By Sophia Augustin
The genetic underpinnings of mental health have been the focus of research for several years in hopes of moving a step closer to treating patients. Racial disparities in this field have been pronounced since the dawn of mental health care itself. Race and ethnicity are not, though, determining factors for mental illness. Research has shown time and again that there is no racial-ethnic demographic who is uniquely at a higher risk of mental illness because of their genome.
So why do we still see mental illness appear disproportionately in certain populations? A paper published in the Sociology of Health & Illness suggested that the disparities stem not from genetics, but rather structural and institutional influences in the surrounding environment (Nazroo et al, 2020). There is not so much disparity in mental health among different demographics, but rather significant disparities in regards to mental health care based on racial-ethnic identity. Literature on this topic frequently references the Institute of Medicine (IOM) definition of disparity as “a difference in health care quality not due to differences in health care needs or preferences of the patient.” Mental health care disparities can stem from discriminatory health professionals, differences in insurance coverage, and unequal access to good providers.
Research has found significant disparities across racial groups in access to and use of mental health care services. The Surgeon General’s Mental Health Report documents that racial-ethnic minorities have less access to mental health services and are more likely to receive poor quality care when treated as compared to their white counterparts. Furthermore, a study published in the American Journal of Psychiatry reported that of the adults with a diagnosed need for mental health or substance abuse care, 37.6% of whites will receive treatment while only 22.4% of Latinos and 25.0% of African Americans will receive treatment (Wells et al, 2001).
A study published in Psychiatric Services compared racial-ethnic disparities in mental health care using data from the 2004–2012 Medical Expenditure Panel Surveys (Cook et al, 2016). Researchers found significant disparities between minority groups’ and whites’ access to and use of mental health services. Black-white disparities in use of any mental health care and psychotropic medication increased from 2004 to 2012; the same was seen for Hispanic-white disparities. Not only were there no reductions in disparities between racial-ethnic groups’ access to mental health care, but the disparities actually worsened and became more pronounced in more recent years.
It is difficult to deny or ignore the glaring racial disparities in mental health care. Provider discrimination has been repeatedly cited as one of the factors that exacerbates these disparities. An instance of discrimination from providers was noted in the findings published in another Psychiatric Services article (Nadeem et al, 2007). Ethnic minority women were less likely to receive depression care than their white counterparts. Some have suggested this disparity stems from preconceived notions that racial-ethnic minorities, particularly women of color, suffer less from mental illness than other demographics. Another example of provider bias was documented in a Health Services Research study that found clinicians were less eager to respond to and treat depression diagnoses in minority patients as opposed to white patients (Balsa et al, 2005).
Policies designed to help reduce mental health care disparities include making mental health services not only available, but also equally accessible, for minority patients. As previously mentioned, it has been suggested that the relationship between patients and providers is a significant factor in care disparities. Economic incentives have been proposed as a way to improve patient-provider communication and trust. These incentives could look like compensation for appropriate screenings and preventive clinical care. Additionally, across various fields researchers agree that increasing the amount of racial minority mental health care providers will help reduce disparities. A diverse workforce can provide patients with more culturally appropriate treatment, as well as communicate better with patients of different language-skills, thus helping to foster more trust between providers and minority patients. It is crucial that policies are implemented to increase outreach and education to create a diverse workforce. Everyone should feel welcome and respected when accessing mental health services.
References
Balsa, A. I., McGuire, T. G., & Meredith, L. S. (2005). Testing for statistical discrimination in health care. Health services research, 40(1), 227–252. https://doi.org/10.1111/j.1475-6773.2005.00351.x
Cook, B. L., Trinh, N.-H., Li, Z., Hou, S. S.-Y., & Progovac, A. M. (2016). Trends in racial-ethnic disparities in access to mental health care, 2004–2012. Psychiatric Services, 68(1), 9–16. https://doi.org/10.1176/appi.ps.201500453
McGuire, T. G., & Miranda, J. (2008). New evidence regarding racial and ethnic disparities in mental health: policy implications. Health affairs (Project Hope), 27(2), 393–403. https://doi.org/10.1377/hlthaff.27.2.393
Nadeem, E., Lange, J. M., Edge, D., Fongwa, M., Belin, T., & Miranda, J. (2007). Does stigma keep poor young immigrant and U.S.-born Black and Latina women from seeking mental health care?. Psychiatric services (Washington, D.C.), 58(12), 1547–1554. https://doi.org/10.1176/ps.2007.58.12.1547
Nazroo, J.Y., Bhui, K.S. and Rhodes, J. (2020), Where next for understanding race/ethnic inequalities in severe mental illness? Structural, interpersonal and institutional racism. Sociol Health Illn, 42: 262-276. https://doi.org/10.1111/1467-9566.13001
Office of the Surgeon General (US); Center for Mental Health Services (US); National Institute of Mental Health (US). Mental Health: Culture, Race, and Ethnicity: A Supplement to Mental Health: A Report of the Surgeon General. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2001 Aug. Available from: https://www.ncbi.nlm.nih.gov/books/NBK44243/
Wells, K., Klap, R., Koike, A., & Sherbourne, C. (2001). Ethnic disparities in unmet need for alcoholism, drug abuse, and mental health care. The American journal of psychiatry, 158(12), 2027–2032. https://doi.org/10.1176/appi.ajp.158.12.2027