Poor mental health and mental illness have become increasingly prevalent in the United States. In 2019, about 20% of adults reported experiencing mental illness, representing over 50 million individuals.. This mental health crisis was further exacerbated by the COVID-19 pandemic, when many experienced social isolation, stress, grief, and financial struggles. WHO (World Health Organization) reported that the pandemic triggered a 25% increase in the prevalence of anxiety and depression worldwide. Among those affected, the mental health of certain racial/ethnic minority groups worsened relative to that of non-Hispanic white individuals. Specifically, there was a greater increase in mental illness reported for Black, Hispanic, and Asian adults. Furthermore, these groups are less likely to seek out mental health treatments and care. This underutilization of mental health services, especially among people of color, is a persistent and important issue in healthcare.
A potential reason for this underutilization is an individual’s perception or experience of acts of discrimination. A recent study published in Journal of Health Care for the Poor and Underserved found that discomfort in asking questions to a health care provider was associated with lower likelihood of underutilization of mental health care, indicating that positive encounters with the health care system contribute to a willingness to seek out care. In addition, researchers found that “everyday discrimination from non-health care sources, major discrimination events, and discrimination from health care sources each independently contributed to lower utilization of needed medical care after adjustment for measures of structural discrimination.” Another study published in PLOS One found that perceived discrimination in medical settings was “significantly associated with report of not having enough time with the physician and not being as involved in decision-making as desired.” Thus, it becomes clear that perceived discrimination contributes to an individual’s lack of trust in health care, leading to a underutilization of its services.
Cultural factors may also contribute to this under-utilization. One major factor is stigma against mental health. For example, mental illness is still considered taboo in many Asian cultures. As a result, many Asian Americans tend to dismiss, deny, or neglect their mental health concerns. Even further, many Asian Americans face parental pressures and pressure to live up to the “Model Minority” myth. Another factor could be language. Many Hispanic and Asian Americans do not speak English as their first language and, as a result, may experience language barriers within the healthcare system when translators or interpreter technologies are not readily available.
So how do we combat this underutilization of mental health services? First, it’s imperative that we combat provider bias. This can be done through cultural competence training, teaching effective cross-cultural communication skills and awareness. It’s also important for policymakers to take into account the cumulative effect of discrimination outside the health care system. Thus, communities can begin to change norms that sanction chronic and everyday discrimination. In terms of combating cultural influences, we can first employ more bilingual services to ensure that everyone can effectively communicate their needs. While the stigma against mental health found in many cultures is a very complex issue, we can take steps against it. As community members, we can take the time to remind our loved ones that mental care is health care and that there is nothing wrong with experiencing mental health struggles.
While the underutilization of mental health services among minority groups is a pervasive issue, it is not one without hope for improvement. By providing more culturally-sensitive information and working to ensure accessible care to all, we can help to eliminate this harmful trend.
Edited by: Elissa Gorman
Graphic Designed by: Sofia DiFulvio
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