On October 10th, the World Federation for Mental Health celebrates mental health awareness with this year’s theme of “Mental Health in an Unequal World”. As we take a moment to reflect on what mental health means to each one of us, this is also an opportunity to reflect on the impact that inequalities have on all people’s mental health.

What are inequalities in Mental Health Care?

Typically, when we think of disparities in health care and/or mental health care, our thoughts go to race and ethnicity. Other factors play a part in the poor mental health outcomes and conditions different groups experience. Sexual orientation, gender, cultural stigma, and lack of awareness are other considerations impacting the state of one’s mental health. Per the Institute of Medicine, “a disparity is a difference in health care quality not due to differences in health care needs or preferences of the patient. As such, disparities can be rooted in inequalities in access to good providers, differences in insurance coverage, as well as stemming from discrimination by professionals in the clinical encounter.”

Those that deal with different mental illnesses disproportionately experience high rates of criminalization, housing and employment discrimination, and poverty. The havoc that the worldwide pandemic has caused has only exacerbated these and other disparities, calling for a demand in accessible, culturally affirming mental health support services.

Here is an article that analyses the barriers prior to COVID-19 and considers the impact is has already had on the inequitable mental health care system: https://www.americanprogress.org/issues/disability/reports/2020/09/10/490221/mental-health-care-severely-inequitable-came-coronavirus-crisis/

What’s the cost?

The largest payer for substance use and mental health services in the United States is Medicaid. Although their role is so significant, 2.5 million Medicaid enrollees reported their mental health treatment needs being unmet in 2017 per a Kaiser Family Foundation report. Factors such as differing eligibility requirements across states, language barriers, lack of transportation services, a shortage of mental health providers accepting Medicaid, and inadequate cover for mental health services contributed and continue to contribute to barriers that prevent people from receiving needed care.

Those who lack insurance also face obstacles with the high cost of services in conjunction with being more likely to be diagnosed with a mental illness. These are the individuals who also lack a consistent or stable source of primary and preventive care services. Don’t forget to bear in mind that the cost of copays and deductibles create a significant barrier to even those who are insured.

What about Representation?

Still to this day, racial, ethnic, and gender minorities are underrepresented in the mental health workforces. Cultural competency is defined by the Office of Minority Health (OMH) as, “services that are respectful and responsive to the health beliefs, practices and needs of diverse patients.” It goes on to state that, “by tailoring services to an individual’s cultural and language preferences, health professionals can help bring about positive health outcomes for diverse populations.” With the lack of culturally competent providers and services, issue that contribute to current disparities in mental health and substance use treatment and services will continue.

According to a 2016 Psychiatric Services study, “cultural and linguistic competency in the delivery of mental health services for racial and ethnic minority populations has a profound effect on access to and quality of care.” A diverse workforce that represents the population is “key to the delivery of such services.”

Read more about the barriers to care for racial and ethnic minority groups here: https://www.ncsl.org/Portals/1/HTML_LargeReports/DisparitiesBehHealth_Final.htm

LGBTQI

People are complex beings who have multiple influences that make them who they are and define their experience. Because of the overlapping aspects of one’s identity, it is important to have environments that foster the understanding of one’s thoughts, perspectives, and understanding. Although there is resiliency and strength among the community, there is also a unique set of challenges that those who identify as LGBTQI face. Counselors and other health care providers are learning every day that recognizing how one’s experience of sexual orientation and gender identity relates to mental health.

What can YOU do?

As mental health and health care providers we need to first start with ourselves and examine any prejudices or biases we may hold for any group of people. When we think of approaching care from a rights-perspective, we are required to examine the language, terminology, and models of mental health we utilize. Beyond thoughtful examination is action. Professional counselors can advocate for change in government legislative and regulation inequalities on a local, regional, and notional level addressing topics such as living wages vs. minimum wages, gender equality with maternity leave, and advocacy within all systems; housing, education, and social services.

On a smaller scale, we are all members of a community and giving our time to volunteer and do outreach goes a long way. The next time you meet with your friends or sit down to have dinner with your family, be the one to spark the conversation. Ask about what mental health means to others, how do they take care of themselves, and what are some misconceptions they may have about mental health and mental health accessibility. This is also a great time to engage in conversations about what community-based solutions look like and what the needs are lacking. It goes without saying that mental health issues are complex and challenging at all levels. However, when we come together--particularly bringing the youth in the conversation--we can bring about awareness and increase our own understanding to bring about change.