By Amanda Cruz and Violet Gabales
Black, Indigenous and People of Color (BIPOC) are less likely than their white counterparts to utilize mental health services despite experiencing mental illness at a similar rate to white individuals.
But why is this the case? It’s complicated. But not unsolvable.
Out of all Medi-Cal enrollees, only small percentages of BIPOC enrollees seek and receive treatment– 19.4% Black, 14.4% Latinx, 13.5% Native Hawaiian or Pacific Islander, and only 8.4% Asian.
These are a few common barriers that prevent BIPOC communities from seeking and accessing mental health services. While these barriers are shared, they can be experienced differently by members of these communities based on their race, ethnicity, gender identity or sexual orientation.
Racism and discrimination
The U.S. has a long history of systemic racism against BIPOC communities leading to experiences of discrimination within institutions, including in mental health services. For example, black men are often over-diagnosed or misdiagnosed with schizophrenia, and BIPOC youth with mental health disorders are often put into the criminal justice system instead of care institutions. These systemic experiences of racism often lead BIPOC to choose not to engage in these services.
Mistrust of health systems and treatment
Distrust in health care providers is common among BIPOC communities, especially among Black and Latino people. Repeated medical mistreatment and malpractice have led these two communities especially to have a general distrust in health care providers and are less likely to seek treatment for any health concerns.
Cultural practices and beliefs often lead BIPOC communities to under-utilize mental health resources. For example, in Indigenous communities, many seek health support from community leaders instead of medical sources. Religion can be another cultural influence on whether someone seeks mental health services.
Cost of services
High costs of services serve as another barrier to mental health care for BIPOC communities. Indigenous, Latino, Native Hawaiian and Pacific Islanders specifically are more likely to lack health care coverage, making them less likely to utilize mental health services. And despite efforts to make insurance coverage for mental health services equal, many health plans have limited affordable options for care, greatly impacting diverse low-income communities.
Lack of diversity and cultural competency
The lack of diversity within the behavioral health workforce leads to a lack of cultural and linguistic competence when caring for the psychological needs of BIPOC communities. For example, Latino communities make up 38% of California’s population, but only 23% of counselors, 24% of social workers, and a mere 11% of psychologists. African Americans make up 6% of the population in California, and only 2% of psychiatrists reported being African American.
BIPOC who seek care from a provider whose lack of cultural awareness led them to feel uncomfortable will often not return for more services.
It’s important to note that these barriers work together to generate mistrust and distrust, leading to more stigma and misconceptions. In addition to making mental health services more widely available, policymakers and providers must address these barriers to care by implementing solutions that are reflective of the wide array of BIPOC community needs including diversifying the workforce. When people can relate to their mental health professional, there’s a higher chance of meeting their needs, leading to greater patient satisfaction.
A few other solutions to consider include:
- Closing insurance access gaps through mental health parity
- Enabling trusted leaders like “promatores” or spiritual leaders to provide certain levels of mental health care
- Training mental health care providers on cultural competency so that they can better serve these communities
- Implementing cultural practices in community-led mental health programs
- Broadening the definition of “behavioral health workforce” and the levels of education needed to provide services in order to expand the workforce