school events and actually being present. You’d see employees returning to work with a sense of purpose instead of just surviving the grind. You’d see neighbors wanting to know who lives next door.
For me, those are indicators of civic health. A community becomes more cohesive when people aren’t stuck in survival mode. And accessibility is not just about getting people into therapy. It’s about creating a culture where asking for help is normalized and supported.
You mentioned presence. What does presence look like when people have access to care?
A lot of us are very functional, but that doesn’t mean we’re present. To get through the day, we often rely on a bit of dissociation. We go on autopilot. We function robotically rather than experiencing our lives.
Better access allows people to shift from asking, “How do I get through this day?” to “How do I actually experience my day?” Those are two very different questions. Presence shows up in how we inhabit our bodies, how we connect with others, and how we move through our spaces. Accessible care makes that possible.
Schools as ecosystems of care
How might schools and classrooms look different if more students, parents, and teachers received early support?
Schools would become ecosystems of care, not just academic spaces. Right now, teachers are operating in crisis mode. They spend so much time managing crises that they have less time to teach, especially in communities with fewer resources.
The first change you’d notice is the tone of the classroom. It would feel calmer and more connected. Teachers would spend less time managing behavior and more time focusing on academics.
Early support also strengthens emotional literacy. We don’t teach kids how to voice their feelings. Instead, we discipline them for expressing those feelings. A child who comes in angry because of what’s happening at home might get detention or lose a sticker on a behavior chart, instead of having a dedicated space to regulate.
Most teachers would love to support emotional regulation, but they don’t have the time, training, or systems that allow them to do it. With more access to care, we’d see less discipline-driven responses to behavior and more emphasis on helping kids understand what they feel.
What changes when families receive support
When treatment works and access improves, what do you see shift in families and caregivers?
When care works, families stop living in constant reactivity. Routines return. Laughter returns. Overall, things feel a bit less overwhelming.
Everyone in a household experiences that household differently. When one person doesn’t have access to care, other family members often have to manage everything that person is going through. Early or consistent support reduces that pressure.
Parents in particular wear so many hats, all while trying to maintain their own identities. Parents personalize their children’s behavior much more than we admit. We tend to believe that a child’s behavior is a reflection of the parent.
With access to care, family dynamics become less reactive and there’s more room for grace.
Mental health in the workplace
What might improve in workplaces if employees had better access to mental health care?
I see this in my own staff. In behavioral health settings, we’re the ones people turn to, and that raises the question of who do we turn to. When employees can ask for help, you see fewer absences, better communication, stronger emotional advocacy, and higher morale.
A big part of what I work on with my team is emotional regulation: how to anchor themselves, how to avoid letting one moment ruin an entire day, and how to understand the way they think about situations. If a coworker says something, why did you interpret it the way you did? That kind of self-reflection happens in mental health care, and it benefits the workplace.
Where communities should invest
Where would you want to see communities, cities, or governments invest to make these improvements possible?
I kept coming back to the word fragmentation. The biggest barrier isn’t a lack of effort; it’s that our systems are so fragmented.
That’s why I would invest in community-based care navigation. Case managers are often overlooked, but they help people navigate health care, housing, employment, and so many other systems that can feel impossible to understand. Most people don’t qualify for these services unless their income or insurance type fits very specific criteria.
Someone who can walk alongside clients between systems can translate treatment themes into stability: staying housed, staying employed, staying regulated. These systems are massive, and when something feels impossible to navigate, I often say it’s that way on purpose.
The middle class especially gets hit hard. They don’t qualify for benefits, their insurance often doesn’t cover what they need, and they’re stretched thin emotionally and financially. Millennials are trying to break generational cycles while dealing with intense economic stress. Without accessible care, functioning becomes unsustainable and crises increase.
How do you build trust in neighborhoods that have felt overlooked or harmed?
Outreach alone doesn’t build trust. Putting up flyers is not the same as showing up. Trust is built through reciprocity, listening before prescribing solutions, and partnering with communities instead of assuming we know what they need.
There’s a principle in community-based participatory practice that says the community knows best how to heal itself. That means recognizing that healing has to happen in relationship to the conditions that caused harm.
That’s where liberation psychology comes in. It reminds us that healing must be connected to the social and structural factors that created the harm. In practice, that looks like embedding care in trusted spaces, being transparent, and creating visible ways for communities to give feedback.
If people distrust institutions, only consistency and transparency over time will rebuild that trust.
Find accessible care today
If Sandra’s reflections resonate with you and you’re ready to explore mental health support, Columbia Mental Health is here to help. Our team is committed to meeting you where you are and supporting your journey toward stability, presence, and connection. For new clients, please click here to schedule an appointment. For existing clients, please click here and find your office location to contact your office directly.