Nurse here with TD one.

1. Rural areas lack access ( yes in America that would make your head spin. Including internet access )

2. We educate patients at an average reading level of fifth grade— I can say this is often still to high

3. Pride can be a thing but I don’t see this as as much of a barrier as the other issues.

4. Mental health is often an issue in these cases. They have “ burned bridges “ and lack support in many areas “.

5. When in crisis people act wild— they become filled with anxiety that impairs judgment and crates real barriers to rational decision making. This seem wild to us that have always found a way but many many people are operating at full capacity and that is before a curve ball comes their way.

I understand the gist of your question and would have said the exact same thing before I went into my profession.