Each July, Minority Mental Health Awareness Month shines light on a critical disparity: While mental health issues affect all people — regardless of race, culture, or ethnicity — minority populations face greater obstacles to care. Here, Lorenzo Norris, MD, psychiatrist and chief wellness officer at the George Washington University (GW) Medical Faculty Associates (MFA), takes us on a brief guide through the complex topic of minority mental health and how we can take better care of ourselves and those we love.
Q. Are minorities at higher risk of stress, depression, or other mental health issues? Why?
Norris: Looking at the data and epidemiology, many racial and ethnic minority groups overall have similar rates of mental disorders in comparison to white patients. However, despite similar rates, minorities may have longer-lasting consequences and often bear a disproportionately high burden of disability resulting from mental disorders.
Although rates of depression are lower in Black (24.6%) and Hispanic (19.6%) groups than in white populations (34.7%), depression in Black and Hispanic patients is likely to be more persistent. In addition, people who identify as being two or more races (24.9%) are most likely to report any mental illness within the past year than any other racial/ethnic group. Suicide was a leading cause of death for Asian Americans, from ages 15 to 24, in 2017. Yet, Asian Americans have been found three times less likely to utilize mental health services. This rates in different populations illustrate an important theme, in my opinion, that lower overall rates of mental disorders in a given population do not necessarily equal better mental health outcomes for minority populations.
Q. What disparities exist for minority patients who need mental health services?
Norris: Minority groups are less likely to receive mental health care. For example, in 2015, among adults with any mental illness, 48% of whites received mental health services, compared with 31% of Blacks and Hispanics, and 22% of Asian American and Pacific Islanders. Some factors related to these health disparities taken from the American Psychiatric Association (APA) Fact Sheet are:
- Lack of insurance or under-insurance;
- Mental illness stigma, often greater among minority populations;
- Lack of diversity among mental health care providers;
- Lack of culturally competent providers;
- Language barriers;
- Distrust in the health care system; and
- Inadequate support for mental health services in safety net settings (uninsured, Medicaid, or health insurance coverage for other vulnerable patients)
Q. What options are available for overcoming disparities? What can physicians, patients, or individuals do?
Norris: There are numerous options available, but I will focus on two starting points: From the clinician standpoint, I would highly recommend educating yourself to become a culturally competent provider. There are a number of resources available to support mental health clinicians in this activity, but I would recommend starting with the APA best practice highlights for diverse populations. From the standpoint of patient advocacy, we must continue to strongly support measures such as the Affordable Care Act, which increases minority access to health care services.
Overcoming disparities also must be addressed at the community level, including creating partnerships with community leaders and organizations. One of the biggest barriers is lack of trust and mental health stigma among some minority populations. Building partnerships in the community is one way to begin conversations where trust can be earned and myths and stigmas pertaining to mental health addressed.
Q. What is the most important thing minorities can do to protect their mental health?
Norris: Seek out accurate information from reliable sources. There are potentially a number of obstacles any individual may face when seeking to maintain their mental well-being, but lack of accurate information is likely one of the biggest factors. Many reliable sources such as the National Alliance on Mental Illness, the American Foundation for Suicide Prevention, the Centers for Disease Control and Prevention, and local branches of the APA have excellent overviews of mental health. In addition to seeking out accurate information, I would say keep an open mind and don’t fall into the trap of “being strong for too long.”
Q. How can loved ones support those needing mental health care?
Norris: Loved ones can support others by being available and willing to listen without offering judgment or advice. After your loved one is heard, then you can partner with them in searching for resources that make sense for their specific context and life circumstance. The biggest mistake I see is loved ones trying to “fix” someone. All of us in life need to first and always be heard and understood before someone can effectively offer advice or support.
Q. Anything you’d like to add?
Norris: The discussion of minority mental health is a huge topic that covers many groups. The data I have shared is at best a fraction of what is available, and I would encourage those interested in taking a deeper dive on minority mental health to read the works of those who have dedicated much of their career to this topic. A good place to start is the APA Diversity and Health Equity Education guide and toolkit. The data quoted for these questions comes from these sources and is a great starting place to get mental health facts on diverse populations.