By American Heart Association News, Health Day reporter
WEDNESDAY October 6, 2021 (American Heart Association News) – Living with a mental health disorder is not easy. It can carry the weight of the stigma, making you feel different. For people facing racial and ethnic discrimination, experts say the additional “otherness” of mental illnesses can prove too much of a barrier to getting the help they need.
“They might not want to share that they have a problem with members of their family or community for fear of being discriminated against or treated differently,” said Alice Villatoro, assistant professor in the public health program at the University of Santa Clara in California. . “They are already treated like ‘other’ as a minority, and don’t want to add more.”
Fear of discrimination and stigma is just one of many complex barriers that contribute to disparities between people who receive mental health care, a gap that research shows is widening as the severity of mental health care increases. mental illness is increasing. It can have long term consequences. A recent scientific statement from the American Heart Association analyzed a large body of research showing a strong link between mental and physical well-being and the impact of psychological stress on heart and brain health.
Although rates of mental health disorders, from conditions ranging from mild to moderate depression and anxiety to more serious and pervasive conditions such as schizophrenia, are similar across races and ethnicities, research shows that white adults are almost twice as likely to receive mental health services as blacks. or Hispanic adults.
When they receive care, research shows they are treated differently from their white peers. Black adults are less likely to be offered medication or behavior therapy and are more likely to be incarcerated than any other racial or ethnic group due to mental illness, according to the American Psychiatric Association. Black, Hispanic, Asian, Native American, and Alaskan Native adults with serious mental illnesses are also more likely to be overdiagnosed with conditions such as schizophrenia and to be involuntarily hospitalized when seeking care.
Treatment disparities begin long before adulthood. Black and Hispanic teens and other youth of color with behavioral health issues are more likely to end up in the juvenile justice system than white teens, who are more likely to be referred to a mental health professional .
These experiences further fuel the mistrust born of America’s “complicated race history,” said Tené T. Lewis, associate professor at the Rollins School of Public Health at Emory University in Atlanta. “There is a legacy of abuse, and people don’t want to be exposed to it.”
Worries about how they might be handled by a counselor, psychologist or psychiatrist – whether that person is from a different race, ethnicity, or culture – can prevent people from asking for help. professional help, Lewis said. The vast majority of mental health care providers – over 80% – are white.
Black people in mental distress may instead seek support from friends, family or church, rather than being vulnerable in therapy, she said.
To remove these barriers, mental health care providers must recognize the impact of the country’s painful history of discrimination and the implicit biases we all have with people different from us, Lewis said.
“Discrimination is often a major source of mental anguish for people of color,” she said. “If you say that can’t be true, you immediately undermine that person’s existence. If you don’t believe there is a problem, you cannot deal with it.”
Sharing the same racial and ethnic background can be critical for some people, Villatoro said. For example, some health care networks offer Spanish speaking counselors, but “just knowing how to speak Spanish is not the same as sharing someone’s culture and the expectations of that community”.
In Hispanic communities, “social bonds are essential to well-being, and the family is closely linked to it,” she said. If “your provider doesn’t understand this, it may be difficult to try and work on your mental health.”
The biases manifest themselves in other ways. Some are structural, said Benjamin Le Cook, director of the Health Equity Research Lab at Cambridge Health Alliance in Boston and associate professor in the department of psychiatry at Harvard Medical School.
The healthcare system is poorly designed for people in jobs where it’s difficult to take time off to schedule or attend appointments, Cook said. “They may have multiple jobs, live further afield, need child care, or lack transportation. If they are uninsured or underinsured, they have to pay more out of pocket.”
Its center works in collaboration with researchers, health professionals and community members to identify and develop strategies to reduce inequalities in the health system. “This is where we spend a lot of time trying to fix this problem,” Cook said.
For example, her team is exploring a system that allows community members to lead support groups outside of the mental health care system to address some of the gaps. These certified peers could also guide people in need of more care through the health system so that they feel better supported.
Another strategy is to integrate mental health screening and referrals into primary care.
“Screening really matters,” said Adam Biener, assistant professor of economics at Lafayette College in Easton, Pa. Her research has shown that although people from racial and ethnic communities may avoid mental health care and preventive care, they are more likely to see a doctor when they are physically ill.
But “nobody talks about mental health when they see a (primary care) doctor,” Biener said.
When referrals to mental health professionals occur, doctors need to make sure the list is diverse and that they ask patients about their preferences, Lewis said.
“We can do this in cardiology clinics,” she said, especially since heart patients have a high risk of depression, which can increase their risk of death.
Yet, Villatoro said, it’s important that providers – regardless of their background – recognize the wide range of identities people have and how they affect mental health.
“We need to go beyond just talking about the main ethnic groups and be more nuanced, take an intersectional approach,” she said. For example, a Hispanic woman whose identity matches her birth sex would face different challenges and likely require different coping strategies than a black transgender woman.
“Our identities influence what we do and experience in life,” Villatoro said. “Context is everything. And your path to good mental health could be very different from my path.”
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