America is more ethnically and racially diverse than ever. This growing diversity amplifies the need for all behavioral health professionals to address barriers to care and other factors that influence outcomes for Black, Hispanic, Latinx, Native American, and Asian communities.
Recent events in America have also underscored social inequities for nonwhite individuals — including inequities that are directly tied to poor health overall. Awareness of the problem isn’t enough, of course. Only a thoughtful path forward with actions to address barriers and improve outcomes will begin to make a difference.
Mental health disorders are prevalent among all racial groups
The National Alliance on Mental Illness found that mental health disorders are prevalent across all racial groups, and there are distinct differences in the percentage of people with disorders who receive treatment.
|Hispanic or Latino||33.9%|
|Non-Hispanic Black or African American||32.9%|
Left untreated, mental health disorders can leave individuals more vulnerable to suicide risk, homelessness, and incarceration. Yet seeking treatment can be a difficult task for those who experience logistical and cultural barriers to care. Stakeholders must take a proactive approach to address such barriers in the context of the individual as well as the context of the population.
Barriers to care for nonwhite populations
Black communities can be cautious about seeking behavioral health services. Some of the reluctance may include the perspective that talking about feelings is the equivalent of sharing your personal business with a stranger. This can lead to distrust of behavioral health professionals.
Among Hispanic or Latinx populations, Mental Health America found that individuals tend to focus on physical symptoms rather than thoughts or feelings, making it more difficult to reach an appropriate diagnosis. And like black communities, they tend to associate mental health issues with shame.
Asian communities have similar experiences. One 2010 report revealed that young Asian Americans are more likely to seek support from close personal networks, rather than professional behavioral health providers. They said the biggest deterrent is stigma.
Very few Black, Hispanic, Latinx, or Asian clinicians
Research released by the American Psychological Association in 2020 reveals that 86 percent of psychologists are white — less diversity compared to the population as a whole. A 2017 Medscape survey also found that more than 69 percent of psychiatrists identify as white.
The lack of racial diversity in the behavioral health work force presents a challenge for individuals who want to see a provider they believe is culturally competent and truly able to understand their perspectives. When opening up about difficult subjects, emotions, and personal challenges, talking to a clinician who shares a similar background — or native language — eases communication and builds a better therapeutic alliance.
Historically, communities of color have been more likely to be uninsured, with Hispanic or Latinx populations demonstrating the lowest rate of insurance coverage. In 2019, more than 27 percent of Hispanic Americans were uninsured. Lack of coverage often means increased cost barriers that discourage treatment.
Strategies to address barriers to behavioral healthcare
According to Victor Armstrong, Director of the North Carolina Division of Mental Health, Developmental Disabilities, and Substance Abuse Services, there are a number of practical strategies that the healthcare system at large can apply to help address barriers to behavioral healthcare for communities of color. Armstrong believes stakeholders are aware of the fact that one size does not fit all and are approaching the issue with a variety of solutions.
Rethink network adequacy
“Because of the way the system has evolved, the larger providers have become the go-to resources,” Armstrong says. “I’ve had conversations with managed care organizations that want to bring in more minority providers, but there is no easy path to get there given limited funding.”
Armstrong recommends engaging minority providers — who might operate in smaller practices — by supporting their infrastructure investments in technology, EHRs, and integration, including connections to resources that can address social determinants of health. The capabilities can help them scale up to serve more patients.
While many networks are built with the intent of satisfying community needs in aggregate, he believes insurers should look deeper at the needs of historically marginalized populations. “A network that addresses 80 percent of the total member population might not meet the needs of 80 percent of the Black or Latinx population,” he says.
“We don’t have a lot of behavioral health services that take race, ethnicity, and cultural differences into account,” Armstrong says. “Typical models don’t take into account some of the complex trauma that people of color have experienced.”
Black communities initiate behavioral health services at about half the rate of white populations, he says. If providers aren’t offering services that speak to the individual’s experiences, it’s less likely the individual will engage or stay engaged with treatment. Providers must learn about and be prepared to offer culturally sensitive services and look at everything from psychotherapy to DSM diagnostic criteria through that refined cultural lens.
Expand service venues
“We have so much more access to telehealth now that we can consider new venues for behavioral health services, such as in churches and community centers,” Armstrong says. “Part of the challenge for providers is that they don’t know the community, and there is a lack of trust.”
By delivering services in familiar venues where trust is already established, providers can connect with families and individuals in a setting that is comfortable for them. A faith-based community or local health center can also reduce the stigma about accessing behavioral health services for many people of color, he says.
Leverage peer resources
Armstrong says only about 4 percent of psychologists and 2 percent of psychiatrists are black. Long-term strategies might include incentives to build up a more diverse work force that is more representative of the communities they serve, but for the immediate future, providers have some options.
For example, peer services have demonstrated excellent efficacy. Providers can look to peer coaches with diverse ethnic, cultural, and racial backgrounds as the point of contact for people of color. When peer services are bundled or integrated in a value-based model, providers have even more flexibility to use the services in a way that makes clinical and financial sense.
“Providers need to look at ways to build relationships with the community so people are willing to engage in services,” Armstrong says. “Part of that is relying on people in the community who have those familiar voices.”