Addressing Disparities in Minority Mental Healthcare: Risk and Access

July 19, 2023 - To achieve improved health equity across the United States, providers, public health organizations, and legislature must address risk and access disparities in minority mental health.

Each July, the US and many of its public health organizations observe National Minority Mental Health Awareness Month, also known as Bebe Moore Campbell National Minority Mental Health Awareness Month. Mental Health America also refers to it as Black, Indigenous, and People of Color (BIPOC) Mental Health Awareness Month.

The CDC estimates that 20% of adults in the US are living with mental illnesses. Although most mental health issues are treatable or preventable, disparities in access to mental healthcare services can significantly impact health outcomes.

Simmons University notes that mental health services in the US can be challenging regardless of the sociodemographic group a patient belongs to. With limited or unavailable services, high care costs, and social stigmas, mental health resources are exceptionally difficult to obtain.

This issue becomes even more significant for minority groups that face systemic and systematic barriers preventing access to mental healthcare.

Even when controlling for other variables such as income, insurance status, age, and symptom expression, racial and ethnic minorities still have the least access to comprehensive mental health treatment.

Racial and Ethnic Disparities

Unfortunately, racial and ethnic disparities persist across nearly every healthcare sector in the US. Mental healthcare is no exception. Race can significantly impact mental health needs. For example, some POC may experience racial violence or trauma that can contribute to mental health issues and increase the risk of depression, anxiety, post-traumatic stress disorder (PTSD), substance use disorders, and other mental illnesses.

African American or Black individuals comprise 13.3% of the US population. Across all healthcare sectors, Black patients have the highest risk of adverse outcomes associated with a lack of access to quality healthcare. Those statistics persist when looking at mental healthcare.

Although the prevalence of mental illness among Black patients is comparable to those in the general population, there are significantly less likely to access mental healthcare. When they access mental healthcare, they are more likely to receive reduced quality care.

Data from 2021 revealed that 52% of non-Hispanic White adults with mental illness receive care. Comparatively, 39% of Black or African American, 25% of Asian, and 36% of Hispanic or Latino Adults were treated for mental health conditions, pointing to significant mental health disparities.

Sexual Disparities

Aside from racial and ethnic minorities, members of the Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) community are twice as likely to have a mental health disorder.

Data from the Trevor Project’s 2023 US National Survey on the Mental Health of LGBTQ Young People revealed that the prevalence of suicidal thoughts among LGBTQ youth was significantly higher than in cis-gendered, heterosexual youth. The organization’s survey of roughly 28,000 LGBTQ youth between 13 and 24 revealed that nearly half of all respondents seriously considered suicide in the past year.

In addition, the report quantified suicide attempts among LGBTQ individuals, noting that 14% had attempted suicide in the past year. The rates were significantly higher for transgender youth, at 23% and 16% for transgender men and women, respectively. Comparatively, only 6% of cis-gendered men and 8% of cisgendered women attempted suicide in the past year.

Even within this minority group, racial and ethnic inequities persisted. While 11% of White LGBTQ youth attempted suicide in the past year, the rates among Native/Indigenous, Middle Eastern/North African, and Multiracial LGBTQ youth were significantly higher at 22%, 18%, and 17%, respectively.

A report published by the US Department of Health and Human Services (HHS) Substance Abuse and Mental Health Services Administration (SAMHSA) based on the 2021 and 2022 National Survey on Drug Use and Health revealed that lesbian, gay, and bisexual (LGB) individuals are more likely to experience substance use and mental health disorders. The data showed that bisexual females were the most likely to report illicit drug use, with 49.7% of respondents doing so. Furthermore, 49.5% of bisexual males reported illicit drug use.

Although discrimination and other societal pressures increase the risk of mental illness and self-harm for LGBTQ individuals, barriers to access continue to perpetuate these disparities. The Trevor Project report revealed that 56% of LGBTQ youth that sought or wanted mental health treatment could not access it. Barriers to care ranged from lack of guardian permission to fear and cost barriers.

Barriers to Adequate Care

According to Simmons, some barriers for minorities with mental illness include racism, discrimination, increased vulnerability to being uninsured, cultural differences, language and communication barriers, cultural perceptions about mental illness and well-being, and fear or mistrust of treatment. The National Alliance on Mental Illness (NAMI) notes that wait times and cost of care also pose significant challenges for minorities to access mental healthcare.

Unfortunately, most healthcare providers, including mental health professionals, are White and apply the same cultural lens to treatment for all patients; however, different minority communities may require varying points of view for improved communication and accurate diagnosis.

A publication in the Journal of Clinical Psychiatry notes that Black individuals comprise roughly 5% of the physician workforce despite comprising over 13% of the US population.

Data from Simmons University reveals that 15% of African American individuals reported thinking they would receive better mental healthcare if they were of a different racial or ethnic background. Among Latino and Asian American communities, the rates were 13% and 11%, respectively.

Beyond patients’ personal experiences and perspectives, data has shown that children from racial or ethnic minority groups are statistically less likely to receive mental health services when struggling with a mental health condition. More specifically, while 31% of White children with a mental health disorder receive care, only 13% of children from minority populations receive care.

Another barrier to minority mental health equity is the stigma associated with mental illness across minority communities. A 2020 systematic review and meta-analysis published in BMC Public Health evaluated the stigma of mental health disorders in racial minorities. Researchers assessed mental health stigma using the Mental Illness Stigma Framework (MISF), finding that mental health stigma was significantly higher among racial and ethnic minorities for common mental health disorders.

Beyond societal influences, disparities in research have also contributed to inequities in mental healthcare. BIPOC are continually underrepresented in mental health studies. The NIH estimates that across all mental health studies sponsored by the organization, only 10% of study participants are African American. Meanwhile, Black people comprise 13.4% of the US population and have mental illness rates similar to the general population.

Comparatively, 64% of study participants are White, 2% are Asian, and 2% identify as more than one race. Additionally, the following groups each comprise less than 1% of study participants: American Indian or Alaska Native, Native Hawaiian or other Pacific Islander, and those of unknown or unreported racial/ethnic backgrounds.

Addressing Barriers to Care

Despite the challenges in minority mental healthcare perpetuated by the health system, some recommendations exist for improving mental health equity across diverse populations. Individuals, public health organizations, health educators or communicators, health systems, and regulatory authorities can facilitate mental health equity across underrepresented groups.

One of the most prominent recommendations includes cultural competency training and an emphasis on culturally competent services. The American Psychiatric Association Guide for Addressing the Mental Health Needs of Racial and Ethnic Minority Youth encourages healthcare providers to exercise cultural humility when addressing patients in marginalized communities. Practitioners can practice respect, acceptance, sensitivity, a commitment to equity, openness, and flexibility.

Beyond practicing cultural humility, providers must understand how intersectionality may further impact a patient’s mental health experiences.

Providers and public health organizations should also engage in advocacy efforts to minimize the stigma surrounding mental health issues in minority communities.

Mental Health America’s 2023 Culture Community and Connection BIPOC Mental Health Outreach Toolkit includes media materials, social media sample messages, factsheets, worksheets, posters, and additional outreach resources.

Diversifying mental health leaders and clinicians may also improve cultural competency and facilitate more equitable care. For example, the NAMI notes that including minorities on staff or boards of mental health organizations can provide additional perspective to these organizations.

Finally, improving clinical trial diversity to assess the best treatments for all patient populations may improve equitable and effective care access. The National Institute of Mental Health (NIMH), a subset of the NIH, acknowledges that minority mental health research is lacking. Efforts by the NIMH to improve this include its minority mental health research program.

The research program coordinates minority mental health research, identifies treatment gaps, and establishes research partnerships. Additionally, the program educates partners and researchers on critical research points.

Despite the ever-present disparities in minority mental health, researchers, clinicians, and public health organizations have multiple tools to improve equity and establish comprehensive care.