One in five American adults experience a mental illness or mental health condition each year, but wellness assistance is arguably more necessary now than it has been in some time, given anxieties of the pandemic and the nationwide civic unrest that has put longstanding issues of racism, injustice and inequality front and center.
Even before the pandemic and unrest came to define American life in 2020, a majority of adults supported mental health assistance options, with a 2018 report from the National Council for Behavioral Health showing six out of 10 Americans were either seeking help for themselves or their loved ones.
In recent years, mental health and substance use disorders were found to have been the leading cause of America’s disease burden, even more than cancer and cardiovascular disease, the latter of which is the nation’s biggest cause of death for men and women. In spite of the outsized burden of behavioral wellness services on the nation’s health care system, and despite the need for increased behavioral health assistance options, those needing such help the most – those disproportionately impacted by social, economic and racial inequity – are struggling with inadequate access to services.
Health disparities, as defined by the Department of Health and Human Services, are “differences in health outcomes that are closely linked with social, economic, and environmental disadvantage.” Using that definition as a reference, race and class had already been shown to be factors contributing to inadequate access to mental health services, just as they have long been factors contributing to inadequate access to healthcare services overall.
According to figures released in 2015 by the Substance Abuse and Mental Health Services Administration (SAMHSA), Whites made significantly more use of inpatient, outpatient and other types of mental health services compared to both Blacks and Hispanics, and more than twice the number of Whites had prescriptions for medications compared to Blacks and Hispanics. Costs to mental health services were found to have been the greatest barrier to assistance for all three racial groups, but for poor adults with incomes around the federal poverty level, Blacks and Hispanics accessed less wellness resources than Whites.
As one psychoanalyst illustrated in a 2017 blog post on the National Association on Mental Illness’s site:
Have you ever tried to unlock a door that wouldn’t open? At first, you think you might be doing something wrong. Maybe there’s a trick to it. You pull the key back a little—doesn’t work. You wiggle the key—doesn’t work. You keep trying, but the door stays locked. After a while, you realize the problem isn’t you, it’s the key.
This is what it’s like for minorities trying to access mental health care.
The United States has more adults with mental health diagnoses than 10 other high income countries of the developed world. However, among other higher income nation peers, America is near the top of the list when it comes to adults not being able to access wellness assistance due to lack of affordability. Perhaps not surprisingly, income has an inverse correlation to the use of mental health resources along racial lines, as White Americans claim a significant bulk of income, home ownership and stock holdings over Blacks and Hispanics, and hold significantly less college student debt.
(The SAMHSA figures did not include data for Asian Americans, who in 2017 had a higher median household income than Whites, Blacks and Hispanics. However, academic research has identified various cultural stigmas among Asian Americans as to why some choose not to seek treatment for different issues.)
Covid-19 is threatening to further complicate matters of access at a time when 41% of Americans have been dealing with at least one mental health challenge since the onset of the pandemic, and when the nation’s unemployment rate remains above 10%. For Blacks and Hispanics struggling with higher levels of job losses and an overall reduction of finances compared to Whites, the situation is even more vexing.
“The COVID-19 pandemic has spotlighted racial and ethnic disparities in access to behavioral health care,” SAMSHA said in a recently released report. “While their rates of behavioral health disorders may not significantly differ from the general population, Blacks and Latinos have substantially lower access to mental health and substance-use treatment services.”
“With the downturn in the economy… people have lost jobs, and they have lost access to insurance,” Robert Fields, a psychologist for the North Carolina Department of Public Safety, told Suit & Artist. “With that loss of access to insurance, they may have lost access to mental health services. And then, just dealing with the stressors that go along with this downturn… it’s like, ‘What’s going to happen next?’ whether it’s the virus, whether it’s what they’re going to do financially or taking care of loved ones.”
On top of that are the racial and socioeconomic concerns for large numbers of people, which have been even more acutely felt since the death of George Floyd sparked protests nationwide.
“I think for some people, there are a lot of things that are happening that are just triggering [emotions],” said Fields. “[The unrest] is bringing up a lot of issues for people who have been involved with the police or have family members have been involved with police.”
“There’s obviously a lot of racial injustices that… have been going on forever, but really are [being] brought to light right now,” Elizabeth Burke, a Chicago-based private mental health practitioner, told Suit & Artist. “There’s just so much happening that I think it’s causing such an escalation in people’s emotional concerns.”
Much work lies ahead toward closing the mental wellness assistance access gap, and at the moment, costs to receiving care are the big hurdle, particularly for those now unemployed and unable to afford out-of-pocket payments for services.
“Many people who… lost their job in light of the pandemic…now they need mental health services more than ever, and yet, they can’t get them,” said Burke.
Burke’s practice accepts sliding scale payments, and she is looking to partner with other organizations to offer prospective patients counseling options they may not otherwise be able to access at her office. She added that her practice has lately seen more people seeking assistance.
“I would say people are now really reaching out and saying, ‘Yes, I’m experiencing a lot of anxiety,” said Burke. “I think being in isolation for so long – whether somebody lives by themselves or they live with family members or a partner – there are different issues that come up in light of being in quarantine.”
Fields – who adds he has not seen a reduction of state services to his department during the economic downturn – is encouraged by what he sees as an increase in telehealth counseling options during the pandemic that have allowed some to receive assistance, as well as the development of free online wellness informational services and workshops.
He believes there needs to be more mental health professionals trained with sensitivity to cultural concerns of certain demographics – particularly of African-Americans – where the distrust of many in such groups towards counselors can influence their choice to not seek wellness assistance.
“One of the things we just have to do… [is develop] the next generation of therapists, because there’s such a need… more than we have out there…to address a lot of concerns that people of color are seeking [to deal with],” Fields said.
Issues of cultural distrust can even be a factor for people of color who may not necessarily experience significant economic impediments to accessing behavioral wellness resources.
“For the people that are experiencing very serious issues and challenges, a wellness program [more tailored for people not experiencing such issues] or one day of yoga in the entire year isn’t going to fix anything,” Kyrah Altman, co-founder and president of L.E.A.D., Inc., a Worcester, Massachusetts-based organization that provides mental health education to workplaces and schools, told Suit & Artist.
“Even if a company… offers a great insurance plan or mental health benefits, many of those mental health clinicians aren’t culturally competent, and also don’t have the training that they need to best connect with employees of color, as well,” she said.
Altman believes that workplaces should play more of a role in closing the wellness assistance access gap on a cultural scale.
“The answer is simple – knowledge is power,” she said. “Simply knowing what resources are out there – knowing how to access them, especially when it comes to people of color and knowing how to access culturally competent mental health resources – all of that really comes down to education.”
Whatever the kind of world that emerges after the pandemic, and whatever comes out of the increased social awareness stemming from the unrest, the need for mental health assistance to address a variety of emotional issues will certainly remain for many, along with the different challenges those needing help will subsequently experience.
“I think what we have to do… is figure out how to bake mental health into our society and take it from a public health standpoint.. in terms of… ‘How do we promote mental health services in school systems and college campuses and workplaces?’” Fields said. “I think that it’s going to take a movement of just figuring out how to really hardwire it into our society as a whole.”