Racism has been declared a public health threat by the Centers for Disease Control and Prevention (CDC) who revealed that there have been racial and ethnic disparities in health care that have ultimately led to disproportionately high mortality rates among Black and Native American people for more than 20 years. Racial discrimination in mental health services has also led to a disproportionate lack of effective treatment for racialized minorities. Some examples highlighted by the US Mental Health Association (MHA) include the following findings.
- While the rates of depression are lower in Black and LatinX individuals, depression is more likely to be persistent in these groups.
- Black males are four times more likely to be over-diagnosed with schizophrenia than white males.
- Native Americans have the highest alcohol dependency and Post-Traumatic Stress Disorder rates among any marginalized groups.
- Black, indigenous and people of color (BIPOC) youth suffering behavioral and mental health issues are more likely to be put through the juvenile justice system rather than being directed to specialty care institutions compared to white adolescents.
Barriers to effective mental health care
Researchers have found that there is a diverse range of reasons why Black and other minorities groups face barriers in receiving the same level of mental health support as their white contemporaries including:
Institutional racism
According to a 2024 survey, BIPOC adults self-reported higher levels of unfair treatment, or more often felt disrespected by a healthcare provider, than their White counterparts. Their experiences included instances where a healthcare provider made assumptions about them rather than asking or suggesting the patient was personally to blame for a health problem. They also reported having had direct requests for medication refused by healthcare workers, as well as being refused access to mental health services.
Another 2020 report by the National Alliance of Mental Illness revealed high levels of distrust in mental health care services among Black adults because of their experiences of racism. The findings led to the organization publicly acknowledging significant disparities in mental health care services available to communities of color. A report by the American Psychiatric Association (APA) backed the findings that Black individuals with mental health conditions were more likely than other minority groups to be incarcerated as criminals rather than being offered mental health treatment for disorders, such as schizophrenia and bipolar disorders.
Cultural incompetency
The KFF survey found that just over 40 percent of all adults questioned said they had difficulty finding a mental health care provider that could understand and relate to their background and experiences. Asian adults (55 percent) and Black adults (46 percent) were more likely than White adults (38 percent) to report this experience.
Underrepresentation
Findings by a CVS Health/Harris Poll showed a lack of ethnic and racial diversity within mental health care professions as an underlying factor in the underrepresentation of culturally competent providers. It found that only five percent of active psychologists in 2021 identified as Black, and only eight percent identified as Hispanic. In contrast to those low figures, 80 percent identified as White.
A supplement to the Surgeon General’s 1999 report on mental health titled Mental Health: Culture, Race, and Ethnicity found that people of color often received poorer quality of care and were underrepresented in mental health research.
Stigmatization
Education on mental health must also be backed at the community level, as cultural barriers may hinder certain minority groups from receiving necessary support. Mental illness remains a taboo subject among numerous African Americans due to the historical belief that psychiatric disorders are a sign of weakness, or because of mistrust towards the medical field stemming from past mistreatment. As a result of this stigma, only 25 percent of Black Americans will seek mental health treatment when they need it, compared to 40 percent of White Americans, according to McLean Hospital.
A study by the National Library of Medicine revealed that levels of self-stigma are also high among Asian Americans, leaving them feeling less hopeful about individuals with mental health problems becoming valued members of society. Similarly, LatinX individuals interviewed in English said they had experienced higher levels of self-stigma, feeling embarrassed or ashamed of mental health issues.
Intergenerational trauma
The effects of traumatic experiences inflicted on past generations can be carried over to future generations through the process of epigenetics (changes in the expression of genes caused by toxic stress/trauma).
Mental health experts have found that Native Americans have much higher rates of substance abuse and depression compared to other minorities groups. The research findings by the University of North Dakota revealed that feelings passed on from previous generations, who have experienced the loss of land and their culture, can be sources of stress and anxiety that can lead to more severe mental illnesses. A further report on mental health disparities on Native American and Alaska Native children and adolescents noted that they have the highest rates of lifetime major depressive episodes among all ethnic and racialized groups.
Dr. Joy Degruy has also developed the theory of Post Traumatic Slave Syndrome (PTSS), which explains the experiences of Black Americans who have been affected by generations of slavery. This has resulted in multigenerational trauma that has never been addressed.
Access
Generations of systemic racism mean minorities individuals are often more likely to live in communities lacking healthcare facilities and less likely to have full health insurance coverage. A report by the Pew Research Center stated that a majority of Black adults say less access to quality medical care in their communities is a major reason why Black people in the US generally have worse health outcomes than other adults. About 49 percent say a major reason for worse health outcomes is that health care providers are less likely to give Black people the most advanced medical care.
Efforts for change
Awareness about discrimination in healthcare is an important step, but more needs to be done. The main objectives of the National Center on Minority Health and Health Disparities, created by Congress, include:
- Raising awareness among the public and healthcare providers of racial/ethnic disparities in care.
- Expanding health insurance coverage options in lower income communities.
- Increasing the capacity of healthcare facilities and the number of healthcare providers who are culturally competent in underserved communities.
- Improving knowledge of causes and interventions to reduce disparities.
Racism in healthcare, especially in mental healthcare, creates significant obstacles to fair treatment, resulting in disparities in access, quality of care, and health outcomes for marginalized communities. It is essential to address these systemic issues to ensure that all individuals receive compassionate, comprehensive, and culturally competent mental health services.
