Mental illness is race-blind and colorblind. According to the American Psychiatric Association, most racial and ethnic minority groups have similar rates of mental disorders than whites. However, minority populations face numerous barriers to treatment that…
Mental illness is race-blind and colorblind. According to the American Psychiatric Association, most racial and ethnic minority groups have similar rates of mental disorders than whites. However, minority populations face numerous barriers to treatment that make them less likely to get the care they need and, as a result, the consequences of mental illness in minorities may be long lasting. Depression in blacks and Hispanics is likely to be more persistent, for example, and ethnic and racial minorities often bear a disproportionately high burden of disability resulting from mental disorders, the APA says.
An APA fact sheet published last year lists the following daunting statistics:
— In 2015, among adults with any mental illness, 48 percent of whites received mental health services, compared with 31 percent of blacks and Hispanics and 22 percent of Asians.
— Compared with non-Hispanic whites, African-Americans with any mental illness have lower rates of any mental health service use, including prescription medications and outpatient services, but higher use of inpatient services at hospitals.
— Compared with whites, African-Americans are less likely to receive guideline-consistent care, less frequently included in research and are likely to use emergency rooms or primary care rather than mental health specialists.
— People who identify as being two or more races (24.9 percent) are more likely to report any mental illness within the past year than any other race/ethnic group, followed by American Indian/Alaska Natives (22.7 percent), white (19 percent) and black (16.8 percent).
These facts are not lost on those who pledge to help. Many groups, including police departments, social services organizations, faith-based groups and mental health professionals, are working to reduce or eliminate the barriers that prevent minority patients from getting the treatments they need and deserve.
“What I think is exciting is that people are starting to think out of the box,” says Dr. Christina Mangurian, professor of psychiatry and vice chair for diversity and health equity in the department of psychiatry at the University of California–San Francisco Weill Institute for Neurosciences.
Barriers to Care
Despite recent efforts to improve mental health services for African-Americans and other minority groups, barriers remain regarding access to and quality of care. These barriers, the APA says, include:
— Stigma associated with mental illness.
— Distrust of the health care system.
— Lack of providers from diverse racial/ethnic backgrounds.
— Lack of culturally competent providers.
— Language barriers.
— Lack of insurance or underinsurance.
Other factors also prevent minority patients from getting proper care. African-Americans are less likely to be offered either evidence-based medication therapy or psychotherapy. Compared with whites with the same symptoms, African-Americans are more frequently diagnosed with schizophrenia and less frequently diagnosed with mood disorders, perhaps because of differences in how African-Americans express symptoms of emotional distress, the APA says. And physicians often communicate with African-Americans and whites differently. In fact, the APA reports that one study found that physicians were 23 percent more verbally dominant and engaged in 33 percent less patient-centered communication with African-American patients than with white patients.
Mangurian, who is also chair of the APA’s Council on Minority Mental Health and Health Disparities, adds that, “So many structural things impede delivery and access to care, people often end up in inappropriate settings. Black people, especially those with schizophrenia or bipolar disorder, are more likely to be incarcerated instead of where they should be, in a hospital.”
Breaking down the stigma of mental illness is perhaps most important, and groups like the National Alliance on Mental Illness and the APA and celebrities like Serena Williams and Jay Z are working to normalize mental illness by talking openly about their struggles. “If you can be a rapper and admit to mental health problems, it’s role modeling for people,” says Ruth White, clinical associate professor in the department of social change and innovation at the University of Southern California’s Suzanne Dworak-Peck School of Social Work.
NAMI is offering fellowships to minorities doing research as well as practicing in mental health, White says. “When training practitioners, we are paying more attention to cultural competencies, developing skills to practice with people of color and other marginalized communities.” She says she has seen tremendous growth in the number of licensed practitioners who are African-American. “I am part of a group called Black Therapists Rock, and there are about 20,000 people on our webpage,” she says. Along with this growing professional cadre, there are more resources within those networks for professionals to access. “I have seen a huge shift. It’s much easier now (to find minority practitioners), but still mostly in big cities,” she says. “It’s not true in other areas.”
Police departments and other government agencies throughout the country are creating teams to address the aftermath of trauma like police shootings, which research has shown is taking a toll on the mental health of minority communities. “They are trained to handle these cases better,” Mangurian says. “They are particularly useful in communities that are traumatized, so instead of using drugs to deal with their feelings, they have an opportunity to talk about it, get help and change that cycle.”
More schools are teaching students about mental health — in New York, in fact, it is now mandated. “Especially with populations of public schools, which are overwhelmingly minority, this will normalize the conversation for the next generation, give them more tools and a better understanding of what mental health and mental illness are,” White says. “I think it is revolutionary.”
The work is far from over, of course. “Right now in our political climate, there is a lot of implicit and explicit discrimination against women, race, gender, sexual orientation,” Mangurian says, mentioning the confirmation hearings of Justice Brett Kavanaugh, the separation of families at the U.S. border, the Trump administration’s attacks on religious freedom and gender identity and the fraught relations between law enforcement and minorities as factors adding to the stress and anxiety many nonwhite, nonmale, non-Christian people are under. “People in those groups are seeking care, and it is the responsibility of providers to appreciate how that discrimination and the events happening in public are impacting these patients. We need to recognize it and deliver trauma-informed care.”