Racial health disparities impact mental healthcare access

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America has a mental health crisis, and new data shows it doesn’t affect everyone equally. According to new survey data from KFF and CNN, there are steep racial health disparities in the mental health crisis, particularly in terms of who can access treatment.

All said, only 39% and 36% of Black and Hispanic people in poor or fair mental health said they’ve gotten the treatment they needed in the past three years. By comparison, 50% of white people reported the same, the survey of 6,000 adults showed.

These findings follow a string of evidence indicating a mental health and mental healthcare access problem in the U.S. Since the start of the COVID-19 pandemic, the number of mental health diagnoses has increased. According to the CDC, 12.5% of adults ages 18 and older had regular feelings of worry, nervousness or anxiety in 2022; 5% had regular feelings of depression.

The number of physician office visits with mental disorders as the primary diagnosis tops 57 million, while 5.8 million emergency department visits were attributed to mental disorders, behavioral and neurodevelopmental diagnoses in 2021, the agency says.

But the treatment options aren’t meeting this need, the KFF data, collected in 2023, said. That problem is worse for populations of color.

Of all survey participants reporting fair or poor mental health, 45% said they could access treatment within the past three years. But the rate of mental healthcare access for Black and Hispanic people is lower than the general population and certainly lower than for white populations.

There are also mental healthcare access disparities among U.S.-born and foreign-born individuals (48% versus 26%) and insured and uninsured people (48% and 27%).

The survey also dug into patients who did not receive the needed mental healthcare.

Of the total study population, about one in five adults said they didn’t receive the mental health services that they needed; this figure was 48% among individuals reporting fair or poor mental health. This shook out to 53% of white folks with fair or poor mental health, 39% of Hispanic respondents and 47% of Black respondents. These findings run contrary to the rest of the report’s data, but the researchers did not dig into why.

The factors affecting mental healthcare access are varied, the survey showed.

“Common barriers to accessing mental health care include costs, not knowing where to obtain care, limited provider options, and limited acceptance of insurance among providers,” the KFF researchers wrote.

The survey showed that around half (48%) of those who needed mental healthcare but could not access it at least tried to meet with a provider. However, 44% said it was hard to find a clinician who could treat them in a timely manner, while 41% reported affordability challenges and 35% said they couldn’t find someone who accepted their insurance.

For 41% of patients, it was hard to find a provider who they believed could relate to and understand their background and experiences. This was more common for Asian (55%) and Black adults (46%) than white adults (38%).

The dearth of perceived cultural competence and a lack of racially concordant provider options are only the tip of the iceberg. The KFF data also showed that past experiences of discrimination in healthcare have also impacted access to mental healthcare, especially for populations of color.

Previous data has shown that Black, Hispanic, American Indian/Alaska Native (AI/AN) and Asian people report healthcare discrimination at higher rates. This latest KFF survey showed that those prior experiences can deter them from accessing mental healthcare.

Four in 10 people who reported being treated unfairly in healthcare settings said they went without necessary mental healthcare. By comparison, only 18% of those without past experiences of discrimination reported similar care access barriers.

This difference persists when looking only at individuals with fair or poor mental health.

These findings about mental healthcare access are unsurprising and underscore widespread calls to overhaul mental healthcare in America. Some experts have suggested better mental health integration in the primary care setting, indicating that telehealth can connect primary care providers with mental health specialists to fill in knowledge gaps.

Mental health parity, better scheduling options, strategies to bolster the mental healthcare workforce and community-based interventions to better serve traditionally underserved groups could also be effective.

In addition to limited access to mental health providers, the KFF survey showed limited access to and awareness of emergency stopgaps, like the 988 mental health hotline, which was set up to intervene during mental health crises.

Only 18% of all patients knew that the 988 mental health hotline was set up, but awareness spread unevenly across racial/ethnic groups. One in five white adults knows about the hotline, compared to 11% of Hispanic people, 16% of Black people, 13% of Asian people and 15% of AI/AN people.

Awareness is also more common among U.S.-born people and individuals who speak English very well, although awareness among those groups is still subpar.

Since the 988 relaunch in July 2022, experts have called for better marketing of the hotline among all populations. Public health communication about the resource should be offered in other languages and be culturally relevant across races/ethnicities.

Sara Heath has been covering news related to patient engagement and health equity since 2015.

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