Author: Sara Habibipour
Nearly 20% of US adults have a diagnosable mental illness in a given year (Psychiatry). Although mental health counseling, therapy, and medications exist to address many of these mental health conditions, many individuals across the US do not have equal accessibility to such services.
The Data
Mental health disorders are common among people in the criminal justice system, which has a disproportionate representation of racial/ethnic minorities. Approximately 50% to 75% of youth in the juvenile justice system meet criteria for a mental health disorder.
Although rates of depression are lower in Blacks (24.6%) and Hispanics (19.6%) than in whites (34.7%), depression in Blacks and Hispanics is likely to persist over longer periods of time without treatment.
Multiracial individuals (24.9%) are the most likely to report any mental illness than any other race/ethnic group, followed by American Indian/Alaska Natives (22.7%), white (19%), and Black (16.8%) individuals.
15% of African Americans, 13% of Latinos, and 11% of Asian-Americans say that they would have received better mental health care if they were a different race.
31% of White children with mental health problems receive mental health services, whereas only 13% of children belonging to racial/ethnic minorities receive the same services.
8.7% of Black adults receive treatment for mental health concerns compared to 16% of White adults.
88% of Latino youth have unmet mental health needs in comparison to 76% of White youth and 77% of Black youth.
51% of White healthcare providers believe that their patients do not adhere to mental healthcare treatments as a result of linguistic and cultural barriers. Yet, 56% of White providers report having no form of cultural competency training.
(Sources: Psychiatry, Simmons University)
Why Are the Numbers This Way? What Barriers to Mental Healthcare Exist?
According to Simmons University, barriers for minorities with mental illness in accessing care include racism, discrimination, increased vulnerability to being uninsured, cultural differences, language and communication barriers, cultural perceptions about mental illness and well-being, and fear or mistrust of treatment.
At an individual level, cultural stigma around mental healthcare can prevent people from seeking out treatment. A 2020 study published in BMJ Public Health evaluated mental health stigma in racial/ethnic minorities and found that mental health stigma was significantly higher among racial and ethnic minorities for common mental health disorders by using the Mental Illness Stigma Framework (MISF).
At the provider level, only 5% of the physician workforce is Black, despite comprising over 13% of the US population. Most mental health professionals are White (AAMC); because of this, often the same cultural lens gets applied to all patients. However, individuals from different communities may require varying points of view to understand their condition and competently communicate diagnosis and treatment plans. Further, people of color have a more difficult time finding a provider within their neighborhoods. Mental health providers also tend to avoid establishing office areas where people can’t pay the full price of the visit out of pocket, which means a lower number of providers in lower income communities. According to 2019 data from Medicaid and CHIP Payment and Access Commission (MACPAC), 62% of psychiatrists accepted new patients with private insurance and Medicare, while only 36% of them accepted new patients with Medicaid.
Addressing Barriers to Care
One of the most widely-accepted recommendations includes cultural competency training for mental health providers. Beyond practicing cultural humility, providers must understand how intersectionality and social determinants of health impact access to mental healthcare for people of color and the conditions that lead patients to develop mental health illnesses in the first place.
Public health programs should be expanded that aim at minimizing mental health stigma in minority communities; this has been done through social media toolkits and community workshops, for example. However, community health workers with lived experience and deep cultural understanding of their communities should also be supported in order to ensure connection to care and adherence to mental health treatment.
Lastly, clinical trial diversity must be improved in order to assess the best treatments for all patient populations. Currently, 64% of mental health trial participants are White, 2% are Asian, and 2% identify as more than one race. Less than 1% identify as Native American or Asian Pacific Islander (NIH). This must change in order to promote equitable and effective care.
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Sources:
https://journalistsresource.org/home/racial-disparities-mental-health/ (The Journalist's Resource)
https://www.macpac.gov/wp-content/uploads/2019/01/Physician-Acceptance-of-New-Medicaid-Patients.pdf (MACPAC)
https://online.simmons.edu/blog/racial-disparities-in-mental-health-treatment/ (Simmons)
https://lifesciencesintelligence.com/features/addressing-disparities-in-minority-mental-healthcare-risk-and-access (Life Sciences Intelligence)
https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-020-08964-3 (BMJ)
https://report.nih.gov/RISR/ (NIH) https://www.aamc.org/data-reports/workforce/data/figure-18-percentage-all-active-physicians-race/ethnicity-2018#:~:text=Among%20active%20physicians%2C%2056.2%25%20identified,subgroup%20after%20White%20and%20Asian. (AAMC)