Are We Closing the Mental Health Treatment Gap?

Mental health’s star is rising in the healthcare world. After two years of an ongoing pandemic, the need for quality psychological support has become a widely discussed topic. This unprecedented interest in the workings of the wounded psyche comes as no surprise.

We have globally experienced 5.5 million COVID-19-related deaths since March 2020, a civic uprising prompted by the disproportionate deaths of Black Americans related to police violence and a wrought socio-political divide due to current public health measures. Homelessness is continually increasing and we’re facing a mass housing crisis.

Multiple professional organizations, including the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children's Hospital Association have declared a national emergency in children's mental health.

At this point, it is safe to say that most of us could use a therapy session.

How Can We Understand the Treatment Gap?

While the acknowledgment of mental wellness feels long overdue in many ways, it isn’t without its issues. There are barriers to care for all, especially for those with marginalized identities. Working within the framework of intersectionality, a term coined by academic and legal scholar Kimberlé Crenshaw, we can assume that each individual is subject to a unique equation of privilege and oppression due to their layered identity.

However, when we think about mental health disparities, it is an issue that spreads beyond the individual level. Verywell Mind turned to critical race theory scholar and social work programming consultant, Nicole Vazquez, MSW, to understand the mental health treatment gap better.

“Intersectionality is the intersecting levels of oppression at the systemic and institutional levels. When Crenshaw first wrote about it, it was a response to a Black woman who was a survivor of domestic violence… making the case that she was having a more difficult time interacting with the [mental health] system not only because she was a woman, but because she was Black,” Vazquez explains.

The Stark Reality

The disparity in access to treatment for folks of color has been well-documented in recent years. A 2021 study from the Journal of the American Academy of Child and Adolescent Psychiatry finds both Black and Latinx disparities in access to treatment and medication amongst youth aged 5 to 17. In fact, between 2010 and 2017, the rate of mental health care use amongst Black youth decreased from 9% to 8% while both White and Latinx youth increased their mental health care use by 2% each.

Research reveals that pediatric emergency room visits for mental health-related incidents have increased overall in the past five years, with Black and Latinx youth being disproportionately affected. This reflects a lack of primary care access and mental health care for these communities.

The treatment gap lies beyond the Black-White binary and wades into the intersectional territory. The AIDS Patient Care and STDs journal published a study in 2021 that centered on mental health service utilization amongst Black LGBTQ+ men who are HIV+. In a Ryan White-funded clinic where mental health and HIV care were co-located, only 19.6% of Black LGBTQ+ HIV+ men engaged in mental health care, despite experiencing identified mental health concerns.

COVID-19’s Impact on People of Color

According to the CDC, Native Americans were 3.3x and Black Americans were 2.6x more likely to be hospitalized than their White counterparts. Additionally, Black women are more likely to succumb to COVID-19 due to a lack of access to healthcare. BIPOC individuals are less likely to have access to potentially life-saving medication for COVID-19.

As a Black clinician myself, I have seen unprecedented demand for BIPOC mental health care. The majority of my clinical practice is BIPOC individuals and I’ve held a waitlist rather consistently since December 2020. I don’t take this to be a mere testament to my clinical skills–rather, I feel it speaks to the immense need.

Recent estimates state that only 4% of the psychology workforce identifies as Black, 4% identifies as Asian, and 6% identifies as Latinx while the rest of the field is 84% White. This, coupled with the preference amongst many folks of color to receive therapy from someone they can identify with culturally, translates into a high need for diverse providers in a hardly diverse field.

Similar trends exist across the spectrum of mental health clinicians—including psychiatrists, social workers, licensed mental health counselors (LMHC)—in that a majority of practitioners are White, and there is a need for an increase in BIPOC.

With these studies in mind, the current whisperings about the importance of mental health can suddenly seem marginal in comparison to the glaring need. Why does the gap exist in the first place?

Where Did This All Begin?

There are many points throughout history one can examine and use to trace inequality in mental health treatment all the way to today.

Inequality in Treatment Facilities

Mab Segret, anti-racist scholar, reflects on the "racist trajectory" that psychiatry took after the Civil War. As part of their treatment, mental health facilities had patients perform chores within the institutions, although Black patients performed more laborious work tasks than White patients. Psychiatrists during this time maintained that emancipation harmed Black patients' mental health, and accounts of physical violence Black patients experienced went unaccounted for.

Segret examines how, in the 1980s, when penal institutions took the place of many mental health facilities, people of color and people with mental illness became "disproportionately incarcerated." Mass incarceration of people of color remains a huge point of inequality today.

Racist and Homophobic Ideologies

Dr. Benjamin Rush, who is considered the father of American psychiatry, was the first to study mental illness systematically and is credited as having written the first systematic textbook on mental illnesses in America. Although he was known for being an abolitionist, he unfortunately was not exempt from racist ideas and beliefs. He promoted the concept that dark skin is akin to leprosy and the cure is to turn white.

In addition, one of the earliest mental health diagnoses created in the United States pathologized Black folks who dared to believe liberation was possible. Dr. Samuel Cartwright, a pro-slavery Antebellum South physician, developed the diagnosis of drapetomania in 1851. This diagnosis was given to enslaved Black individuals who fled plantations to pursue freedom. Due to our nation's history of medical racism, distrust of health care developed as a protective factor amongst folks of color.

Drapetomania isn’t the only discriminatory diagnosis staining our history of mental health care. It wasn’t until 1973 that the American Psychiatric Association removed homosexuality as a diagnosis from the Diagnostic and Statistical Manual (DSM). As we delve deeper into the context of the mental health treatment gap, it isn’t surprising that marginalized groups may opt to avoid therapy.

Intergenerational Trauma

Beyond discriminatory diagnoses comes the impact of intergenerational trauma. Intergenerational trauma is a chronic trauma response derived from an adverse event, or series of events, affecting multiple generations. While modern mental health professionals have evolved in their understanding of cultural competency, the mental health treatment gap was developed through a series of marked events mirroring the hardship marginalized folks have faced throughout our country’s history.

Culturally competent therapy means providing mental health treatment that doesn't further oppress an individual based on race, gender, sexual orientation, physical ability, socioeconomic status, language, or education.

Change Is Rising

Freedom fighters are everywhere and they are especially present amongst mental health practitioners. Socorro ‘Soco’ Reynoso, LCSW, psychotherapist and owner of South Los Angeles-based therapy practice Soco Rey Therapy, happens to be one of them.

After a stint in social services, Soco realized that the people in need who looked like her were not seeking mental health care. Being a person of Black and Mexican heritage, she knew it was due to current mental health care offerings being unrelatable, an issue we can presume is linked to the industry’s pathologizing past.

In 2018, Soco Rey Therapy was born with the simple tagline, “Therapy that’s chill AF.” Showing up in her full personhood only proved the need was begging to be fulfilled. Within two years, she hired six associate therapists, all of whom identify as people of color, and her business quadrupled in growth.

The rise of BIPOC-based therapist directories has also helped increase access to care for folks of color. Therapy for Black Girls, Therapy for Black Men, National Queer and Trans Therapists of Color Network, and Latinx Therapists are just a few places folks can find a provider they feel safe expressing their full identity with. Yet, finding a therapist is only half the struggle–affording care is another leg of the journey.

The Loveland Foundation, an organization focused on making healing accessible to Black girls and women, created a program that funds anywhere from four to 12 therapy sessions for Black women. These therapy vouchers are community-funded and are available every quarter. Covering up to $120 of the session cost, the client submits a voucher in place of therapy payment and the Loveland Foundation then directly reimburses the provider.

The Queer and Trans Therapists of Color Network Mental Health Fund follows a similar model. If you are a queer or trans person of color based in the United States and are experiencing financial hardship, you can qualify to receive up to six therapy vouchers, each valued at $100.

Some therapists have opted to turn towards community-funded mental healthcare to expand their accessibility.

“After George Floyd died, I posted a post that said, ‘If you’re interested in helping people in the Black community heal from what is going on right now, here is the Venmo and here is the Cash App,’” Rey explained.

Due to the increased conversation regarding the need for diverse and accessible healthcare, many are willing to crowdsource funds for healing services.

“In 24 hours, we got $16,000,” Rey concluded.

Embodying the Shift

We have our work cut out for us if we want to close the mental health treatment gap for good. If you are fortunate enough to have financial stability during these times, please consider giving to The Loveland Foundation or the Queer and Trans Therapists of Color Network. Reach out to a BIPOC therapist in your area and ask if you can donate funds to sponsor sessions. If funds are limited, give your time. Crisis hotlines are constantly seeking volunteers–The Trevor Project, Didi Hirsch, and The National Sexual Assault Hotline are good places to start.

Collective power is greater than individual effort. Becoming involved in your local government through voting, canvassing, and volunteering are also ways to become an advocate for the shift in mental health treatment. However, personal reflection and education must come first.

She suggests that political awareness is null without personal introspection.

“Everyone needs to take stock and ask ourselves how we are contributing to this system,” she concluded.

Reimagining Mental Healthcare

Mental health care is only one part of the healing needed in BIPOC communities. In a pre-colonial world, many of us lived in cultures that thrived in communities, some of which even relied on communal wellness as a cornerstone of health.

Beyond closing the mental health treatment gap is a world of healing that research has hardly begun to conceptualize, one where we recognize that individual healing will be stunted until structural shifts in how we treat one another occur, a space where the mind-body connection moves beyond healing trauma and into embodied living that is in alignment with the natural world.

Rey shares this vision for mental health care focused on halting the impact of systemic racism and moving towards a more holistic lifestyle.

Yet, she isn’t defeated by the limitations of what therapy can provide:

“I created Soco Social, a club for people who are on a healing journey… for people who share a similar vision to be in community and support one another as we trek towards that.”

A Word From Verywell

Change can be slow and arduous, our current state of nationwide mental health disheartening. We implore you to see this as an invitation rather than a seemingly unending fight–an invitation to give more than you get, lean in and listen when it feels uncomfortable, and hold the vision of collective mental wellness for all. It is closer than we think.