BY ANABEL STAROSTA
Mental health is an incredibly debilitating health problem around the world, yet due to the stigma and lack of understanding, it is an extremely difficult issue to address. According to a study by the World Health Organization, the World Bank, and Harvard University, in high-income countries, mental disorders have the second largest impact on disability, following only cardiovascular disease (Murray and Lopez) and are particularly relevant for racial and ethnic minorities; these minorities typically have a greater burden of disease due to poor mental health, yet have less access to mental health services (Report of the Surgeon General). In the United States, people often claim that we are “beyond racism,” and that this should not be a factor contributing to mental and physical health (Mental Health News). However, as recent events at the University of Missouri and Yale have shown, racial and ethnic struggles are still incredibly present – even if often suppressed – and continue to impede mental health.
Minorities have faced racism and discrimination both historically and in present day, leading to mental health issues that may contribute to lower economic, social and political status (Report of the Surgeon General). Mental health services, if available, are often under-utilized or of poor quality. In the United States, only 16.6% of white adults, 15.6% of American Indian or Alaska Native adults, 8.6% African American adults, 7.3% Hispanic adults, and 4.9% Asian adults were likely to use mental health services (National Institute of Mental Health). This number is low for all races, however because minorities typically face greater mental health burdens, increasing minorities’ access and quality of care is especially important. Barriers to proper treatment include cost of care, lack of insurance, societal stigma, and clinician’s lack of understanding of the unique mental health challenges that minority groups face (Report of the Surgeon General).
All of these factors are worth addressing, but given the contentious status of racial discrimination in the United States today, the clinician’s role as a barrier to beneficial mental health treatment is particularly worth addressing. The clinician currently may act as both an unknowing perpetrator of discrimination and an unhelpful resource because of lack of proper education and understanding. Properly helping patients often requires understanding of their culture-specific backgrounds and difficulties. Clinicians, however, are often unaware of cultural issues and cultural bias, do not speak the patient’s language, or do not understand the patient’s fear of treatment (Report of the Surgeon General). These are problems that could conceivably be resolved with proper training, yet knowledge about race and ethnicity-related oppression, class characteristics, and problems specific to a particular culture are often not included in the graduate curricula (Mental Health News). While individual clinicians may educate themselves by choice, in order to truly improve mental health, this knowledge must be understood and utilized across the entire mental health profession. Adding a few extra graduate level classes and/or creating continuing education courses addressing these issues would be both a helpful and cost-effective way to address this problem.
Additionally, people of a particular race or ethnicity often feel more comfortable discussing their mental health status with someone who shares this identity. However, due to the cyclic nature of discrimination and mental health status, minorities are often underrepresented in the mental health profession. In light of recent events across the United States, perhaps this will began to change. After speaking out about racism and lack of understanding on campus, Yale students called for more mental health programs specifically tailored to minority communities, where more mental health professions would be of minority groups and identify with students (The Washington Post). This is an initiative that would be valuable not only at Yale or other college campuses, but for minority groups everywhere. Although sharing a cultural identity may hinder objectivity, if the physician has the proper training, he or she will be able to provide the proper context to help the student – including the views both minority and non-minority groups might have.
While mental health professionals and policy-makers can try to decide what factors contributing to debilitated mental health they should try to improve, perhaps it is worth listening to the specific calls of members of racial and ethnic minorities. Their struggles are unique, relevant, and prevalent — proper mental health treatment requires, first and foremost, this acknowledgment and respect.
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Murray, C. J. L., & Lopez, A. D. (Eds.) The global burden of disease. A comprehensive assessment of mortality and disability from diseases, injuries, and risk factors in 1990 and projected to 2020, Cambridge,, MA. Harvard School of Public Health. 1996. Web. 17 Nov. 2015.
“Mental Health: Culture, Race, Ethnicity.” Report of the Surgeon General. Office of the Surgeon General, Center for Mental Health Services, National Institute of Mental Health. Aug. 2001. Web. 17 Nov. 2015.
“A New Look at Racial/Ethnic Differences in Mental Health Service Use Among Adults.” National Institute of Mental Health. National Institute of Mental Health. 23 Apr. 2015. Web. 17 Nov. 2015.
“The Impact of Race and Racism on Mental Health Clients.” Mental Health News. Mental Health News. Nov. 2011. Web. 17 Nov. 2015.
“Yale, Unviersity of Missouri, and the broken promises of America’s Universities.” The Washington Post. The Washington Post. 11 Nov. 2015. Web. 17 Nov. 2015.
Yale Global Health Review 