Recovery-oriented social psychiatry and psychiatric rehabilitation increasingly emphasize rights, participation, community-based care, supported decision-making, supported employment, and prevention-oriented early intervention. Yet formal access to services, information, rehabilitation, legal-administrative procedures, or participation formats does not by itself ensure that people can use these resources when shame, mistrust, affective overload, fatigue, cognitive narrowing, or structural vulnerability are already present. This Hypothesis and Theory article introduces psychodynamic accessibility as a provisional middle-range mechanism for the formal-access/effective-agency gap. Psychodynamic accessibility refers to the degree to which services, rehabilitation pathways, workplaces, administrative procedures, and prevention-oriented access pathways remain usable when affect tolerance, self-worth, mentalizing, epistemic trust, defensive functioning, or personality functioning are strained by the setting itself. The article does not propose a general theory of socioeconomic inequality or service disengagement. Its narrower aim is to define psychodynamic conversion factors that may infl
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