Organizations and advocates across the world bring attention to mental health through educating the public and sharing what we can all do to practice self-care and support people living with a mental illness. With mental health becoming more widely recognized over the last few years, more people are advocating for expanding research, starting the tough conversations on mental health with their loved ones, and fighting for policies that encourage mental wellness and suicide prevention. Though modern mental health advocacy calls attention to mental health problems on a global or national scale, we must address how certain communities reap lesser benefits from mental health campaigns. People of color, communities with a low socioeconomic status (SES), and people with disabilities are all subjected to additional barriers in safeguarding their mental health. By expanding conversations in mental health awareness to highlight these discrepancies, we can work to prioritize and improve upon mental health inequities.
Although general rates of mental illness are lower overall in racial and ethnic minority groups, the burden of the illness tends to be greater and more long-lasting for these individuals. A lack of culturally competent mental health care can lead to underdiagnosis and/or misdiagnosis, which also lessens the amount or quality of services received. Promoting the work and education of therapists/clinicians of color is a step in removing this cultural barrier to mental health care. For Spanish-speaking populations and other minority groups in America that do not use English as their first language, language barriers also stand in the way of adequate healthcare. Among all adults with any mental illness, 48% of white people received mental health services in 2015, compared to 31% of Black and Hispanic people, and only 22% of Asian people. Black youth with behavioral health issues are more likely than white youth to be referred to the juvenile justice system than to mental health services.
On top of systematic barriers like discimination, lack of insurance, distrust in the medical system, cultural stigma, which is often greater in minority populations, can also keep individuals from seeking support when in need. Distrust in the medical system is not completely misguided, as there is a long American history of mistreating Black Americans and other communities of color in the medical field. Medical mistrust can lessen people’s willingness to seek care, and thus contributes to discrepancies in accessing mental health services across diverse populations. Interventions such as teaching critical race theory in medical school is an attainable step in alleviating the impacts of institutional racism within medical establishments. By using mental health awareness campaigns to continue to speak out about mental health, we can help fight stigma, start community-wide conversations, and connect people with the resources they need. Furthermore, greater structural changes are needed to address the systemic barriers contributing to these inequities.
Individuals in low SES communities and/or who are living in poverty are particularly susceptible to high stress. The impacts of poverty, which is one of the greatest risk factors for developing a mental health condition, can strengthen the impact of other risk factors and therefore cause poorer outcomes in already vulnerable individuals. Black people are more likely to live in low SES areas or areas with limited mental health resources, which exacerbates the already existing risk factor of facing discrimination. When assessing SES and accompanying factors, such as income inequality and unemployment, poor mental health outcomes are consistently associated with a lower SES. It’s important to advance interdisciplinary research on upstream public health approaches that mitigate the impacts of low SES on mental health. This entails cross-sectoral policy action like improving policy in housing, taxation, employment, and health, which pulls on various facets of health promotion to alleviate the burden of poverty. By tackling public health issues like unemployment and housing insecurity, mental health care becomes more accessible to people who face monetary and community barriers.
People with disabilities face both physical and societal barriers in accessing mental health care. The term “disability” encompasses a vast array of physical and mental conditions, and is defined under the Americans With Disabilities Act as “a physical or mental impairment that substantially limits one or more major life activities.” Disability positive testimony consists of a person with a disability giving a positive account of their experiences with such disability. They share the value in their experiences as a person with a disability, and attest to the fact that they are pleased with their lives. However, many able-bodied people will attribute this positive testimony to adaptive preference, in which a person’s preferences change towards something suboptimal due to constraints in their options. Discreting the individual’s experience with their disability, particularly their positive sentiments towards their disability, stems from ableism.
Ableism is a type of discrimination and stereotyping that limits accessibility, and devalues a person with a disability in society. This discriminiation can contribute to adverse mental health symptoms in people with disabilities, and may even pose an additional barrier to seeking support. Approximately 17.4 million (32.9%) of adults with disabilities reported experiencing frequent mental distress in 2018. People with disabilities suffering from a mental health condition may be brushed off by providers who believe that their conditions stem from their disability and that these individuals therefore have “unfixable” problems. People with disabilities can have bad days or suffer from a mental health condition that is not directly related to their experience as a disabled person in the world, or that actually stem from the discrimintation they receive because of their disability, not because of the disability itself.
The view of disability as bad or suboptimal is deeply misguided, and objections to disability positive testimony on the account that people do not know what they are missing or what it is like to be without their disability are rooted in ableist beliefs. Society views being able-bodied as the standard for a healthy life, and disability is perceived as “mere lack” and not as a unique and valuable experience. For example, society generally doesn’t require people to know what it’s like to be deaf to accept that they like hearing, but will contradict positive testimonies from Deaf people because they “don’t know what it’s like to hear.” Disabled people are not just claiming to value who they are with their disability, but to value their disability itself, which is integral to the disability pride movement.
The Deaf communitiy faces both discrimination in mental health care but also a language barrier, as most Deaf people use sign language as their primary mode of communitcation. A 2012 study revealed that only 17% of Deaf patients receive an interpreter for their health care visits. While there is some overlap with English vocabulary, American Sign Language has its own grammatical structure that is different from English. Writing and reading is not always the preferred method of communication for a Deaf patient. There is a need for increasing interpreters and making equipment that alleviates this language barrier more accessible in healthcare settings. Mental health research pertaining to the Deaf community is lacking, and common self-care tips and coping mechanisms shared throughout Mental Health Awareness Month do not cater to Deaf culture.
It is necessary to advance research on structural and societal barriers to mental health care, including racism and ableism, the lack of accessible low-cost care options, access and quality of services available, and the economic system itself that allows millions of people to suffer from the detrimental health effects of poverty, if society wishes to promote better mental health.
To promote equity in mental health care, organizations and individuals should amplify the voices of people of color, people with disabilities, the Deaf community, and other marginalized groups in their advocacy. Don’t discredit their lived experiences – listen to their experiences and take them for their world. Learn more about the cultural and societal stigmas placed upon these groups, and address how you may contribute to their discrimination in society. Racism and ableism is deeply engrained in our society, but the first step to dismantiling these forms of discrimination is by unpacking your internal biases. Along with working to restructure your own biases, work towards feeling comfortable calling out others, whether it be friends, families, or structures like schools and workspaces, when they contribute to racist or ableist ideologies or policies. On an advocacy level, encourage organizations and policymakers to invest in research, programming, and policies that address inequities in mental health.
By calling attention to and working to change the biases and structures restricting people from accessing adequate mental health services, we can help break down these systemic barriers. While we do have awareness months, such as Mental Health Month in May, we must continue these conversations year-round in order to create real change.