18 Jan Recognizing and Addressing Disparities in Mental Healthcare
Healthcare disparities by race and ethnicity impact almost every aspect of seeking and obtaining health care. These discrepancies in physical healthcare are apparent in notable ways, such as in diagnosis and mortality rates for life-threatening cancers, and deadly chronic conditions such as diabetes and high cholesterol. Additionally, Black Americans are two times as likely to suffer a stroke than their White counterparts, and even more likely to develop dementia later in life.
Unconscious bias can have an outsized impact on healthcare delivery, creating inequality for both physical and mental healthcare. Studies show that doctors are more likely to recommend advanced medical treatments for their White patients than for their Black ones. And, while positive outcomes are often dependent on timely interventions, it can take up to 25% longer for minorities and unemployed individuals to see a healthcare professional. These moments can make a difference. The link between disparities in healthcare and poorer health outcomes creates a vicious cycle.
Bias, Stigma, and Access Drive Inequities in Mental Healthcare
While healthcare inequities for physical ailments and illnesses have been documented for decades, the pandemic’s spotlight on mental health is helping illuminate critical gaps in mental healthcare. While more than 51.5 million Americans live with a mental illness, risk factors that contribute to these disorders disproportionately impact minority populations.
Social determinants of health (SDOH) – including factors such economic stability, access to education, social and community context, physical and mental healthcare, and community – greatly influence an individual’s long-term health and well-being, including the rates of suicide and mental health disorders in the United States. Furthermore, the experience of racism, discrimination, and inequity – and its compounding stress – has been shown to drastically impact an individual’s mental health. A study from 2020 revealed that perceived discrimination was associated with depressive behaviors in Black adults, including suicidal ideation. Even when help is sorely needed, access is lacking.
The high price of services and the lack of insurance coverage for behavioral healthcare are compounded by the United States’ national shortage of healthcare providers – especially in economically disadvantaged areas. Data suggests that 38% of individuals who needed mental health treatment in 2016 could not afford the cost of seeking care. With an uninsured rate of nearly 25%, this is especially relevant for the Black community. 22% of the African American population lives in poverty, and are two to three times more likely to report serious psychological distress than those living above the poverty threshold. For those sorely in need of specialized services, they are often financially out of reach.
Stigma associated with mental health can also weaken an individual’s determination to seek needed care. Negative perceptions of mental health service utilization is especially noted among African American communities. Studies indicate that Black women are half as likely as White women to seek mental healthcare. According to the American Counseling Association, Black, indigenous, and people of color (BIPOC) are:
- Less likely to have access to mental health services
- Less likely to seek out services
- Less likely to receive needed care
- More likely to receive poor quality of care
- More likely to end services prematurely
Today’s Issues are Fueling the Need for Equitable Access
A confluence of factors is further exacerbating the need for accessible and equitable mental healthcare. Most prominently, the COVID-19 pandemic is driving an unprecedented mental health crisis. According to the U.S. Census Bureau, symptoms of anxiety and depression have more than tripled since the start of the pandemic, especially among people of color, who are facing disproportionately high levels of infection, hospitalization, and death.
Additionally, recent data reveals startling trends in suicidal ideation and depressive tendencies among BIPOC youth. While suicide rates are steadily rising among all adolescent groups, recent data reveals Black children are more than twice as likely to die by suicide than their White peers.
The only other group reporting similarly high levels of anxiety? Asian Americans. The pandemic has fueled race-related discrimination, violence, and hate crimes. More than 9,000 anti-Asian incidents have been reported since the pandemic’s start. People of Asian descent say they are being made to feel as though the virus is their fault. Individuals report being shunned, coughed on, and even verbally and physically assaulted. While laden with some of the largest recent jumps in mental health concerns, these two communities face some of the toughest obstacles to identifying and accessing equitable care.
Towards a More Equitable Future
The pandemic has helped fuel the mental health crisis that disproportionately affects Black, Asian American, Latinx, Native American, and Pacific Islander populations. It has also helped illuminate the drastic need to address racial and ethnic disparities in mental healthcare.
While much work must be done at the federal level to reduce barriers to care and improve coverage for all, there are steps that providers, agencies, and health systems can take:
Examine your own internal bias. Professionals can look within to ascertain personal levels of cultural awareness and unconscious bias. Ask yourself reflective questions like:
- What privileges do I possess that others do not?
- How does my background influence the way I communicate with—and treat— my patients?
- Do I use a different approach when working with patients from different cultural, ethnic, or racial backgrounds?
For a full framework, refer to a guide from a trusted organization, such as The Implicit Bias Training Guide from the American Academy of Family Physicians.
Embrace diverse hiring practices. Whenever possible, hire staff that reflects the community in which you serve. Patients who feel heard, represented, and understood are better equipped to be active participants in their healthcare journey. Culturally and linguistically competent staff and services will help reduce some initial barriers to care.
Develop local relationships. Help increase community awareness of mental health issues, warning signs, and work to reduce the stigma around seeking mental healthcare. Partner with organizations that provide necessary services to address SDOH and support the health of the community, including shelters, food banks, community centers, schools, and hospitals. Relationships with local and non-profit groups help build referral and support networks that promote early intervention and treatment.
Foster diversity within your organization. While 84% of America’s psychologists are White, the field is gradually growing more diverse. 26% of psychologists under the age of 36 represent racial and ethnic minorities. Mental health professionals can help encourage BIPOC individuals to pursue the profession by offering mentorship and guidance on the path toward an advanced degree in behavioral health. They can do this by helping to identify financial aid packages, promoting research opportunities, and providing recommendations and advice from past experience.
Understanding and addressing the root causes of systemic inequities in healthcare is a necessary first step toward reducing those disparities. Ultimately, providing empathetic, culturally sensitive care can go a long way to reducing disparities, overcoming stigma, and helping to build an equitable future of mental healthcare.
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