October 10, 2023 - Carla Petree, LMHC, MA
Mental health is not immune to disparities within the health care system. Individuals with mental health illnesses in the United States can face fragmented or unavailable services, high costs, and social stigma.
Mental disorders are among the costliest health conditions for adults 18 to 64 in the United States, along with cancer and trauma-related disorders.1
According to the National Institute of Mental Health (NIMH), mental health disparity is defined as “significant disparity in the overall rate of mental illness incidence or prevalence, morbidity, mortality, or survival rates in a health disparity population as compared with the health status of the general population.”2 Some of the commonly susceptible groups and/or subcategorizations include racial and ethnic minorities, sexual and gender minorities, lower socioeconomic status, and rural communities. For example, among adults with any mental illness, 48% of individuals who classified as White received mental health services, compared with 31% of Blacks and Hispanics, and 22% of Asians.3
How Does It Happen?
Although everyone carries his/her own personal barriers to mental care access, most minority groups share common barriers such as lack of insurance/inability to cover the cost of care, language barriers, lack of diversity within providers, cultural stigma, and historical distrust in the health care system.
- Language barriers
- Distrust in the health care system
- Lack of diversity amongst health care providers
- Mental health/illness stigma
Understanding the underlying social and economic inequalities such as economic instability, neighborhood environment, food security, educational level, and structural racism/discrimination systemically impact health.4 These factors serve as important frameworks to consider when planning health interventions and providing outreach.
How Do We Close the Gap?
There is a high need for targeted efforts to help reduce the impact of mental health disparities. These efforts can be conducted on personal, community, and national levels to promote better outcomes and equity among these populations. It is important to consider which population to focus efforts toward, because each of the defined subgroups carries its own barriers and needs. Clarifying the desired outcome and developing communication mechanisms not only to provide mental health care, but to evaluate its effectiveness in these subgroups to help improve the current state of affairs.
On an individual level, considerations can, and should, include the following5:
- Assessment of a patient’s cultural beliefs, attitudes, and stigma related to mental health
- Advocacy within one’s own health care organization
- Understanding of one’s own potential biases
These considerations can apply primarily to direct care providers.
Both community and nationally, changes should include the following5:
- Addressing of mental health disparities through ongoing research
- Increased outreach to populations facing the highest level of disparity
- Partnership with mental health organizations and advocacy groups
- Professional employee training and recruitment that leads to a multicultural mental health workforce
A public health approach that promotes mental health among minority populations and eliminates treatment disparities requires public policies that track and reduce disparities and seek solutions for these diverse communities.6
These goals will not be fulfilled quickly. They start with improving service/communication pro-grams, overcoming barriers to care, and building public health capacity.
- Agency for Healthcare Research and Quality. Statistical Brief #471 Top Five Most Costly Conditions among Adults Age 18 and Older, 2012: Estimates for the U.S. Civilian Noninstitutionalized Population, April 2015. Accessed July25, 2023. https://meps.ahrq.gov/data_files/publications/st471/stat471.shtml
- Overview. National Institute on Minority Health and Health Disparities. Updated May 5, 2021. Accessed June 29, 2022. https://www.nimhd.nih.gov/about/overview/
- Agency for Healthcare Research and Quality. 2015 National Healthcare Quality and Disparities Report. 2016. https://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/chartbooks/personcentered/qdr2015-chartbook-personcenteredcare.pdf
- Ndugga N, Artiga S. Disparities in health and health care: 5 key questions and answers. KFF. May 11, 2021. Accessed June 29, 2022. https://www.kff.org/racial-equity-and-health-policy/issue-brief/disparities-in-health-and-health-care-5-key-question-and-answers/
- Alegría M, Zhen-Duan J, O’Malley I, DiMarzio K. A new agenda for optimizing investments in community mental health and reducing disparities. Am J Psychiatry. 2022;179(6):402-416. doi:10.1176/appi.ajp.21100970
- Primm AB, Vasquez MJ, Mays RA, et al. The role of public health in addressing racial and ethnic disparities in mental health and mental illness. Prev Chronic Dis. 2010;7(1):A20. Epub 2009 Dec 15. PMID: 20040235; PMCID: PMC2811515 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811515/#B4