The Importance of Mental Health Care in Diverse and Marginalized Communities
Mental illness is a problem among groups that have been marginalized, ostracized, or otherwise excluded from consideration, both historically and in the present day. Too often, the problem is made worse because access to adequate treatment is lacking, along with awareness about how deep and pervasive the problem actually is. Good quality mental healthcare is an essential element of wellness, regardless of what space someone occupies on the various spectrums of race, ethnicity, class, gender, or sexual identity. Without it, no one can reach their full potential.
Proper mental health care should be seen as a birthright. The incidence of mental health disorders is growing among all groups in the United States, including those that have been historically marginalized and too often excluded from our society’s circle of caring.
Unfortunately, society’s attempts to come to terms with that marginalization and exclusion are not bearing fruit in the mental healthcare sector. A recent report from the U. S. Agency for Healthcare Research and Quality found that only 31 percent of Blacks and Hispanics and 22 percent of Asians had received proper treatment for their mental health conditions, as opposed to 48 percent of whites.
In the midst of a global pandemic that has not ended and may not end anytime soon, the need to address the inequities in our healthcare system, including those related to mental healthcare, is vital. Disparities in mental healthcare based on race, ethnicity, gender identity, sexual orientation, and class are all unjust and harmful to individuals, families, and society. They are linked to unnecessary suffering and poor life outcomes in general, acting as yet another unfair burden to those who’ve traditionally faced more than their fair share.
Why Mental Health Care Is Failing the Underserved
Nearly 21 percent of adults will experience an encounter with a mental health disorder in any given year. Among this sample, about one in four will suffer from a serious and debilitating mental health condition.
Members of diverse and marginalized groups don’t necessarily have higher rates of mental illness than the population as a whole. But those who do develop mental health symptoms often have a hard time obtaining an accurate diagnosis, or finding treatment services that are both available and appropriate.
There are a number of barriers that can prevent African-Americans, Muslim-Americans, Latinos and Hispanics, Native Americans, members of the LGBTQ community, and the poor from finding the healthcare assistance they require. These problems are especially acute when the care needed is related to a serious mental health issue.
A few of the barriers that have been identified include:
Shortages of Service Providers and Limited Access to Care
It can be difficult to get treatment for mental illness when there are no treatment experts offering outpatient services at nearby and accessible locations. This is often a huge issue in communities or neighborhoods where poverty rates are high. Language barriers can act as a related problem, in situations where those who aren’t native English speakers don’t have access to bilingual or multilingual healthcare.
Problems related to access could be most easily addressed if the United States had a publicly funded and universally available healthcare system. But in the U.S. the profit motive determines how healthcare services of all types are distributed. This inevitably creates inequities in the way healthcare is distributed, with marginalized and diverse communities suffering the brunt of the impact.
The Stigma Associated With Mental Health Disorders
Among groups where mental health problems have traditionally been overlooked, the stigma associated with mental health disorders is more likely to persist. When efforts to educate and inform are restricted, many people will continue to see mental health issues as something to be ashamed or embarrassed about. They may see problems like depression and anxiety as a form of weakness, in a world where those who face discrimination must always be strong if they expect to survive.
There is less of a stigma attached to mental illness now than in the past, among all groups. But long-standing misconceptions can take a long time to disappear completely. This may be a particular problem among older members of marginalized groups, whose attitudes were shaped more decisively during less aware times.
Distrust in the Healthcare System
Many people in marginalized communities are reluctant to seek treatment for mental health issues, even when they know there is a problem. This is often based on a past history of unpleasant experiences with health care providers, involving behavior that seemed discriminatory or dismissive. Reports of such experiences are common, and it has helped create a generalized mistrust among people of color and members of the LGBTQ community toward the healthcare system in general.
The underrepresentation of people of color among mental healthcare providers can help exacerbate this perception of hostility or unreceptiveness. Private organizations and public agencies often don’t do enough to recruit across a broad social and multicultural spectrum, which reinforces the idea that they aren’t really interested in helping men and women who come from marginalized communities.
Lack of Knowledge About the Symptoms of Mental Illness
It is easy to dismiss chronic anxiety if it seems to be caused by stressful life situations. Clinical depression can be misinterpreted as sadness, which again may be seen as a sign of a personal problem that could be quickly resolved. Even more severe outbreaks of mental illness can be misunderstood as a consequence of drug or alcohol abuse, if such behavior accompanies the mental health issues (as it often does, since people often develop addictions through their attempts to self-medicate for poor mental health).
A lack of knowledge about the true nature of mental health disorder symptoms is a universal problem that doesn’t affect marginalized communities exclusively. But public health initiatives that are specifically designed to raise awareness about mental health are seldom targeted at underserved populations, which leads to lower levels of awareness among those who are so often left on the margins.
Insufficient Alternatives to Incarceration
Tragically, in the United States untreated mental illness is often left to the legal system to address. One study by the U.S. Bureau of Justice Statistics found that 75 percent of women and 60 percent of men currently in prison had some form of mental illness.
As is so often the case, the members of marginalized communities are especially impacted by this societal problem. African-Americans and Hispanics account for about 56 percent of all prisoners in the United States, despite comprising 28 percent of the population. Many of these individuals could have been helped by treatment for their mental health disorders, if it had been offered as an alternative to imprisonment when mental health symptoms first began to manifest.
Mental health courts are helping reduce the numbers of people from marginalized communities who are entering the prison system with serious mental health issues. But there are not nearly enough mental health courts currently operating in the United States, given the desperate need for this sensible alternative to mass incarceration that could help end the warehousing of the mentally ill.
Inadequate or No Insurance
The U.S. healthcare is run like a business, rather than as a public service. Unlike every other economically advantaged country, the United States does not offer its citizens access to vital healthcare services regardless of their ability to pay. It does have private and some publicly subsidized health insurance. But a significant portion of the population either can’t afford this health insurance, or their plans include high deductibles and/or co-pays that make them virtually worthless in most instances.
A lack of adequate insurance is a huge problem for poor and working-class Americans from all backgrounds. This disproportionately affects marginalized communities, limiting their access to mental healthcare services along with critically important services of other types.
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Solutions to the Mental Health Crisis in Marginalized Communities, and Society as a Whole
Healthcare providers, and public agencies that help people secure healthcare services, have a responsibility to the communities they are supposed to serve. Part of that responsibility is to be as welcoming and inclusive as they need to be to make sure people from marginalized groups feel comfortable seeking out their services. Another part of that responsibility is to treat everyone with dignity and respect, openly, outwardly, and consistently.
A society that pretends historical wrongs never happened, or are no longer relevant, will inevitably fail to take care of its most vulnerable. A society that fools itself into believing people’s class status is somehow a reflection of their character, and that those who have little are somehow to blame for their dire situations, will lose touch with their compassion and empathy. A culture that refuses to listen to members of its Black, Hispanic, Asian, Muslim, Native American, and LGBTQ communities when they testify to their personal experiences will struggle to develop solutions that are comprehensive and properly targeted.
Plans that claim to address the inequities in mental healthcare must be multifaceted. They will focus on raising awareness among the suffering populations, among healthcare professionals, among policymakers at all levels of government, and in educational institutions of all types. They should seek to leverage the talents and passions of nonprofit community organizations, the best of which know how to create pressure campaigns that can actually produce results.
Members of marginalized communities are not getting the mental health care they require and need to thrive. That represents a profound failure that reflects badly on society as a whole. It is a legacy of both past discrimination and present discrimination, and a clear sign that we are not living up to our highest ideals and aspirations.
Mental health disorders do not have to represent a life sentence of misery. If outpatient and inpatient treatment are provided as needed, they can be the forerunners of a healthy and positive transition to long-term sustainable wellness. Until our mental healthcare system is functioning for the benefit of all, it won’t be contributing anywhere near as much to the health and welfare of our society as it could be and should be.