Let’s Talk Equity: Racial Disparities in Mental Health Treatment

Written by Mustafaa Munir, a student of neuroscience

In the past several years, you most likely have encountered work against mental health stigma. And in the past several months, you also most likely have encountered work against systemic racism – on social media, in class, and blog posts like this. I’m here to tell you that unless these two things are thought of together – we’re ultimately never going to conquer either.

One may think that because underneath everyone’s skin we all have the same anatomy, how could there possibly be racism between my internal organs and my white neighbor’s? The unfortunate reality is that systemic racism already plagues the field of medicine without even looking at mental health. To start at the top, physician diversity is lacking amongst most minorities – comparing the U.S. Census Bureau’s 2019 estimates to the American Association of Medical Colleges’ 2018 data on physician diversity, Black Americans make up a little over 13% of the U.S. population but only 5% of active physicians. Those who are Hispanic or Latino makeup almost 19% of the U.S. population but only account for a little less than 6% of physicians. The notable exception are those who identify as Asian, who make up 6% of the population but 17% of physicians. Moving on to the patient level, the Center for Disease Control’s maternal mortality data shows a stark gap between white women and black women – black women are 2.5x more likely to die in childbirth than white women. Although the U.S. already ranks higher in maternal mortality than other developed nations, this racial gap here is accounted for by numerous factors that also apply to other specific issues of medical racism. Infrastructural disparities in predominantly minority communities such as specialized equipment or drugs are part to blame, but also the doctors, the healthcare professionals, and medical education as a whole. Numerous anecdotal stories have demonstrated that there are healthcare professionals that treat minority patients worse, notably, the pain of black women in childbirth isn’t taken as seriously compared to white women in childbirth. Finally, medical education and literature tends to heavily be biased towards the white population – for example, skin diseases are depicted on mainly white skin in books, and medical research literature isn’t inclusive in who they test.

And that’s not even accounting for disparities in mental health. Mental health as you know, isn’t visible. It isn’t one of those skin diseases you can find in a medical textbook and identify with a picture. It’s disparities are much, much worse.

To start at the top again, psychiatrist diversity is extremely lacking, it’s worse than general physician diversity. Almost 70% of psychiatrists identify as White, while only 56% of all physicians identify as White. The problem of such a low amount of minority psychiatrists is that now we encounter more of the mental health side of things. Many minority communities not only have more stigma against mental health than the general population, but also different stigmas. In all practicality, part of mental health deals with one’s relationship with society and their community, and since minority communities have different definitions of community – mental health simply is different in these communities. Any qualified internal surgeon could work on my intestines just as well as my white friend’s intestines, but not every psychiatrist or mental health professional would work with my mental health just as well as my white friend’s mental health. Both in the research literature and practicality can we really see this difference. Dr. Tanya Luhrmann is a professor of anthropology at Stanford who conducted a study on psychosis in the U.S., Ghana, and India, and her findings were simply amazing. The hallucinatory voices were just different in these vastly different cultural areas – those in the U.S. with psychosis tended to describe voices as harsh and violent, while those in Ghana and India tended to describe them as not-violent, and these individuals actually were less likely to view it as a “sign of a violated mind”. As stated before, medical research literature is far from being fully inclusive, so we simply just don’t know much about an entire subfield of “ethnopsychiatry”. As also stated before, there’s also just practicality in seeing that mental health is just different in different communities. I myself am a first-generation Pakistani American, meaning that my parents immigrated to this country before I was born, and I was born and raised here. A very common internal conflict that first-generation children like myself encounter is the conflict between two cultures – and to view this in practicality, only someone who has been through something similar could be the best mental health professional for me.

So what can we do? From what I have talked about so far, it’s safe to say one of the biggest things to do is to encourage diversity in both healthcare as a whole, but also within psychiatrists and other mental health professionals. However, one of the biggest obstacles in doing so are the stigmas that exist within individual minority communities. It’s my belief that because of respect and practicality, only those within these communities can tackle the stigmas for their own communities, I can do as much as I can for the Pakistani American community, but I shouldn’t and couldn’t do much for other communities. And obviously there’s still ways to help without crossing this line, and that’s via politics and other ways of fixing the systemic racism we have today.

Preventative healthcare aims to do exactly what it says, prevent diseases and conditions so they never arise in the first place. The prevention of heart disease, obesity, and other related conditions is mainly eating well and exercising. But what’s preventative mental healthcare? It’s when people don’t have to worry about healthcare, when they don’t have to worry about providing food for their families, when they don’t have to worry about rent or utilities, and much, much more. The current COVID-19 pandemic has revealed a swath of systemic racism – the disease itself ironically, is the symptom of the greater disease. Black Americans are dying more than White Americans because systemic issues in housing such as food deserts or denser living conditions, but also because systemic issues in the workforce due to Black Americans being more likely to work in the service industry, one category of “essential workers”, and also the tying of healthcare to employment. Additionally, more specifically to mental health, the War on Drugs that has caused a disproportionate amount of Black Americans and other minorities in the prison system is another aspect of society that needs to be addressed for preventative mental health. The prison system’s blatant systemic racism has caused for a greater societal criminalization of minority mental health, where the U.S. Department of Justice themselves published a study stating that Black Americans were 20% less likely to be identified with a mental illness in the criminal justice system than any other racial group, and also less likely to be provided with needed care during and post-incarceration.

Plainly put, preventative mental healthcare for minorities and anyone else is when you, the reader, supports initiatives that help these communities in attaining better conditions in healthcare and the workforce, initiatives that work against the current systemic racist state of the criminal justice system such as decriminalization of drugs, and much more. This blog post is coming after one of the biggest elections of our time, but there still is plenty, and I mean plenty, of work to be done locally, statewide, and nationwide.

In the past several minutes, you just encountered one post about the intersection of mental health stigma and systemic racism. I urge you to take away at least one thing from this post, and to share it with those you know – maybe then, we as a community can conquer both of these societal perils.

Sources Consulted (No Particular Order):

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