| StarNews Correspondent
According to American Psychological Association, mental and behavioral health is a critical and frequently unaddressed issue in racial and ethnic minority communities. These groups experience various mental health disparities related to access and use of services, diagnosis and outcomes.
Dr. Laura Ginther, a psychologist at the Sand Dollar Wellness Center, 1136 Shipyard Blvd., Wilmington, and Daniela Williams, a National Board Certified Counselor and Licensed Clinical Mental Health Counselor Associate (LCMHCA) at A Place of Solace, which offers tele-therapy, said it’s important to find ways to close the gap in mental health care for minority communities and improve the care they receive.
1) Mental health disparities among minorities include less access, lower quality of care
According to the U.S. Department of Health and Human Services Office of Minority Health, OMH, the Agency for Healthcare Research and Quality reports that racial and ethnic minority groups in the U.S. are less likely to have access to mental health services, less likely to use community mental health services, and more likely to receive lower quality care.
Poverty plays a role in both mental health stress and access to care.
“A lot of people talk about ACE or adverse childhood events now, and poverty is a significant one,” Williams said. “If we can shed light on that then we can begin to foster that equity and equality that we need that can mediate those disparities that we see in health, education and across the board.”
According to a 2017 American Psychiatric Association report, African Americans often lack access to culturally competent care and are less likely to receive guideline-consistent care, less frequently included in research, and more likely to use emergency rooms or primary care instead of mental health specialists. Hispanics are more likely to report having poor communication with their provider and are more frequently undertreated. American Indians/Alaskan Natives report higher rates of post-traumatic stress disorder and alcohol dependence compared to other ethnic/racial groups.
2) Many minorities experience problems with mental health diagnoses
According to the American Psychological Association, minority individuals may experience symptoms that are undiagnosed, under-diagnosed or misdiagnosed due to cultural, linguistic or historical reasons.
“Frequently, there are black men who are diagnosed with schizophrenia without detailed histories that would show that they better qualify under another mood disorder,” Williams said. “They get a harsher or a more substantial mental health diagnosis rather than a lesser diagnosis that can be treated in an outpatient basis. Multiple studies have demonstrated that this happens.”
American Psychiatric Association said differences in how Blacks express their symptoms of emotional distress may play a role in some misdiagnosis.
“African American men are also more likely to get first-generation medications that have more side effects versus second-generation medications (newer, more recently developed medications) that have been proven to have less side effects,” Williams said.
American Psychiatric Association, said under diagnosis and misdiagnosis of mental illness in minorities sometimes stem from lack of cultural understanding by health care providers and language barriers.
3) Cost, societal stigma, providers’ lack of cultural awareness among barriers
According to some studies, barriers that either deter minorities from seeking mental health treatment or reduce the quality of care they receive include cost of care, societal stigma about mental illness, a client’s fear and mistrust of treatment, and the clinician’s or mental health provider’s lack of awareness of cultural issues.
Lack of insurance or under insurance also limits access to treatment for some minorities. Ginther and Williams said feeling uncomfortable talking with a provider and one’s faith community can also influence seeking care.
“If they are connected to a strong faith community, the faith community may disparage the need for treatment and feel that they need to just pray,” Ginther said, adding that fear of deportation can also prevent some from seeking treatment.
4) Removing stigma around mental health issues is an important step in addressing barriers
Ginther and Williams said destigmatizing mental illness and increasing cultural competence among mental health providers can improve the access and quality of mental health care minorities receive.
Williams encourages spiritual leaders to normalize getting professional mental health care.
“I have heard people say they have been told they just need to pray more or haven’t prayed hard enough, or they are going through (a mental health issue) because of something they did in the past,” Williams said. “The answer to your prayers may be a mental health therapist. You can have therapy and Jesus too.”
Ginther and Williams also said making it easier and more cost-effective for more mental health professionals to accept Medicaid can help increase access to mental healthcare for many minorities, including making Medicaid reimbursement rates comparable to private insurance.
5) Not receiving appropriate mental health care can have long-term and short-term impacts
“When minorities are not effectively treated, it limits their education, their wealth, and what they can provide to the next generation, and it continues a worsening cycle of ill health,” Ginther said. “That’s the long-term effect that we have to look at as mental health providers.”
“In the short-term, by not seeking out mental health care you have a higher (incidence) risk for substance use and trying to self-medicate and a higher occurrence of jobless because of dealing with medical issues and dealing with depression,” Williams said.
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