The way we talk about certain groups of people has changed a lot over time, especially in the last several years. The continually updated language we use to describe historically marginalized groups like BIPOC – Black, indigenous, and people of color – may be confusing or even irritating to some people. Yet, understanding and talking about the issues of BIPOC, including the barriers to mental health care that they face, and how having access to mental health care can empower them, is crucial.
Equity vs. Equality and What it Means for BIPOC
The relatively recent upsurge in the focus on marginalized groups and the difficulties they face is important, because in order for humankind to advance further, we must build a society built on equality – and, to do that, we must start with equity. Most of us are familiar with the concept of equality, but the meaning behind equity isn’t as well known. Equality is defined as the state of being equal, and often specifically refers to “the right of different groups of people to have a similar social position and receive the same treatment.” Most people acknowledge that they want an equal society, but the problem is that the structure of our society doesn’t always allow for equity. Equity is the “state, quality or ideal of being just, impartial and fair.”
While equality means that we give everyone the same things to improve their quality of life, equity means that we give different groups of people what they need specifically to improve their quality of life. This could mean that disadvantaged or vulnerable groups might need to receive different resources or more resources than other groups. Both equality and equity attempt to make things fair for everyone, but only equity can promote true fairness.
Mental Health in the BIPOC Community
Many Americans face barriers to mental health care access, but these barriers are more prevalent for BIPOC. In a BIPOC Mental Health Fact Sheet compiled for Resources to Recover, Diversity Outreach Resource Specialist Danielle Leblanc, MSW discusses mental health in the BIPOC community and why many BIPOC aren’t accessing mental health care.
Statistics on Mental Health in the BIPOC Community
- Although rates of depression are lower in Black (24.6%) and Hispanic (19.6%) communities than for white people (34.7%), depression in Black and Hispanic individuals is likely to be more disabling and persistent
- Most mental illness goes untreated, and this is especially true in communities of color. In 2015, 46% of whites with a mental illness received mental health services, compared to 30% of Blacks and 27% of Hispanics.
- Up to 75% of youth in the juvenile justice system meet the criteria for a mental health disorder and 41% percent of these youths are Black, even though Black Americans comprise only 15% of all youth across the United States
- Black and Latinx children were about 14% less likely than White youth to receive treatment for their depression
- Over 25% of Black youth exposed to violence have proven to be at high risk for post-traumatic stress disorder (PTSD)
- Self-reported suicide attempts rose nearly 80% among Black adolescents from 1991 to 2019, while the prevalence of attempts did not change significantly among those of other races and ethnicities
- In 2018, Asian Americans were 60% less likely and Hispanic Americans 50% less likely to have received mental health treatment than non-Hispanic Whites
- American Indians/Alaskan Natives report higher rates of PTSD and alcohol dependence than any other ethnic or racial group
- According to a 2019 study, Black Americans have the highest lifetime prevalence of PTSD (8.7%), compared to their white (7.4%), Latinx (7%), and Asian (4%) counterparts.
- Inmates of color are disproportionately punished and placed in solitary confinement, which has been shown to exacerbate mental illness. Many individuals experience their first psychotic episode in these conditions.
The statistics in the fact sheet indicate significant health inequities in the United States, which are reflected in the disparities in quality of life, average length of life, rates of disability, severity of illness, and access to treatment experienced by marginalized groups.
Barriers to Access to Mental Health Care in the BIPOC Community
Why do the numbers consistently show that BIPOC are more affected by mental illness and less likely to receive care? The barriers that keep BIPOC from accessing mental health care include both obstacles from outside of the community, like systemic racism and discrimination, and those from within the community, like cultural beliefs and behaviors.
Some of the barriers to mental health care for BIPOC include:
- Different cultural perceptions about mental illness and well-being, including the belief that mental health treatment doesn’t work
- Racism, bias and discrimination in treatment settings
- Being more vulnerable to being uninsured (And even for people with insurance, high deductibles and copays often make it difficult to afford treatment)
- Cultural differences in help-seeking behaviors, including the belief that seeking help is shameful
- A lack of resources, like a lack of availability of services in the area or difficulties finding transportation or childcare, or not having the ability to take time off work.
- Language and other communication barriers
- Fear and mistrust of treatment
- Fear and mistrust of non-BIPOC practitioners
Rachel Wahba-Dunkley, a psychotherapist, holistic life coach, and person of color, discusses some of the barriers that often keep BIPOC from accessing mental health care in her blog post “Why BIPOC mental health empowerment is important and what you can do about it”:
“Talking about our personal, deep inner lives is already difficult. For us BIPOC, it’s even more difficult when we see the generations before us getting misused or harmed when they’ve trusted someone who later on betrays them. For us children of immigrants, many of our parents didn’t have the luxury of time – to think, explore their feelings, and realize they needed support. And then there’s finances, where the cost is too high and the waitlist for affordable mental healthcare is too long. Not to mention, we also live in a world where those who have pride don’t ask for help…”
In the BIPOC community, there’s often a stigma surrounding mental illness and reaching out for help. Part of this is because of cultural beliefs, but is also due to the history of racism, discrimination and other injustices in our country.
The Impact of Disparities in Access to Mental Health Care
Mental health conditions have a huge negative impact on the well-being of Americans, and on our country overall.
- In 2009, an expert panel found that mental illness, substance abuse and behavioral problems among children and young adults cost the U.S. $247 billion each year.
- A 2017 report published by the Kaiser Family Foundation found that mental health and substance use disorders are the “leading cause of disease burden in the United States, and the U.S. has the highest mortality rate for these disorders among similarly wealthy countries.” Access to mental health and substance use disorder services is lacking for many Americans, especially for BIPOC.
- Each year, about 1 out of every 20 Americans experience a serious mental illness that causes substantial functional impairment. Adults who are uninsured or low-income are more likely to experience serious mental illness than individuals with insurance or higher incomes. Uninsured rates are higher for BIPOC, compared to their white counterparts, and income data from 2007 shows that over half of low-income families (58%) were BIPOC.
Despite the high costs of lack of access to mental health care, especially for youth, disparities in access to and quality of mental health care for BIPOC youth still persist. Psychiatric disorders in childhood have been linked to negative outcomes later in life, including poor social mobility and reduced social capital. When BIPOC don’t receive the fair and just care they need in childhood, they are more likely to continue the cultural trend of avoiding talking about mental health into adulthood, and to reinforce these beliefs with their own children.
About these common beliefs and practices in the BIPOC community, Rachel Wahba-Dunkley says:
“Because of systemic injustices, many of our ancestors survived and didn’t have the time, resources, or capacities to thrive. And since they teach us what they know, we continue the same cycle – not trusting health professionals, not learning coping mechanisms, and not believing that we have time to think and grow personally. This gets reinforced in our homes, contexts, and the world.”
What Is Social Empowerment and Why Is It So Important for BIPOC?
Social empowerment is the “process of building the autonomy, power, confidence and other necessary means to enact change and pave the way for a better future.” Social empowerment is something that can happen at an individual level or at a collective level. We all need to work together at this collective level to make real change. What does this look like? On a collective or societal level, social empowerment means that organizations and institutions (like our healthcare and political systems, schools, banks, military and police forces, etc.) help marginalized groups of people gain the resources they need to be empowered, like material assets, good health, education, social belonging, self-esteem, self-confidence and economic opportunity.
What We Can Do To Help Increase Access to Mental Health Care and Empower BIPOC
When it comes to increasing access to mental health care for BIPOC, we’ve come a long way, but there’s still more work to be done.
Some of the ways you can work to increase access to mental health care for BIPOC on an individual level include:
- Educating yourself and others on the inequities in our society, especially those in our health care system
- Encouraging mental health organizations to include BIPOC on staff or boards of directors.
- Writing, calling or talking to your local and federal legislators to support efforts to improve access to and the quality of mental health services in your area.
- Taking advantage of opportunities to speak out on the challenges BIPOC face when it comes to accessing mental health care – this could be as simple as posting something on social media.
- Putting yourself in someone else’s shoes and trying to be more open and understanding towards what BIPOC communities might be experiencing that your experiences might not reflect.
Rachel Wahba-Dunkley notes that things are changing in the BIPOC community. For example, many members of the community, especially youth, are more vocal about mental health – but there’s still more to be done. Wahba-Dunkley asks her fellow BIPOC community members to do what they can to normalize and destigmatize mental health, seeking help, and being vulnerable, saying:
“Instead of passing down generational trauma, we’ll pass down generational wealth and coping skills. Instead of normalizing pride and stubbornness, we’ll normalize vulnerability, growth, and healing.”
Some of the ways we can work to increase access to mental health care for BIPOC on a collective or societal level include:
- Practicing cultural competence – Terry L. Cross, MSW, the founding executive director of the NICWA (National Indian Child Welfare Association) and co-author of the study “Towards a Culturally Competent System of Care,” defines cultural competence as “a set of congruent behaviors, attitudes, and policies that come together in a system, agency or among professionals and enable that system, agency or those professions to work effectively in cross-cultural situations.” In regards to the mental health care field, this means that agencies must do all that they can to develop and encourage an organizational culture that encourages their providers to value diversity, have the capacity for cultural self-assessment, become conscious of the dynamics inherent when cultures interact, have institutionalized culture knowledge, and to adapt their service delivery methods to reflect an understanding of cultural diversity
- Increasing the number of BIPOC practitioners – Many BIPOC feel that they would be better understood by a fellow member of the BIPOC community, but there is a major lack of BIPOC mental health providers. According to a report from the American Psychological Association, in 2015, 86% of U.S. psychologists were white, and, in 2019, almost 70% of U.S. social workers and 88% of mental health counselors were white. As a result, many BIPOC avoid seeking help. By providing resources designed to promote equity and give BIPOC access to the education and other resources they need to pursue a career in mental health, we can work on closing this disparity.
In order to truly build an equal society, all members must have the same access to those resources that are crucial for quality of life. Health care is one of the most important, and that includes mental health care. The barriers that marginalized groups face when it comes to accessing mental health care have been created over centuries of systemic racism that was – and still is – deeply embedded into every facet of our society. That’s why it’s crucial that we understand and accept this reality, and that we all do our part to break down systemic racism and discrimination and the barriers they create and reinforce for BIPOC.
As Danielle Leblanc, MSW, says:
“Mental health equity will be achieved when all people have the opportunity to attain their full health potential, and no one is impeded from doing so because of socially determined circumstances.”
Mental Health Support for BIPOC in Virginia
There is no shame in getting the help that you need to ensure quality of life. We pride ourselves on providing equitable and culturally competent behavioral health care to all of our community members. If you live in the Region Five area of Virginia, also known as coastal, Southeastern Virginia, and are looking for help for mental health concerns, substance abuse, or developmental or intellectual disorders, we are here to help. To get help, contact your local CSB (community service board) for same-day access.
If you’re experiencing a behavioral health or substance abuse crisis, talk to someone right away by calling the Region Five crisis line at 757-656-7755.