Verified by 
Key points
- Suicide was the second leading cause of death for Black or African Americans, ages 15 to 24, in 2019
- In 2019, suicide was the leading cause of death for Native Hawaiians/Pacific Islanders ages 15-24
- One in six gay men have made one suicide attempt in their lifetime.
- LGBTQ+ individuals are more than twice as likely as heterosexual men and women to have a mental health disorder in their lifetime.
In 2008, the U.S. House of Representatives designated July as "Bebe Moore Campbell National Minority Mental Health Awareness Month," in order to “enhance public awareness of mental illness and mental illness among minorities.” A devoted mental health education advocate, co-founder of the National Alliance on Mental Illness (NAMI) Urban Los Angeles, author, and spokesperson, Ms. Campbell died of cancer in 2006.
There has always been stigma associated with mental illness, and especially so in minority communities in the U.S. and some of those same communities abroad. Yet the statistics paint a picture of great need for prevention and treatment among all minority sectors in our country:
- Suicide was the second leading cause of death for Black or African Americans, ages 15 to 24, in 2019.
- In 2018, Asian Americans were 60 percent less likely and Hispanic Americans 50 percent less likely to have received mental health treatment as compared to non-Hispanic whites.
- In 2019, suicide was the second leading cause of death for American Indian/Alaska Natives ages 10 to 34, and the leading cause of death for Native Hawaiians/Pacific Islanders ages 15-24.
- One in six gay men has made one suicide attempt in their lifetime.
- LGBTQ+ individuals are more than twice as likely as heterosexual men and women to have a mental health disorder in their lifetime.
- Almost one-third of Muslim Americans perceived discrimination in healthcare settings.
Since this data was recorded prior to the COVID-19 pandemic, mental health risks and the difficulty of accessing services have grown even greater for all these groups. Before we explore some of the efforts to address minority mental health locally and globally, we must look at the factors that have resulted in education and treatment inequities among minority populations.
What Leads to These Disparities?
According to the American Psychiatric Association, more than 50 percent of all Americans will be part of a minority group (one other than non-Hispanic White) by 2044. While the total incidence of mental illness among these groups may be similar to that among non-Hispanic Whites, the mental health outcomes of racial/ethnic, gender, and sexual minorities are often much worse. What circumstances lead to these consequences?
- Inaccessibility to high-quality mental health care services
- Cultural taboos regarding mental health care
- Discrimination
- Lack of education and knowledge surrounding mental health
Racial and ethnic minorities often have additional hurdles to overcome as well, such as lack of insurance or underinsurance, inadequate diversity and cultural competence among healthcare providers, language barriers, and healthcare system distrust.
“What Happens in This House, Stays in This House”
According to licensed clinical mental health counselor Rwenshaun Miller, that was the mantra in his home and community as he grew up. In some communities of color, people are uncomfortable acknowledging or discussing any mental health issues, let alone asking for help to improve and preserve their mental health. There is often too much shame associated with a lack of strength, including mental fortitude, so many people live in denial.
Due to internalized stress caused by housing, employment, education, transportation, incarceration, physical health, and safety factors, members of minority communities often develop substance use disorders (SUDs). It has been shown that having a mental illness can cause individuals to become prone to a SUD—and conversely, people with SUDs are at greater risk for mental health challenges. Unfortunately, the majority of these are young people whose brains are still developing, and they may lack support both at home and in their communities for their SUDs and/or their mental health issues.
In our work around the globe, we see that many other countries, both wealthy and not, have an even poorer record of mental illness among communities of color. Even in highly developed countries like the United Kingdom, men from minority ethnic groups and women report worse mental health declines than White British men as a result of the COVID-19 lockdown. Although psychiatric hospitals began in the Middle East in the first century, today mental health services in many Middle Eastern countries operate below-accepted standards. Despite education efforts to address and erase taboos, the sustained stigma surrounding mental illness plays a fundamental role in the culture of many lands, and is not easy to change.
Investment, Education, and Persistent Commitment to Change
Overall, we need to be better at recognizing when someone is facing a mental health challenge, then addressing it from all perspectives: as an individual, family member or friend, community, government, institution, and society. We must look at the entire spectrum of services and determine if we have the right assistance to offer them—or develop it if we do not.
The U.S. Department of Health and Human Services (HHS) created the Office of Minority Health (OMH) 35 years ago, to spread and sustain health equity. Besides those goals, OMH has two current priorities: increasing the use of community health workers and working with healthcare providers to expand their cultural competence in patients’ beliefs, languages, interpersonal styles, and behaviors. Among its funding opportunities, OMH offers grants for projects aimed at reducing health disparities and improving services. It is also working with local governments to increase health literacy, so individuals from minority communities better understand symptoms they experience and how to seek and use the correct services.
My colleagues and I have been fortunate to consult with OMH to improve areas including peer-to-peer health services. We have also supported minority mental health in other ways such as addressing how police interact with individuals living with serious mental illness; investigating suicide trends in the American Indian population; providing service delivery training for state opioid treatment facilities; and assisting healthcare professionals in offering tools to adolescents to help them avoid alcohol, tobacco, and drugs. Gratefully, much of our support for government agencies here helps to drive best practices for providers and patients in other countries.
Mental disorder treatment for minorities is most successful when a connection is made to treatment providers within the community. But what if the local providers do not feel comfortable treating patients for mental illness? We need to find that expertise and compassion and make it locally available. Rwenshaun Miller is showing the success of making a connection with Black American men in his community, by breaking down taboos with his “Let’s Talk About It” walks and Injured Reserve book.
Many experts argue that expanding Medicaid coverage is also an important step towards meeting minority mental health challenges. It would allow many more people of color to access mental health and SUD care, which many of them need but are unable to afford.
To be effective, mental health care must address every aspect of an individual and what she or he needs to recover and flourish. This month, let us rededicate ourselves to this model for all minority groups, as a further commitment towards achieving healthcare parity in our country and around the world.
References
