Mental Health Care for All

 
It is well-known that the number of individuals with a mental health disorder has increased significantly in numbers. While mental illness is not selective and impacts those of all races, ethnicity, religions, and gender, there are significant differences in access to mental health services, resources, and care for minorities.  While everyone experiencing a mental health disorder deserves quality mental health care, it has become apparent this is not the case.
 
The challenge to access and receive mental health care is greater for minorities in the United States.  Shushansky (2017) gives a very thought-provoking description of what is like for minorities attempting to access care for mental health needs.
     “Have you ever tried to unlock a door that wouldn’t open? At first, you think, you might be doing something wrong. Maybe there is a trick to it. You pull the key back
 a little-doesn’t work. You wiggle the key-doesn’t work. You keep trying, but the door stays locked. After a while, you realize the problem isn’t you, it’s the key”.
 
There are certain challenges to accessing care which are universal to all populations such as, availability of appointments, insurance issues, and finding providers. However, in addition to these barriers, minority populations face additional and unique challenges.  These unique challenges contribute to the disparities in access to mental health care for minorities. Awareness and identification of challenges may assist in understanding why this disturbing issue exists.
 
Why
 
There are effective treatments and care for mental health disorders and mental health care. That is not the problem. The problem appears to be that minority populations have less access to these, and when care is provided there is a chance it will be at a lower level of quality.  So, what are some contributing factors to this.

Contributing Factors
 

• Availability
• Transportation
• Language barriers
• Lack of health insurance
• Insufficient providers
• Lack of ethnic providers or providers from a specific race
• Lack of culturally competent providers
• Stigma
• Past experiences of bias
• Beliefs that the offered treatments do not work
• Negative ideas regarding mental health care
• Mistrust of the health care system
• Poverty-Low income

 
While all the above are important; stigma is the one factor which should not be ignored, as it is extremely significant in the struggle to access care in the African American Communities. While this certainly should not be ignored in other populations, evidence shows that mental health issues are associated directly to the psychological stress of systemic racism. In the African American community this results in African American adults reporting serious psychological stress 20 percent more than those in the white community. The evidence also supports the distrust in the care and the hesitancy to seek mental health care.  While the evidence supports the fact that mental illness stigma is higher among minorities, what are the proposed solutions.
 
Solutions
 
One study states that “anti-stigma strategies related to metal illnesses according to specific racial and/or ethnic backgrounds with the intention to improve mental health outreach” is indicated. Yes, this sounds good, but changes need to be made on an individual, organizational, and systemic level. Everyone needs to have role in promoting equity. While there are too many proposed solutions to discuss here, there is something that all individuals can start with. That is understanding personal bias. There are tests available to assist in identifying bias, and increasing awareness.
Education and increasing awareness on mental health equity and prioritizing minority mental health is the focus of the CDC  as National Minority Mental Health Month is recognized this month of July. Both sites provide information and multiple resources promoting awareness on minorities and mental health, and ensuring this issue is addressed not just in the month of July. Sharing these resources, educating others, and promoting awareness is a valuable way to ensure this issue gains the attention deserved. 
Mental health disorders are treatable, but only if access to appropriate care and treatment is available to all.  Everyone should work together for this equity so everyone can experience the best mental health possible.
                                                                                 Peggy Fossen DNP, RN CNE

 
 
 
 
 
 
 
 
 
 References
 
Bell CC, Jackson WM, Bell BH. Misdiagnosis of African-Americans with Psychiatric Issues - Part II. J Natl Med Assoc. 2015 Mar;107(3):35-41. doi: 10.1016/S0027-9684(15)30049-3. Epub 2015 Dec 2. PMID: 27282721.
 
CDC. (2023). Prioritizing Minority Mental Health. https://www.cdc.gov/healthequity/features/minority-mental-health/index.html
 
 
DBSA. Statistics about Disparities in Mental Health Care. https://www.dbsalliance.org/education/disparities-mental-health-care/
 
 
Dworak-Peck, S. (2019). Why Mental Health Care is Stigmatized in Black Communities. https://dworakpeck.usc.edu/news/why-mental-health-care-stigmatized-black-communities
 
He, S. (2020). How would You Tackle Mental Health Disparities. Psychiatric Times. https://www.psychiatrictimes.com/view/how-would-you-tackle-mental-health-disparities
 
 
OMH. Mental and Behavioral Health. African Americans. https://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=24
 
Eylem, O., de Wit, L., van Straten, A. et al. Stigma for common mental disorders in racial minorities and majorities a systematic review and meta-analysis. BMC Public Health 20, 879 (2020). https://doi.org/10.1186/s12889-020-08964-3
 
SAMHSA. Behavioral Health Equity. https://www.samhsa.gov/behavioral-health-equity/black-african-american
 
SAMHSA. African American Behavioral Health Center of Excellence. https://www.samhsa.gov/african-american-behavioral-health-center-of-excellence
 
 
Shushansky, L. (2017).  Disparities within minority mental health care. NAMI. https://www.nami.org/Blogs/NAMI-Blog/July-2017/Disparities-Within-Minority-Mental-Health-Care#:~:text=As%20shown%20in%20the%20most,aren't%20getting%20proper%20care.