Barriers to Obtaining Mental Health Treatment
There are a lot of reasons why there is not always the same access to mental health treatment across the board for every person. While there are systems like Medicare and Medicaid in place, there are still 26 million, or 8% of the US population, who do not have health insurance.
This unequal access to healthcare happens more often with people of racial and ethnic minority groups, who are more likely to receive less optimal care and only seek out care in case of an emergency. This is because of a lack of community-based intervention, unequal access to evidence-based practices, and a lack of resources to fund health services. Unfortunately, there is also unconscious bias and stereotypes when it comes to racial and ethnic minority groups. An example is that African Americans are more likely to get a schizophrenia diagnosis than a bipolar diagnosis.
Then, there is the issue of culturally informed treatment. Since the foundation of psychology as a science, many studies have been conducted by white male doctors on white male and sometimes white female subjects. Sometimes, cultural practices can be seen as pathology through this lens, meaning that certain parts of a culture that are unfamiliar to treatment centers may seem like an indication of a type of disorder when they are truly just cultural practices. Also, racial, ethnic, and minority groups are more likely to be left out of genomic studies, which means that it is harder to have a biological understanding of the psychology of these groups, meaning that evidence-based treatment may not work because there is no evidence for this specific group. There is also the issue of language barriers. Only 5.5% of psychologists in the US report being able to provide services in Spanish.
LGBTQ+ people are found to have a greater prevalence of depressive episodes, substance misuse, and suicidal ideation according to the meta-analysis data. This could be because of the historical and current marginalization of LGBTQ+ individuals as well as the social isolation that can occur with having an LGBTQ+ identity. The field of psychology is not blameless for the marginalization of gay people. Homosexuality used to be classified in the DSM as a disorder by the American Psychiatric Association. While it has been 30 years since then, the damage of what has been done historically cannot be scrubbed away, though now, the APA says that intervention intended to change sexual orientation is unethical and harmful.
The most extreme health inequities are for individuals experiencing homelessness, incarceration, former incarceration, severe mental disorders, drug addiction, and immigrant populations. This is likely due to the isolation of these situations. Mainstream society excludes individuals who experience these things, and combined with the low income that can be associated with people who are in this situation, it can make accessibility to mental health treatment seem impossible.
People experiencing homelessness are more likely to experience trauma, medical comorbidity, and exposure to violence or extreme weather. Combined with the cost of mental health treatment, it can be extremely difficult for unhoused people to access mental health services because of the location as well.
Almost half of all inmates have been diagnosed with a mental illness. This means that there are 10 times the number of individuals with serious mental illness in prisons rather than treatment centers. Upon release, formerly incarcerated people with mental illness are at a greater risk of re-offending and hospitalization.
Individuals with severe mental disorders are at a greater risk of being poor or unhoused. They are also at a greater risk of developing PTSD and substance use. Delivering appropriate care and ensuring proper diagnosis are extremely important for these individuals.
Immigrants may have trauma that they have experienced in their home country or during their journey to their new country. They are also more likely to suffer from racism, economic hardship, and social isolation. These are all likely to cause or contribute to mental health issues as well as limit access to mental health treatment.
What is being done to address this?
African Ancestry Genomic Psychiatry Cohort is working on expanding the Genomic Psychiatric Cohort for people with African ancestry. There are also more and more studies done on psychology in other cultures. This includes the creation of the Cultural Formulation Model, which is working to address and aid clinicians in culturally informed diagnosis and treatment.
The legalization of gay marriage and accessibility to transition procedures for transgender individuals has shown to lower levels of stigma and has a long-term positive effect on mental health outcomes. Affirmative practices of transgender individuals and unbiased services for LGBTQ+ populations are ever-expanding.
Housing First has been an effective approach for individual communities with homelessness. Essentially, unhoused people are provided with permanent housing as a right, not something that is earned through complying with a program, and with that, these formerly unhoused people are offered support. This method is one of the most effective methods for actually helping people, and they often stay in these homes.
There are mobile outreach teams - people that go around an area to bring services to people rather than requiring people to come to a location have been a great practice for engagement with mental health resources to people who may not have the means to go to a physical location or do not know where to start to find services.
In the case of incarcerated individuals, experts agree that there needs to be more intensive rehabilitation programs and better social reintegration programs. These are things that have been implemented in specific jails and prisons, but there is no current plan for an overhaul in all US prisons.
Many people cannot afford or do not even have a psychiatrist in their area and are limited to their primary care provider (PCP). This can be addressed by collaborative care, which involves having a psychiatrist available to PCPs to help aid in the diagnosis of complex mental health disorders and help provide patients with better diagnoses and accurate medication that is accessible to them.
Global mental Health initiatives are also answering the call. This means providing accessible care for underserved communities by using global resources. Even in wealthier countries, access to mental health treatment has more demand than supply. Nurses and assistants are now able to provide some services that only doctors used to provide. Which can help distribute some of the needs of a community from one doctor to several nurses, a doctor, and a pharmacologist. Other organizations involved in global mental health are Mental Health First Aid, Assertive Community Treatment, FRIENDS, and Head Start REDI.
Technology has helped significantly. This includes telehealth, telepsychiatry, and teletherapy. This has been expanded by PSYPACT, which is a certification process where therapists can get approved to provide therapy in other states. This can help in areas where there may be no available therapists or not enough therapists. This can help serve more rural communities especially, but it can also help people stay in therapy even when they move momentarily or permanently.
Psychiatry is on the decline worldwide, so it is no question that there is a lack of access. There have been some promising studies showing that exposure to the psychiatry field earlier in medical school can encourage more medical students to go into and stay in a psychiatry specialty. This is something that the U.S. physician organization is working to improve on.
Other than the organizations listed here, many other organizations, projects, and studies are looking to address inequity in mental health care. For a list of local groups providing mental health services, check out the Denver Foundation, which made a list of minority mental health resources for the Denver area.
Spanish-speaking clinician at Birch
PSYPACT clinicians at Birch
Citations
Mongelli, F., Georgakopoulos, P., & Pato, M. T. (2020). Challenges and Opportunities to Meet the Mental Health Needs of Underserved and Disenfranchised Populations in the United States. Focus (American Psychiatric Publishing), 18(1), 16–24. https://doi.org/10.1176/appi.focus.20190028
Spanish for Counseling and Human Services Certificate | World Languages and Culture. (2018). Tcnj.edu. https://wlc.tcnj.edu/programs/certificates-spanish-for-the-professions__trashed/spanish-for-counseling-and-human-services/
