As we observe National Minority Mental Health Awareness Month we sat down with Dr. Diane Felder, Medical Director, Magellan Healthcare of Texas.
Magellan Health Insights: Dr. Felder, thank you for speaking with us today. Of course, everyone’s mental health is critical, but why is it important to pay particular attention to minority mental health?
Dr. Diane Felder: We know mental illness can often be successfully treated. However, minorities are significantly less likely to receive treatment for mental health conditions, including substance abuse. And it’s reaching crisis levels, especially among our young people. For example, suicide is now the third leading cause of death among African American males who are 15-24 years old.
Magellan Health Insights: What are the barriers to minorities receiving high quality mental health treatment?
Dr. Diane Felder- Members of minorities are less likely to seek treatment, both for their physical and mental health. However, when minorities do reach out for assistance, they are less likely to receive consistent, high-quality treatment.
There are many contributing factors to these barriers. The high costs of care can be a deterrent. Most minority groups in the U.S. (with the exception of Asians) have higher than average rates of poverty. Members of minorities are more likely to lack insurance coverage, and may only seek emergency care, which costs more and is less effective than sustained treatment. Medications or diagnostic procedures may be viewed as too expensive. Or, reliable transportation for follow up care may not be available.
There are also what are called the social determinants of health (SDOH) These include factors such as consistent transportation, the availability of healthy food and safe and affordable housing, access to education, public safety and environmentally safe living and working conditions. Minority populations are more frequently negatively impacted by the SDoH. For example, these members are more likely to be homeless or move frequently, which interferes with maintaining consistent treatment. They may lack adequate nutrition and are at greater risk for having associated medical conditions like hypertension or diabetes.
Further, the stigma around mental illness, while improving, is still a deterrent to seeking treatment – for everyone. Some cultures may see it as taboo to request help or to be seen as someone who needs help.
When minority patients do seek treatment, there may be no one available who speaks their language. In some clinical settings I’ve been in, it might take a week to arrange for an interpreter or a therapist who was proficient in the patient’s language. They may not have a primary care physician to help with screening for mental health conditions or provide follow-up care. In addition, the community clinics where minority members are more likely to receive care may be understaffed, overcrowded and have long wait times. Understaffing may lead to inadequate screening or even misdiagnosis. And, frankly, the clinic also may not be in a place where the member feels safe traveling so they may hesitate to go in the first place or return for continued treatment.
Magellan Health Insights: How can everyone, including healthcare professionals, best support minority mental health?
Dr. Diane Felder: Everyone can help eliminate stigma. Be open to talking and hearing about mental illness, and make it clear that you know that having a mental disorder is nothing to be ashamed of. When someone you care about is going through a difficult time, encourage them to get help, and learn ways you can support someone who coping with a mental illness.
As healthcare providers, we personally can help by:
- Ensuring we are taking into account each person’s wishes when referring them to other providers: We should ask every patient whether they prefer to see someone of a specific race, ethnicity, gender or sexual orientation.
- Educating ourselves to be more culturally competent and making cultural training a priority for our staff: For example, the U.S. Department of Health & Human Services recently launched a free online course for behavioral health professionals.
- Expanding our workforces with staff from various backgrounds, sexual orientations, cultures and with varied linguistic skills particularly for the unique cultures that are most prevalent in the community.
- Screening for psychiatric conditions during routine visits: Many patients will report physical symptoms instead of talking about the underlying behavioral health concerns. PCPs and others see many cases of mild or moderate depression during routine care, and screening every patient can help prevent costly emergency visits and admissions. Digital screening tools can also help.
Beyond what we can personally do to educate and equip ourselves and our staff, I believe that the best solutions come from an integrated, collaborative approach. Everyone can help eliminate the disparities. If we work with leaders in the community, like leaders in community services, churches and schools, we can raise awareness of mental health conditions, destigmatize seeking treatment, help address the social determinants and improve the lives of everyone in our communities.