Most Americans are frustrated with the mental healthcare system in this country, despite the historic reckoning that the COVID pandemic forced to the fore more than two years ago. In response, the Biden administration has begun implementing a strategy to transform mental health services for all Americans, including a nationwide tour by the secretary of the Department of Health and Human Services himself, Xavier Becerra. This tour, and all efforts to bolster mental healthcare, must make the mental health of Black and Hispanic communities a prime focus.
While frustration with mental healthcare in America holds true across demographics, this dissatisfaction holds particularly pointed implications for Black and Hispanic communities, who report being more concerned with their mental health than white Americans. Yet, these communities are also less likely than white Americans to report getting support from a mental healthcare provider during a difficult time, a National Alliance on Mental Illness/Ipsos poll finds. Key to promoting more equitable access to mental healthcare will require breaking down the barriers of cost, stigma and unequal treatment.
So how did we get here?
Many of the barriers to expanding mental healthcare predate the pandemic and appear poised to outlast it, including a lack of affordable mental healthcare options, a persistent gap in racial and ethnic representation in the psychology workforce, and the stigma surrounding mental health issues.
To begin with, a majority of Americans — 75 percent — say that they are not content with mental healthcare treatment in this country. Many cite costs and coverage as a major issue. Mental healthcare is not universally covered under insurance and forces many to pay high out-of-pocket costs. More so, the uninsured are more likely to be Black and Hispanic, posing an even bigger hurdle in getting affordable care to these patient populations.
This disparity cannot be attributed to affordability issues alone. The data suggest stigma and racism in patient experience are other major contributing factors.
According to Beryl Institute/Ipsos polling, two in five Black Americans (42 percent) and one in five Hispanic Americans (21 percent) report experiencing prejudice and discrimination in their healthcare encounters with some frequency, compared to just 5 percent of white respondents.
Given that 84 percent of the psychology workforce is white, accessing a provider who shares a similar racial and ethnic background is yet another obstacle in connecting Black and Hispanic patients to mental healthcare. Without a diverse workforce of providers, other culturally sensitive barriers, such as language, also pose significant hurdles to care.
The problems with access and barriers are further exacerbated by the stigma surrounding getting help. Many acknowledge there’s still a stigma around mental health, with majorities of white, Black and Hispanic Americans expressing concern.
These findings aren’t isolated to one survey. Other studies found that some Black Americans view struggling with mental health as a personal failing; three in five Black Americans (63 percent) believe depression is a personal weakness. Likewise, for some in the Hispanic community, sharing intimate details with a provider may cut against cultural norms.
There are also macro forces the pandemic aggravated that added stress and loss to Black and Hispanic communities. Black and Hispanic workers were more likely to be frontline workers and not have sick days or comprehensive medical insurance, forcing many to directly grapple with the risks of COVID day to day. At the same time, the systemic racism in the healthcare industry and elsewhere pushed mortality rates from COVID higher for Black and Hispanic patients than for white patients.
That loss of life touched so many in Black and Hispanic communities. By the most recent estimates, 39 percent of Black and 31 percent of Hispanic people personally know someone who died of COVID-19.
Many Black and Hispanic Americans are concerned about their mental health but aren’t getting the help they need through the formal mental health system, due to cost, stigma and treatment disparities. While complicated problems on their own, the pandemic has added another layer of urgency to this confluence of issues. Understanding the extent to which these forces limit access now is the first step in seeking to alter the current status quo and creating a more equitable system of mental healthcare in America.
April Jeffries is global president of market research firm Ipsos Understanding Unlimited. Dr. Manuel Garcia-Garcia is global lead of neuroscience at Ipsos.