Mental Health Services And Mental Health Promotion In Diverse Communities

Diversity is a concept referring to the differences in humanity and certain social groups. This term is often used in reference to marginalized communities, who may face unique challenges compared to others in their communities. Mental health for marginalized and diverse populations can be complex, and these individuals may be at a higher risk of mental health challenges. Several resources are available for these individuals, and understanding current mental health statistics on diversity can be a step toward reducing stigma and encouraging support.

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Understanding mental health statistics 

Mental wellness and mental health problems are concerns facing a significant amount of American society. Statistics from the American Psychiatric Association indicate the following: 

• Almost one in five Americans meet diagnostic criteria for mental illness and mental disorders.
• 4% of adults have a serious mental illness that impacts their relationships and their ability to function day to day.
• Mental disorders are among the leading cause of disability and premature death in the United States, increasing since the opioid epidemic.
• Mental disorders, particularly trauma-related disorders, are comparable to cancer in terms of overall cost to society.
• Over 50% of people in the US receive mental health treatment. 

Diversity and mental health barriers 

For some individuals, a significant barrier to accessing mental health services is ongoing stigma and lack of understanding around mental health concerns. Stigma could lead people to delay or avoid reaching out to mental health professionals because of:

• Concerns about being treated differently 
• An internalized sense of shame, which can be compounded by the casual use of stigmatizing language around mental health (“crazy,” “psycho,” “mental health issues,” etc.)
• Beliefs that people are responsible for their own mental illness
• Structural stigma or societal systems that may limit opportunities for people with mental illness
• Beliefs that associate mental illness with weakness, a lack of self-control, incompetence, or character flaws
• Fear that being diagnosed with a mental illness could impact their employment
• Lack of understanding of symptoms of mental illness or believing physical symptoms of mental illness are caused by a physical ailment (can be a common experience with the fatigue, aches, and pains associated with depression
• Negative media representations of people with mental illness
• Fear of bringing shame to their family and loved ones, which can be especially relevant in some cultural traditions
• Beliefs that people with mental illness are dangerous and unpredictable

Accurate promotion of mental health awareness may dispel some of these outdated and disproven attitudes toward mental illness and help more people be comfortable accessing mental health facilities.

Different mental health promotion needs and strategies for diverse populations

A one-size-fits-all mental health promotion campaign may not be effective for targeting the American population, which is comprised of many diverse groups and communities. Even within specific communities themselves, mental health needs can vary widely, as members of racial and ethnic groups are not monoliths and what works for some may not work for all. Several specific mental health needs are more closely associated with certain population subgroups, and there are various strategies community-based mental health providers can adopt to meet these needs.

Black Americans

Although Black people experience mental illness at similar rates as the general U.S. population, they are much less likely to be connected to mental health systems and receive care. The care they do receive is usually of lower quality and it is more likely to involve inpatient or emergency services, which can be more costly. 

Other concerns related to mental healthcare for Black people include:

• Black people are less likely to be included in mental health research.
• Black people are more likely to be misdiagnosed.
• Black people are less likely to receive care from a mental health specialist and more likely to receive care from a primary care provider, who may not have specific mental health training.
• When Black people are connected to appropriate mental health care, they are more likely to be talked down to by their care provider.
• Black people may have a higher level of distrust toward the medical system as a whole due to either personal experiences with racism within the system or a sense of community distrust because of historically discriminatory practices (a lack of Black mental health providers can magnify this distrust).
• Black culture can sometimes emphasize family discretion, which may lead some Black people to avoid seeking mental healthcare out of a sense of shame.

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Promotion of mental health services to Black people may be most effective if incorporating Black cultural values, which can include community, kinship, family, and spirituality. Black community organizations and leaders may be valuable resources. Actively listening to Black people explain their mental health needs and avoiding Eurocentric attitudes can also help connect more Black people to care.

Native and Indigenous populations

Members of Native American tribes in the United States and Indigenous communities consistently demonstrate some of the most negative mental health outcomes out of all racial and ethnic groups. These outcomes include:

• Higher rates of substance use disorders, post-traumatic stress disorder (PTSD), and attachment disorders that may be linked to the historical trauma of the US government forcing tribes off of their land, separating children from parents, and sending them to boarding school settings where they were explicitly taught to reject their “inferior” culture
• Native American children have the highest depression rates as compared to children of other races.
• 10% of Native Americans have a substance use disorder, a rate three times higher than that of the general population.
• Over 20% of Native Americans report having a mental health condition.
• Native Americans have the lowest life expectancy of all racial groups, in part because of higher suicide rates.

Native Americans living on reservations may not have access to healthcare or telecommunication services and may be skeptical of health clinics run by the federal government, which historically have had ulterior motives when treating Native people. 

Focus on building trust and respecting indigenous traditions may promote mental health for Native Americans. Holistic approaches to healing that emphasize balancing the mind, body, and spirit and connecting to the land, the community, and one’s ancestors may also be effective.  

Asian Americans

Asian Americans tend to have higher levels of health insurance coverage, decreased poverty levels, and lower rates of mental health conditions than other ethnic groups, including White people. However, that does not mean this population does not require mental health services.

Asian Americans are the racial and ethnic group least likely to seek out mental healthcare. The “model minority” myth or the idea that Asian people are more successful than any other marginalized racial group in America could contribute to this myth, which can increase pressure to conceal any mental distress. The cultural traditions of some Asian populations can also perceive mental illness as a form of personal weakness. 

Recommendations for promoting mental health services to Asian Americans include:

• Making services available in multiple languages so they are more accessible to immigrant and refugee populations
• Integrating mental healthcare with traditional Eastern medical practices like acupuncture, yoga, tai chi, herbal medicine, and spiritual healing
• Understanding cultural expressions of mental distress, which for Asian people may manifest as somatic symptoms
• Involving family and community members in healthcare decisions
• Emphasizing the benefit of cognitive-behavioral therapy, which can be more compatible with Asian cultural values of education and self-improvement

Support options 

Mental health concerns can disproportionally impact marginalized communities, who may then also have more difficulty accessing mental health services. If you face barriers to in-person care, you may find online therapy through a platform like BetterHelp more accessible. 

Online therapy can be a way of bridging this accessibility gap. These platforms can often be accessed from anywhere with an internet connection and may be more affordable than other therapy options. In addition, research has indicated that outcomes for online therapy can be comparable to those of traditional in-person therapy. One study found that completing sessions of cognitive-behavioral therapy, one of the therapy modalities, often recommended for use in treating diverse communities, reduced mental health symptoms.