“An individual has not started living until he can rise above the narrow confines of his individualistic concerns to the broader concerns of all humanity.”
-Martin Luther King, Jr.
Mental illness touches individuals and communities physically, emotionally and spiritually. Individuals and communities cannot be fully understood without taking into account the full context and culture, including but not limited to: age, gender, ethnicity, religious affiliation, sexual orientation, disability, and income status.
Therefore, diversity and inclusion in the mental health field has been a growing movement for the past couple decades. Despite the vast number of research, awareness outreach programs and clinical practice changes, mental health disparities for minority populations is still an overwhelming issue.
- African-American adults are 20% more likely to report serious psychological distress than Caucasian adults.
- Older Asian-American women have the highest suicide rate of all women who are 65+ years old in the United States.
- Adults with disabilities are 3 times more likely to commit suicide than peers without disabilities.
- Gay and bisexual men have higher prevalence of eating and body image disorders than heterosexual peers.
- Individuals in poverty are more likely to be exposed to complex trauma and less likely to receive quality mental health services.
What Affects Someone’s Utilization of Mental Health Services?
Understanding minority help-seeking behaviors for mental health services is a complex topic. There are several individual and systematic factors at play. The following are some (not all) major barriers to utilization of services.
Cultural differences of what mental health is
There are many different views of mental health. Latin populations tend to view mental illness as a health or medical issue focusing on physical complaints, such as stomach aches and body pain. The concept of speaking with a professional about emotional issues may not fit with their conceptualization of health.
There are also translation issues when trying to explain symptoms. For example, in Korean populations, depression and anger can be described as a burning fireball in the back of one’s head. Therefore, Asian populations are more likely to seek treatment from medical professionals or primary care physicians, rather than seek treatment from mental health professionals.
Stigma and discrimination within community
Mental health and treatment is still a primarily Western and European construct. Mental Health America conducted a survey and found that 63% of African-Americans believe that depression is a “personal weakness.”
Many cultures operate from stoicism and emotional restriction. Therefore, individuals may be hesitant to seek mental health treatment in fear of shame and disgrace from their family, friends, and community.
Unique challenges faced
Minority populations are less likely to know and understand mental disorders, symptoms and treatment in the United States.
For many minority populations, there is significant distrust and fear in the system. There are fears that mental health professionals may not understand or pathologize unique challenges the minority client may experience, such as discrimination, acculturation issues, and lack of access to resources. For example, homosexuality was viewed as a mental disorder until 1973. Although many advancements have been made, individuals who are homosexual still endure significant discrimination. LGBTQ individuals are less likely to receive treatment as well as feel that their symptoms have been over-pathologized or misunderstood.
Lack of access
Many minority populations have less access to resources, such as access to insurance, transportation and culturally sensitive treatment. Individuals who have lower forms of insurance tend to receive less quality of care. For example, individuals with Medicaid insurance in Michigan are allotted 20 sessions a year, which averages out to less than 2 sessions a month.
There is also less availability and awareness of resources among minority communities. Therefore, minority clients are less likely to utilize resources, even if there are available. In 2009, 68.7% of Caucasian adults with a major depressive episode received treatment, while only 53.2% of African-American adults did.
Another barrier is the lack of mental health professionals who speak different languages as well available interpreters. Seemingly simple tasks, such as making an appointment, are difficult. There are resources of phone interpreters, but counseling can be more difficult speaking into a phone.
Stigma and discrimination from providers
Whether explicit or implicit, bias exists. According to the Surgeon General, African-American physicians are 5 times more likely than Caucasian physicians to treat African-American patients.
Minority populations are less likely to receive treatment. Studies have shown that people of color are more likely to drop-out of treatment because they do not feel fully understood or feel that the professionals are being biased. Studies found that heterosexual health care providers preferred heterosexual clients. Despite much advancement of research and programs, there is still a lack of culturally sensitive understanding and training.
What Can We Do?
Culturally Competent Care
Many training programs for mental health professionals still lack strong training programs integrating culturally-sensitive care. Many providers are ill-equipped with information and experience. It is impossible to know everything about everyone.
However, schools, companies, and organizations should provide trainings and conferences on how to better understand and treat diverse clients. For example, African-Americans are more likely to be misdiagnosed with schizophrenia. It is critical that mental health professionals understand clients’ context and culture to provide quality care.
Culturally competent care will provide ethical care as well as decrease drop-out rates in services.
Mental health affects individuals of all races, cultures, ages, genders, religions and income levels. Awareness and outreach are crucial components to addressing disparities in the mental health field. Many minority populations are unaware of resources and services available to them. Latin populations tend to seek treatment from churches, family, and community leaders. Therefore, it is important to provide information and resources.
Understand the System
More programs, such as the Office of Behavioral Health Equity, are being created to ensure quality of care for all who need it. However, there is still a lack of knowledge in the general public about the significance of disparities in the mental health field for minority populations. The problem is both individual and systemic.
Educate yourself and support organization and programs. It is vital that as a community we come together to fight such inequality and work towards availability of mental health services to ALL WHO NEED IT.
“Diversity is about all of us, and about having to figure out how to walk through this world together.” – Jacqueline Woodson
Links to Helpful Online Resources:
- NAMI: National Mental Health Awareness Month
- Reach Out
- “Toward Culturally Centered Integrative Care for Addressing Mental Health Disparities Among Ethnic Minorities”
- “Addressing Disparities in Mental Health Agencies: Strategies to Implement the National CLAS Standards in Mental Health”
- “Ethnic Minorities Still Receiving Inferior Mental Health Treatment, Says APA Journal”
Diana Ro, PsyD is a Doctoral Limited Licensed Psychologist at the Pine Rest Southwest Clinic. Diana earned her Bachelor’s degree in Psychology and Social Behavior from University of California of Irvine. She received her Master’s degree in Psychology and Christian Leadership as well as her Doctorate of Psychology degree from Fuller Graduate School of Psychology in Pasadena, California.