By April Jeffries and Dr. Manuel Garcia-Garcia
Most Americans are frustrated with the mental healthcare system in this country- despite the historic reckoning around mental health that the pandemic has forced to the foreground for two years (and counting). This dissatisfaction holds particularly pointed implications for Black and Hispanic communities, who report being more concerned with their mental health than White Americans.
Yet, these communities are also less likely than White Americans to report getting support from a mental healthcare provider during a difficult time, a National Alliance on Mental Illness/Ipsos poll finds. Key to promoting more equitable access to mental healthcare will require breaking down the barriers of cost, stigma, and unequal treatment.
So how did we get here?
Many of the barriers to expanding mental healthcare predate the pandemic and appear poised to outlast it, including a lack of affordable mental healthcare options, a persistent gap in racial and ethnic representation in the psychology workforce, and the stigma surrounding mental health issues.
To begin with, a majority of Americans—75 percent—say that they are not content with mental healthcare treatment in this country. Many cite costs and coverage as a major issue. Mental healthcare is not universally covered under insurance and forces many to pay high out-of-pocket costs. More so, the uninsured are more likely to be Black and Hispanic, posing an even bigger hurdle in getting affordable care to these patient populations.
This disparity cannot be attributed to affordability issues alone. The data suggests stigma and racism in patient experience are other major contributing factors.
According to Beryl Institute/Ipsos polling, two in five Black Americans (42 percent) and one in five Hispanic Americans (21 percent) report experiencing prejudice and discrimination in their healthcare encounters with some frequency, compared to just 5 percent of White respondents.
Given that 84 percent of the psychology workforce is White, accessing a provider who shares a similar racial and ethnic background is yet another obstacle in connecting Black and Hispanic patients to mental healthcare. Without a diverse workforce of providers, other culturally sensitive barriers, like language, also pose significant hurdles to care.
The problems with access and barriers are further exacerbated by the stigma surrounding getting help. Many acknowledge there’s still a stigma around mental health, with majorities of White, Black, and Hispanic Americans expressing concern about this.
These findings aren’t isolated to one survey. Other studies found that some Black Americans view struggling with mental health as a personal failing; three in five Black Americans (63 percent) believe depression is a personal weakness. Likewise, for some in the Hispanic community, sharing intimate details with a provider may cut against cultural norms.
There are also macro forces the pandemic aggravated that added stress and loss to Black and Hispanic communities. Black and Hispanic workers were more likely to be frontline workers and not have sick days or comprehensive medical insurance, forcing many to directly grapple with the risks of COVID day-to-day. At the same time, systemic racism in the healthcare industry and elsewhere pushed mortality rates from COVID higher for Black and Hispanic patients than White patients.
That loss of life touched so many in Black and Hispanic communities. By the most recent estimates, about half of Black (54 percent) and Hispanic (48 percent) people personally know someone who died of COVID-19.
Many Black and Hispanic Americans are concerned about their mental health, but aren’t getting the help they need through the formal mental health system due to cost, stigma, and treatment disparities. While complicated problems on their own, the pandemic has added another layer of urgency to this confluence of issues. Understanding the extent to which these forces limit access now is the first step in seeking to alter the current status quo and creating a more equitable system of mental healthcare in America.
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