Identifying and reducing racial and ethnic health disparities: What can we do?
By Li Huijun, PhD, Assistant Professor in the Department of Psychology Florida A&M University
Great effort has been made in the last decade to reduce health disparities in the United States. This includes the most recent “Healthy People 2020” initiative by the U.S. Department of Health and Human Services “to achieve health equity, eliminate disparities and improve the health of all groups.” In order to accomplish this overarching goal as it pertains to mental health, greater attention must be given toward eliminating obstacles to access, quality and the availability of mental health services for racial and ethnic minority Americans. These obstacles include: high levels of social stigma; differences in cultural perspectives; low health literacy levels; and a critical shortage of mental health professionals.
Research findings indicate that racial and ethnic minority groups experience higher levels of mental health stigma that is manifested as bias, distrust, stereotyping, fear, embarrassment, anger, shame, and avoidance. Stigma may lead to individuals delaying or aborting treatment prematurely, which increases morbidity and mortality. In order to reduce stigma, the President’s Commission on Mental Health has called for implementation of awareness campaigns that use television, Internet, and print media to spread understanding through personal stories and education. However, such campaigns may only be effective at reducing mental health disparity if the messages are culturally sensitive and directly target the issues that affect these racial and ethnic groups the most.
Culturally constructed experiences
Second, mental health and illness are culturally constructed experiences. This means there is often disconnect between how mental health service providers and seekers explain the same illness. The two perspectives can be drastically different. Many racial and ethnic minority groups have their cultural specific understanding of the causes/etiology and treatment of a mental illness. Therefore, in addition to providing a professional diagnosis, mental health professionals should listen to the patient and his/her family members explain the “perceived” causes of mental illness and what they are doing to cope with the symptoms. This process is cost-effective as it may help build trusting relationships, increase the return/retention rate, and eventually enhance long-term treatment outcomes.
Third, according to the Institute of Medicine, health literacy levels are lower among racial and ethnic minorities, especially those with limited education and English skills.
In fact, research findings on psychosis list lack of knowledge as one of the most common reasons given by patients and their parents for their delay in seeking psychiatric help. Generally, persons with low health literacy also incur higher health care cost and are less likely to comply with prescribed treatment, or seek preventative care.
In order to promote mental health literacy, local mental health agencies, grant funded outreach community education activities, and mental health consumers in the process of recovery must all strive to demystify mental health problems by promoting health knowledge and literacy.
This will reduce mental health stigma and promote help-seeking activities. Additionally, culturally tailored and culturally appropriate/sensitive educational approaches and formats would work more effectively within racial and ethnic minority communities.
Shortage of Mental Health Professionals
Lastly, there is a critical shortage of mental health professionals from racial and ethnic minority backgrounds. Take the field of school psychology as an example. A recent survey of National Association of School Psychologists members shows that only three percent surveyed were from Hispanic background. About two percent were African American. Less than one percent was Asian American or American Indian and Alaskan Native. This is striking in comparison with 93 percent of school psychologists who are white. Research findings demonstrate that health providers from racial and ethnic minority backgrounds are more likely to serve large numbers of racial and ethnic minorities.
Therefore, according to the U.S. Department of Health & Human Services Action Plan to Reduce Racial and Ethnic Health Disparities, it is critical to increase the diversity of the mental health workforce to “address the compelling need for reductions in healthcare disparities.” One strategy proposed is to train clinicians, faculty members, and students through the Historically Black Colleges and Universities (HBCU) Center for Excellence funded by the Substance Abuse and Mental Health Services Administration (SAMHSA). These trainings will focus on best practices in promoting culturally sensitive mental health, prevention, and intervention. At the local institution level, it is extremely essential that we recruit and retain students from underrepresented groups to mental health related fields. This is a time to expand a diverse student body rather than shrink or cut psychology related programs in higher educational institutions.
While there are many strategies for reducing mental health disparities, these four are necessary for helping relieve the disproportionately high burden of mental illness among racial and ethnic minorities.
Huijun Li, PhD is an assistant professor in the Department of Psychology at Florida A&M University and is a National Certified Psychologist. Her research focuses on mental illness in adolescents and young adults.
Join Li on Twitter for a live chat on Oct. 25 at 6 p.m. to answer your questions on mental illness. Follow@FAMU_LivingWell.