Biden wants to correct racial inequalities. Access to mental health is an important starting point.
President Joe Biden has pledged to fight against the scourge of systemic racism that has plagued our country since its inception. To this end, he signed racial equity decrees during his first days in power and Wednesday night at a town hall on CNN reaffirmed his administration to this goal, in particular the need to change relations between communities of color and the police.
In this Black History Month, we call on the Biden administration to prioritize the mental health of Black and Brown communities by addressing their lack of access to such care.
But to fully address the impacts of racial inequality in our society – to keep the promise of these decrees and to truly fight against them. the structural racism he noted permeates criminal justice and other systems – access to culturally appropriate mental health and substance abuse treatment is necessary. In this Black History Month, we call on the Biden administration to prioritize the mental health of Black and Brown communities by addressing their lack of access to such care.
Right now in America the symptoms of depression are three times higher as they were before the pandemic, and from January, 41 percent of adults reported symptoms of anxiety and / or depressive disorder, up to four times higher than levels reported before the pandemic. But this burden is not shared equally. While prepandemic rates of substance use, depression, anxiety, and severe mental illness among black Americans are more or less similar to the general population, access to treatment is significantly lower for black Americans at all levels, especially during Covid-19.
Before the coronavirus, black Americans suffered mental health impacts born from intergenerational trauma, community violence, lack of culturally competent care and a higher probability of a misdiagnosis of schizophrenia. Confronted with a lack of access to medications and therapeutic supports leading to untreated mental illness, too often this has resulted in targeting and entanglement with law enforcement and the legal system, as opposed to involvement in the health and social system, thus perpetuating further cycles of trauma and violence.
Before the pandemic, an estimate 119 million people were already living in an area of shortage of mental health professionals – also known as the mental health desert – which means they have been unable to access mental health care due to the low number of mental health care providers in relation to the needs of the population. Most of those who live in mental health deserts are people of color and those in rural areas. For example, in the Bronx, one of New York’s neighborhoods hardest hit by the pandemic, 91% of residents insured by Medicaid living in a wasteland of sanity. The vast majority of them are black and brown and low income.
It is a portrait that is painted in communities of color across the country. The Health and Human Services Office of Minority Health finds that African Americans living below the poverty line are twice as likely to report psychological distress than those who exceed double the poverty line. Yet less than half of Black adults who need mental health care for serious conditions receive it.
But it’s not just the lack of providers that makes it difficult for black and brown Americans to access health care. They need to receive cultural skills and trauma-informed care. Phone care is made of skills and approaches to build patient engagement, empathy and trust. They can be learned, or originate or be enhanced by shared experiences and backgrounds. This trust and commitment is especially crucial in behavioral health relationships in order to communicate and connect with disordered thoughts, moods, or other behaviors that can affect a person’s day-to-day functioning.
According to American Psychological Association, about 86% of psychologists in the US workforce were white in 2018, and about 15% were from other racial and ethnic groups, compared to 62% versus 38% nationwide. This means that black and brown Americans often see mental health care providers who have not shared racial, ethnic, or cultural experiences, all of which can influence the quality and efficiency of the care they receive.
There are also other types of structural barriers. Black and brown communities are disproportionately to be uninsured or underinsured than their white counterparts. We must build on Biden’s recent decree protect and expand Medicaid and the Affordable Care Act ensuring the effective creation of a public health insurance option, including sustained engagement, education and awareness of communities of color, and we must chart a course towards universal coverage. This will have a significant impact on access to mental health care.
But extending insurance coverage is just the start. We also need to increase the mental health workforce, especially in known mental health deserts, by advancing a series of policy solutions who will not only encourage the next generation of graduates to embark on mental health by reducing their debt, but will also focus on expanding the existing community workforce by shifting to managed care and reimbursement models of care as a team.
We need to put in place measures to encourage more people of color to access health care, especially behavioral health professions like social work, psychology, addiction medicine and psychiatry. Expansion federal loan forgiveness programs and encouraging school admission criteria for health professionals who value life experiences, as well as standardized testing capability, would advance this goal.
Despite its record, Covid-19 could provide a silver lining. The technology has the potential to overcome localized labor shortages.
To achieve cultural competence, we must start by expanding cultural humility and racial justice training and workforce development programs for the existing health and mental health workforce. We also need to create a trauma-informed health workforce to deal with the short- and long-term health and mental health impacts of trauma caused by violence – especially police violence and oversight– which is endemic in low-income communities of color and is often associated with chronic social and economic stressors such as unaffordable housing, underfunded school systems and a lack of access to capital and economic opportunities.
Federal support should help health, social and public service workers – anyone who interacts directly with community members – to receive specific training in trauma-informed interactions, de-escalation and safety techniques, and empathetic communication. We also need to put in place workforce systems, such as human resources and workforce welfare, that emphasize employer engagement with trauma-informed skills.
Despite its record, Covid-19 could provide a silver lining. The technology has the potential to overcome localized labor shortages, and the temporary changes put in place during the pandemic have improved access to care through telehealth and tele-mental health care. Let’s make these temporary fixes permanent and also ensure that virtual and in-person services, as well as mental and physical health care, are reimbursed equally.
Mental health deserts are not only the result of lack of access to providers and health care, but also of community supports such as housing programs and holistic community mental health services like those provided by Fontaine House. We need massive expansion and investment in community models of recovery such as these to ensure that punishment and institutionalization – which disproportionately land on black and brown people living with mental illness– are not the default option.