Barriers to Quality Mental Healthcare for People of Color

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Mental Health is a primary area of concern in the United States. Moreover, recent data suggests that depression is on the rise for Americans as a whole. Earlier this year, The Blue Cross Blue Shield Association released a study on the overall impact of major depressive disorder (MDD) on Americans’ mental health. The findings revealed that more than nine million insured American (4.4 percent) had been formally diagnosed with major depression. Furthermore, certain groups, like women, who are diagnosed at rates double that of men, millennials, who had a 47 percent increase in diagnosis, and adolescents, who had a 63 percent increase, all experienced a dramatic increase in major depressive diagnoses.

There are many adverse health outcomes associated with major depression. Increased likelihood of suicide, reduced quality of overall health, and a shorter life expectancy are all examples. However, MDD is just one of many mental health conditions that impact Americans.

Thankfully, more researchers have begun looking at the impact of depression on certain groups based on their demographic factors, like gender, age, sexual orientation, and ability status. By aggregating specific data about the people who have depression, mental health professionals can compare experiences and tailor resources to meet specific needs. For example, one demographic factor that is often overlooked is that of race and ethnicity. Many people of color (POC)  move through life without having discussions about mental health or the way daily experiences with racism and bias can have a long-term impact on mental health. The stress that accompanies living life along the margins is negatively affecting people of color in the United States. However, the impact of a racialized identity is often overlooked when discussing the obstacles to obtaining adequate access to mental health services.

Data suggests:

  • The Health and Human Services Office of Minority Health indicates that Black Americans have a 20% increased likelihood of mental health issues compared to the general population.
  • Asian American women have the highest suicide rate for women over 65.
  • Suicide attempts for Hispanic girls (9-12 grade) were 70 percent higher than white girls of the same age.
  • In 2014, suicide was the second leading cause of death for the American Indian/Alaska Natives population.

Despite, more intracommunity dialogue (the slow increase in mental health conversations taking place in communities of color) and researchers and organizations taking race into consideration, there are still many obstacles to obtaining quality mental health care.  

Dr. Erlanger Turner, Ph.D., assistant professor at the University of Houston-Downtown and faculty affiliate with the Center for Critical Race Studies has spent a great deal of time familiarizing himself with the unique struggles impacting people of color seeking mental health treatment.

Some of the primary challenges are locating providers in proximity to their homes, accessing services through their health insurance, and locating providers of color. Although providers may be available, some do not accept health insurance, which causes a dilemma for many families,” he explains.

Other components are a bit more complicated to solve. For example, people of color often find themselves uncomfortable with speaking to mental health providers who lack cultural context or lack a solid understanding of the ways provider bias in mental health can impact the mental health professional-client relationship.

Unfortunately, neither mental health professionals nor clients of color are immune to the subliminal messages we are sent through entertainment media like television.

Media portrayals and social scripts often center conversations about mental health around white characters. Since many people of color don’t have these conversations in their homes, this can lead to feelings of isolation in the larger context of depression and other mental health conditions.

According to Sahra Ali, a former nonprofit mental health and addiction service worker, the portrayal of mental health as a “white people thing” has left many people of color further marginalized in the discipline and reluctant to seek mental health services.

Generally speaking, the stigma on mental illness is greater in the minority, POC population in part because they receive it from both sides. People of color are not only discouraged by the general public but also by their own culture. I recall this being one of the hardest, most persistent deterrents for POC when they came to inquire about treatment,” Ali explains.

The lack of representation of POC in the mainstream, as well as inner community, mental health dialogue can also leave them uncomfortable with seeking treatment. Similarly, many mental health providers have internalized bias from these same mainstream, social scripts. The result is people of color are further discouraged from seeking help.

Based on the research and the work that I have been doing, POC often are reluctant to work with providers that don’t look like them for fear of being misunderstood,” Turner explains.

Ali also notes that for many people of color, mental health treatment comes with dual marginalization. “Most White people do not have to think about the cultural stigma when they seek treatment. To be fair, there are two stigmas we are talking about here—the overall stigma of having a possible mental illness or issue and the stigma of seeking treatment as a member of an already ‘othered’ group,” she explains.

While the freedom to exist outside of the expectations of one’s community is a privilege that many white people take for granted, people of color have to consider both how they will be perceived as an individual, as well as, a representative of their racial group.

Thankfully, many mental health professionals are actively researching ways to improve mental health-related experiences for people of color.

One of the most effective ways to buffer people of color from real as well as perceived bias is by connecting them with providers who understand racial differences.

“When they are connected with a provider that looks like them or that is culturally sensitive they feel more open to treatment. The research also supports that when providers are culturally competent, it increases the client-therapist relationship and improves treatment outcomes,” Turner continues.

Research has shown positive outcomes for people of color when seeking treatment with those who have a cultural understanding. However, those providers can be hard to find due to shortages of cultural education as well as limited professionals of color.

“In general, it seems that perceptions about mental health treatment are improving among POC. However, the field still needs to improve its representation of diverse providers to meet the needs of communities of color,” concludes Dr. Turner.

The importance of culturally competent care is severely underemphasized in mental health improvement dialogue. To combat this, Ali suggests that we need to move beyond accommodating cultural difference and more towards expecting it. She reminds us of the extreme vulnerability involved in seeking out mental health services and discusses the ways the fear of being misunderstood can further complicate the process.

“Mental health is a very personal thing. Patients are more likely to seek and continue treatment if they feel they are understood and seen…With that said, it is essential for us to recognize the various challenges that POC face in this arena…plan for it and expect it and most of all, respect their varying experiences,” she states.  

Ironically, the cultural shift to openly discuss mental health conditions like anxiety and depression doesn’t always yield immediate benefits. For example, it isn’t uncommon for individuals of color to hold on to cultural frameworks that emphasize prayer, spirituality, and persistence as a tool for survival through struggles. As a result, transparency about seeking mental health resources might have the accompanying internalized stigma of “weakness.”

“For POC, it is even more difficult. You are perceived as weak and not in control of your life. For Black Americans with a history of slavery or even those from Somalia or other war-torn countries; anxiety and depression are just not talked about. It is not [seen as a] feasible means of survival. It is the same with PTSD which often coincides with anxiety and can enable prolonged depression,” she explains.

One way to alleviate the discomfort surrounding mental health treatment is to increase representation of people of color in the mainstream mental health dialogue.

We owe it to all patients to ensure mental health professionals have received training that is comprehensive and has components of culture education.

Lastly, both Turner and Ali emphasize the importance of the impact of financial class as an isolating factor limiting people of color seeking assistance. Segregated areas with Black and brown people are significantly less likely to have access to quality care. Also, even when care is available, there are often other limitations like trouble receiving time off work or finding childcare.

Targeted campaigns (like National Minority Mental Health Awareness Month, which takes place in July) aim to look at the unique needs of people of color, but there is still work to do.

Being a person of color comes with many challenges. The mental health industry can improve outcomes by making sure mental health professionals of color, as well as patients of color, have the freedom to customize care and spearhead the dialogue about what best benefits those communities.   


Rochaun Meadows-Fernandez is a diversity content specialist whose work can be seen in The Washington Post, InStyle, The Guardian, and many other places. Follow her on Facebook and Twitter.  

 

 

References:

Major Depression: The Impact On Overall Health. Blue Cross Blue Shield. Retrieved from https://www.bcbs.com/sites/default/files/file-attachments/health-of-america-report/HoA_Major_Depression_Report.pdf

Does depression increase the risk for suicide? U.S. Department of Health & Human Services. Retrieved from https://www.hhs.gov/answers/mental-health-and-substance-abuse/does-depression-increase-risk-of-suicide/index.html

How Does Depression Affect the Heart? American Heart Association, Inc. Retrieved from https://www.heart.org/en/healthy-living/healthy-lifestyle/mental-health-and-wellbeing/how-does-depression-affect-the-heart

Zivin K, Pfeiffer P, Ilgen M, et al. Years of Potential Life Lost Associated with Depression Among Veterans,” Psychiatric Services. 2012 Aug 1:63(8):823-6. doi: 10.1176/appi.ps.201100317

Mental Health Data/Statistics. Office of Minority Health. Retrived from https://www.minorityhealth.hhs.gov/omh/content.aspx?ID=6471

Office of Minority Health. Mental Health and American Indians/Alaska Natives. Retrieved from https://www.minorityhealth.hhs.gov/omh/content.aspx?lvl=3&lvlID=9&ID=6475

Suicides Among American Indian/Alaska Natives — National Violent Death Reporting System, 18 States, 2003–2014. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/mmwr/volumes/67/wr/mm6708a1.htm

Aggarwal NK, Cedeno K, Guarnaccia P, Kleinman A, Lewis-Fernandez R. The Meanings Of Cultural Competence In Mental Health: An Exploratory Focus Group Study With Patients, Clinicians, And Administrators. Springerplus. 2016; 5: 384. Published online 2016 Mar 31. doi: 10.1186/s40064-016-2037-4

Merino Y, Adams L, Hall WJ. Implicit Bias and Mental Health Professionals: Priorities and Directions for Research. Psychiatric Services. 2018 Jun 1;69(6):723-725. doi: 10.1176/appi.ps.201700294. Epub 2018 Mar 1.

In Search Of Cultural Competence. American Psychological Association. Retrieved from  www.apa.org/monitor/2015/03/cultural-competence.aspx

Rowan K, McAlpine D, Blewett L. Access and Cost Barriers to Mental Health Care by Insurance Status, 1999 to 2010 Health Aff (Millwood). 2013 Oct; 32(10): 1723–1730. doi: 10.1377/hlthaff.2013.0133

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