By Wesley Gallagher
We all know how frustrating it can be to schedule a doctor’s appointment. The simple act of getting a real person on the other end of the phone can seem like an Olympic feat, much less nailing down an appointment and figuring out insurance coverage. Mental health care can be even trickier. There’s a wide range of providers, a lack of insurance coverage for some types of treatment and a social stigma that often makes it hard to talk about mental health issues.
Research has shown that, for minority communities and people living in poverty, the road to mental health can be a steep climb. Not only are people of minority races and ethnicities more likely to struggle from mental health issues, but the barriers to receiving help for those problems are also incredibly high.1, 2
Mental Health in Minority and Underserved Communities
Why is this?
While individual characteristics and family situations always contribute to mental health issues, studies show that institutional racism and prejudice — and the segregation created by these mindsets — may play a larger role in mental health than once thought.2
While low-income communities and African-American communities are certainly not synonymous, years of systemic discrimination have disproportionately impeded the economic prospects of people of color. According to 2015 data from the United States Census Bureau, 25.4 percent of the black population lived below the poverty line, while nationally that figure was 14.7 percent.7
Some noticeable disadvantages to living in highly segregated, lower-income neighborhoods might be higher-than-average rates of unemployment, homelessness, crime and residential turnover. But there are also less obvious drawbacks, such as the effects it can have on the mental health of the neighborhood’s residents.1
Here are some of the common ways that living in underserved communities can negatively impact the mental health of residents:
Many of the factors mentioned above contribute to stress in the lives of people in underprivileged neighborhoods. The instability that comes from unsteady employment can be a huge stressor, as can the fear and uncertainty that come from living in an area with higher-than-average crime and turnover. Studies show that social disorder, rather than financial poverty itself, is the neighborhood characteristic that most directly causes mental health issues such as depression.3
As a demographic, African-Americans are more likely to experience many of the stressful factors that increase risk for developing mental health issues, such as homelessness and exposure to violence.2 High levels of police surveillance may be another significant but unaddressed source of stress in black communities.1
Lack of Community
High rates of residential turnover and unsafe conditions in low-income communities inhibit the development of community bonds that form a sort of informal mechanism of social stability. This can leave individuals to fend for themselves more often than in communities that are not below the poverty line. This lack of community stability exacerbates the impact of personal vulnerabilities on people’s lives, leaving individuals more susceptible to mental health issues.4
Lack of Resources
Underserved neighborhoods often lack the resources needed to maintain necessary community services, which by itself is a source of stress for residents. And unfortunately, this means these communities have little access to mental health treatment when it’s needed.4
Safety net providers — like public hospitals and mental health centers — serve as primary sources of care in vulnerable communities, and these resources are often scarce and struggle to provide the level of care needed.4
Cultural Stigmas About Mental Health
Even when resources are available, cultural stigmas about the nature of mental health prevent many individuals from seeking proper care when needed.2 In fact, research published by the American Psychological Association found that black young adults are significantly less likely to take advantage of mental health services than white young adults. This same study found that, while higher levels of education increase the likelihood that someone seeks mental health care in the white demographic, the opposite is true in the African-American community. Cultural stigma and lack of understanding were found to be two of the primary barriers.8
Studies have shown that perception and internalization of racial discrimination are adversely related to mental health. Our culture’s erroneous characterization of white as superior — combined with the economic marginalization of minorities — can sadly lead people of color to perceive themselves as inferior and powerless. This internalized racism can often lead to negative effects, such as increased alcohol consumption and psychological distress.1
Obstacles to Mental Health Care
Even if someone from a minority community or low-income neighborhood is able to reach out for care for mental health issues, studies show that the likelihood of getting proper, effective care is lower than it is for higher-income white Americans.
Harvard Medical School researchers found that, despite increased attention to racial and ethnic imbalances in healthcare, disparities in access to mental health and substance use treatment have not changed since the early 2000s. Even when minorities do enter care, they usually receive lower quality care because the current healthcare system at-large doesn’t take into account the latest research on how to treat minority populations.5
Overall, minority patients are less likely to receive treatment for things like depression and less likely to remain in treatment for substance use disorders. Current policies designed to improve access to healthcare may not address the specific issues facing minority groups in this regard.5
Research has also found that many psychotherapists are racially biased when it comes to choosing their clients, which can make it hard for people of color to even schedule appointments with mental health providers.6
Change Is Coming
Fortunately, researchers are seeking ways to change the status quo of healthcare for minority and impoverished populations. Experts who have found that neighborhood environments impact mental health suggest implementing changes that will improve underserved communities, remedying some of the factors contributing to mental health issues in the first place.
- Expanding outreach efforts outside of clinic walls with mobile clinics and technologies like telephone and video-based treatment
- Social marketing campaigns designed to reduce stigma and tell people about treatment options
- Inviting feedback from individuals about their mental health needs and obstacles to care and informing policymakers and providers about the specific needs of minority patients
- Providing behavioral health training to the more than 120,000 community health workers in clinics and community organizations treating these populations
- Improving payment options5
While there is still a long way to go toward equality of mental health care, there are some glimmers of hope. As more research comes to light and educates the leaders of the healthcare and policy communities, more meaningful change should make its way into every American neighborhood.
1 Williams, David R., and Ruth Williams-Morris. “Racism and Mental Health: the African American experience.” Ethnicity & Health, /em> 2000.
2 “African American Mental Health.” National Alliance on Mental Illness, Accessed February 12, 2018.
3 Cutrona, Carolyn E., et al. “Neighborhood Characteristics and Depression: An Examination of Stress Processes.” National Center for Biotechnology Information, January 9, 2008.
4 Chun-Chung Chow, Julian, et al. “Racial/Ethnic Disparities in the Use of Mental Health Services in Poverty Areas.” National Center for Biotechnology Information, May 2003.
5 McGreevey, Sue. “Faulty Assumptions, Unequal Care.” Harvard Medical School, June 22, 2016.
6 Khazan, Olga. “Not White, Not Rich, and Seeking Therapy.” The Atlantic, June 1, 2016.
7 “FFF: National African-American History Month.” United States Census Bureau, January 10, 2017.
8 Broman, Clifford L. “Race Differences in the Receipt of Mental Health Services Among Young Adults.” Psychological Services, February 22, 2012.
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