A 1999 report by the Surgeon General report stated that despite the existence of effective treatments, “disparities lie in the availability, accessibility, and quality of mental health services for racial and ethnic minorities.”
Unfortunately, its findings still hold true nearly two decades later. According to the Agency for Healthcare Research and Quality, minorities still have less access to mental health services than whites.
Despite advances in health equity, including the expansion of mental health coverage thanks to the Affordable Care Act, disparities in mental health care persist. Why are minorities still not getting proper mental health care? There are a number of reasons. Here are few:
- A lack of availability of services
- Transportation limitations
- Difficulty finding childcare/taking time off work
- Racism in treatment settings
- Language barriers and not enough bilingual providers
According to the National Alliance of Mental Illness (NAMI), there is an especially high level of mental health stigma among minority populations. Surveys and studies have shown that Hispanics and minorities in general experience higher levels of self-stigma—internalizing negative societal beliefs about mental illness—and are more likely to conceal a mental health problem from coworkers, friends, or classmates than whites.
Indeed, in 2018, NAMI is promoting the theme of “CureStigma” throughout its awareness events, especially during Minority Mental Health Awareness Month in July. National Minority Mental Health Awareness Month was established by the U.S. House of Representatives in 2008.
The belief among some in the minority populations that mental health treatment “doesn’t work” also plays a role in avoiding or delaying treatment, as does a lack of adequate health insurance. Poverty also affects mental health status: Hispanics living below the poverty level, as compared to Hispanics above the poverty level, are over twice as likely to have psychological distress—and low income populations have less access to health care.
Also factoring into the disparities is a mental health system weighted heavily toward non-minority values and culture norms, as well as language barriers. That problem in particular was the impetus for the founding of the Gándara Center in 1977, when no other agency in the area specifically met the needs of providing culturally sensitive care to the Hispanic community. Today, the Gándara Center specializes in Hispanic services, but also delivers services to African-Americans and other diverse populations.
Disparities in Care for Minority Youth and Children
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), over 70 percent of African-American adolescents with a major depressive episode did not receive treatment for their condition, and the percentage of African-American and Hispanic youth who use mental health services is less than half than that of white children (4-5 percent and 10 percent, respectively).
Korie Johnson, director of education support services for the Gándara Youth Development Center in Holyoke, said that when parents have unaddressed mental health concerns, that in turn leads to challenges with their children because many of them are unaware that their kids and teenagers need treatment. “When parents suffer from depression, for example, many of them aren’t doing what they need to do for their children,” she said.
The Youth Development Center offers at-risk youth in Gándara programs and in the community a place to access educational and vocational training support, as well as art enrichment programs. Johnson said many of the youth that come to the center have ADHD and suffer from trauma. “Most of the youth we work with have trauma issues because of domestic violence in their backgrounds,” said Johnson. “I think that plays a big role in how they interact with their peers, how they interact with their teachers—with everyone.” Many minority children also experience “compounded community trauma”—the experience of children when they witness violence both in their homes and in their neighborhoods. Compounded community trauma has been linked to high rates of mental illness, including PTSD, depression, and externalizing behaviors such as physical aggression and destruction of property.
The light at the end of the tunnel, said Johnson, is community health organizations such as the Gándara Center are narrowing the disparities that hinder the most vulnerable populations’ access to mental health care.
“I think Gándara as a whole has been really stepping in and getting those who are in need the proper services,” said Johnson. “More and more people in the community know they have a place to go and not be looked at in a negative way.”
The LGBTQI+ Community and Mental Health
According to NAMI, LGBTQ individuals are almost three times likely than heterosexuals to suffer from a variety of different mental health conditions, such as major depression or generalized anxiety disorder, and are two to three times more likely to be diagnosed with a substance use disorder.
There is also a common denominator regarding the mental health treatment disparities of the LGBTQI+ community and those of racial and ethnic minorities and other marginalized groups (such as the homeless and those with limited mobility): they all endure discrimination, which creates stress responses and traumatic experiences.
While great strides have been made in terms of society’s treatment of LGBTQI+ individuals, ostracization and stigma still affect this population’s access to mental health care.
Past, Present, and Future
In 1985, the U.S. Department of Health and Human Services (DHHS) released the Report of the Secretary’s Task force on Black and Minority Health. Also known as the Heckler Report, it called the extent of the health disparities, including mental health, “an affront to our ideals and to the ongoing genius of American medicine.” In the decades since this landmark report, much has improved, but health and health care disparities have persisted.
DHHS enacted its Action Plan to Reduce Racial and Ethnic Health Disparities in 2011, providing a comprehensive framework for federal agencies to align efforts and promote policies and programs to reduce racial and ethnic health inequality. Its implementation progress report, released in 2015, detailed important work that had been accomplished, including SAMHSA incorporating health disparity impact statements into all new Requests for Applications for grant programs.
In addition, the Affordable Care Act (ACA), which is still the law of the land, requires group and individual health plans to provide benefits for mental health and substance use disorders equivalent to those provided for physical health conditions. The ACA also created offices of minority health in six agencies within the DHHS. Despite the Trump administration’s efforts to curtail the ACA, the fundamental elements of the act remain in place.
Today, and into the future, what can the average person do to help ensure better mental health treatment in marginalized communities? NAMI’s CureStigma theme stresses the fact that taking on the challenges of access to care requires all of us, and fighting stigma one of the keys. “Stigma is 100 percent curable,” reads NAMI’s Minority Mental Health Awareness Month web page. “Compassion, empathy, and understanding are the antidote. Your voice can spread the cure.”
Korie Johnson, director of education support services for the Gándara Youth Development Center in Holyoke