Race and Hispanic ethnicity factor into emergency department (ED) visits for people with mental health disorders, concludes a recent study by the Centers for Disease Control and Prevention (CDC). Among the findings: Black adults visited EDs for mental health-related care almost twice as often as white adults.
Other data also indicate that Black, Indigenous, and People of Color (BIPOC) face disparities in mental healthcare. According to the National Alliance on Mental Illness (NAMI), for example, therapy for a mental health diagnosis is received by:
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- 49% of American adults who identify as white
- 33% of those who identify as Hispanic or Latinx
- 32% of those who identify as multiracial
- 31% of those who identify as Black
- 25% of those who identify as Asian American or Pacific Islander
Plenty of research supports the fact that mental healthcare inequities exist. The real question is: What can we do to address them?
Hopefully, healthcare’s collective experience with Covid-19 has taught us how to do things differently. Here are four opportunities to leverage our learnings to improve care for people with mental health disorders—especially within BIPOC communities that contend with racism, discrimination, and other unique mental health stressors.
Opportunity 1: Educate and destigmatize
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The BIPOC acronym comprises many distinctly different races, ethnicities, and cultures. However, one common denominator among all BIPOC communities is the pressure and expectation to assimilate into a majority-White society. The desire to “deal with it,” “fit in,” and appear strong often causes BIPOC populations to tolerate and even normalize experiences that cause stress, anxiety, fear, and trauma. Stigma worsens the problem by preventing people from talking about mental health and learning the symptoms of mental illness.
Healthcare leaders have an ideal opportunity to educate BIPOC communities and encourage mental health conversations. First, they must understand precisely who comprises their local communities. While the census and other publicly available data provide a good snapshot on paper, a better appreciation of BIPOC communities comes from direct engagement.
For example, in-person occasions to educate BIPOC young people—such as school festivals or health clinics—simultaneously teach about mental health and enable organizations to see communities’ needs firsthand. Those insights can then be used to ensure that ongoing education accurately reflects the communities served.
Healthcare organizations must invest in efforts to educate their communities about what mental health is, what healthy mental health choices are, and what mental health services are available. Targeted social media campaigns, for instance, could help call attention to mental health conditions and treatments, and explain where to go for mental health services. By explaining conditions such as anxiety, depression, and trauma, providers can help people identify what they’re experiencing.
Opportunity 2: Build trust
Trust is a complex, multilayered issue in healthcare. Within some Black communities, for example, general mistrust of the medical community remains due to injustices such as the unethical Tuskegee experiment and the use of Henrietta Lacks’ cancer cells without her consent.
No matter why someone distrusts healthcare, their suspicions intensify when their care experience doesn’t align with their expectations. Conversely, doubts may ease, and trust may develop if patients fully understand what to expect. Therefore, healthcare organizations should offer a “mental health orientation” when patients walk through their doors. Patients must understand that the usual course of care for mental health and physical health is not the same.
Patients with physical ailments typically see a provider, get treatment, and get better within a relatively short time frame. In comparison, treatment for mental health conditions such as moderate depression may last many months. Some antidepressant medications take several weeks to begin working, with additional time needed to adjust the dose to achieve the best effect.
To build trust, busy providers must take time to reassure patients and manage their expectations by confirming that:
- their condition didn’t happen overnight and won’t get better overnight.
- providers can give them the treatment they need.
- their condition can improve overtime if they stick with treatment.
By setting appropriate expectations, providers can improve patients’ likelihood of staying in treatment and achieving a positive outcome. In turn, patients’ success may persuade others within the community to trust providers and seek treatment.
Opportunity 3: Nurture cultural curiosity
It’s important to inspire cultural curiosity in everyone—including BIPOC providers. I know a lot about being Black, for example, but I’ve had very little exposure to Native American communities. That’s why I tried to learn about their mental health needs during my residency.
Healthcare leaders can play a significant role in encouraging cultural curiosity by being intentional about making it an integral part of organizational culture. Some ideas for doing so:
- Actively engage BIPOC community groups, ask about their current mental health challenges, and propose solutions.
- Ensure mental health outreach is helpful and appropriate by asking clinicians with diverse backgrounds to work with the organization’s communications and marketing teams.
- Support people on leadership teams who want to nurture diversity, equity, and inclusion (DEI) and cultural competence.
Although many patients indeed want providers with whom they can relate, it’s also true that people across communities often deal with similar issues. As providers, we must sometimes step forward to put ourselves in other people’s shoes. We must learn about the different groups in our communities and show patients that we’re interested, curious, willing to learn, and ready to listen. I firmly believe that when we approach care that way, patients will connect with us and be comfortable with us even if we come from different backgrounds.
Opportunity 4: Explore new approaches
Traditional approaches to mental healthcare often fall short—especially within BIPOC communities where access barriers may be high. Lack of insurance benefits or transportation, prohibitive treatment costs, and few available providers are among many well-known challenges.
Therefore, we must lean into lessons learned from the Covid-19 pandemic to make care easier to access. That may mean exploring continued or expanded partnerships with community organizations and providers, such as:
- Making telehealth a permanent part of mental health services—helpful for BIPOC communities in care “deserts.”
- Partnering with local organizations to expand internet access. Many companies offered gift cards for internet service when schools shut down during the pandemic. Would they consider similar partnerships to improve telehealth access? Would libraries be willing to provide internet access in locations with the privacy necessary for mental health services?
- Preventing burnout among mental health providers. Think about paid time off offerings, for example. Particularly in small markets with little provider coverage, ensure staff can use their PTO by increasing the bank of providers willing to cover during vacations. Even if it’s not ideal from a patient perspective, it works—Covid-19 showed that it can keep patient care on track while providers get the rest and rejuvenation needed to prevent burnout.
Finding solutions
Too often today, BIPOC communities must deal with mental health obstacles without the necessary education, support, and coping strategies. Fortunately, healthcare organizations have opportunities to start addressing these challenges by building cultural competency and by strengthening community education, trust, and access.
The situation requires us all to embrace active curiosity. We must be willing to listen, learn, and look honestly at challenges that may differ from our own lived experiences. If we do, we will find common ground. Solutions are out there, if we look.
Photo: Irina Devaeva, Getty Images
Dr. Candice Tate, MD, MBA, is a medical director at Magellan Healthcare and a board-certified psychiatrist by the American Board of Psychiatry and Neurology. Her treatment philosophy includes a strong physician-patient therapeutic alliance and safe, responsible medication management. Dr. Tate is experienced in psychotropic medication management for a variety of psychiatric conditions in inpatient and outpatient settings. In addition to extensive training in psychodynamic psychotherapy, she is also familiar with cognitive behavioral therapy (CBT), interpersonal therapy (IPT), and dialectical behavior therapy (DBT). Dr. Tate graduated from the University of Tennessee Medical School in Memphis and completed her graduate medical education in General Psychiatry at Northwestern University's Feinberg School of Medicine in Chicago.
