
How Would You Tackle Mental Health Disparities?
Targeted and collaborative efforts are needed at individual and systemic levels to address underlying causes of mental health disparities.
The definition of mental health disparity varies depending on the focus and purpose of different agencies. Essentially, mental health disparities refer to gaps in the health status, health outcome, quality of treatment, or access to care among various populations.
The National Institute of Mental Health (NIMH) defines significant disparity in the overall rate of mental illness incidence or prevalence, morbidity, mortality, or survival rates in a health disparity population as compared with the health status of the general population. NIMH defines health disparity populations to include: American Indians/Alaska Natives, Asian Americans, Blacks/African Americans, Hispanics/Latinos, Native Hawaiians and other Pacific Islanders, sexual and gender minorities, socioeconomically disadvantaged populations, and underserved rural populations.1 Alternatively, the National Conference of State Legislatures refer to behavioral health disparities in terms of differences in outcomes and access to services related to mental health and substance use, which are experienced by groups based on their social, ethnic, and economic status.2
Factors That Influence Mental Health Disparities
The field of medicine and public health are increasingly recognizing how external factors can impact individuals’ health, and not solely attributing mental health disorders to the fault of the individual. Social determinants of health, or those “conditions in which people are born, grow, live, work, and age, which are shaped by the distribution of money, power, and resources” are underlying drivers that exacerbate gaps in health status and care access.Underlying social and economic inequalities such as economic instability, neighborhood environment, food security, educational-level, and structural racism/discrimination systemically impact health. These factors serve as important framework to consider when planning health interventions.3
For mental health specifically,
Promoting Equity
Mental health parity laws try to ensure that mental health conditions and
How to Address Mental Health Disparities
Focused, targeted efforts are needed at personal, community, and national levels to address
Following are some ideas for creating personal and systematic changes to promote health equity.
Individual-Level Changes
-Assess patients’ cultural beliefs, attitudes, and stigma related to mental health in clinical interactions.
-Provide culturally appropriate interventions such as suicide hotlines targeted for specific populations (such as for the
-Advocate for changes in your health care organization—eg, ask for support staff to help with prior authorizations, promote availability of addiction services, advocate for appropriate interpreters and staff members, and create workgroups to examine data on health disparities, outcomes, and access.
-Understand your own potential biases. You can take free 5-minute Implicit Association Test that may reveal certain implicit biases at
Systemic-Level Changes
-Addressing mental health disparities through research: Although it is important to examine the incidence or prevalence of disease burden among various populations (such as how many individuals are impacted by serious mental illness or suicide attempts), research efforts must also move beyond incidence or prevalence data. Further research should acknowledge the underlying structural and cultural factors that contribute to mental health disparities and seek for ways to address them.
NIMH encourages researchers to examine underlying causes of mental health disparities as well as to explore ways to test novel approaches to reduce disparities.12 Interventions that address
-Alliance building: Partnerships are needed between mental health providers, physicians, educators, community leaders, and government agencies to create targeted, effective interventions. Such efforts may focus on destigmatizing mental health, improving insurance coverage access, providing culturally and linguistically appropriate mental health services, or addressing other barriers to care. Promoting connectedness among members of a community, building alliances with local communities, and improving culturally appropriate access to care can help reduce some factors that contribute to disparity. For example, the Centers for Disease Control and Prevention (CDC) works with local partners/states to reduce suicide disparities: They teach community members how to identify and refer individuals at risk of suicide, work on reducing access to lethal means by promoting
-Policy advocacy: Get involved with local or national mental health policy advocacy organizations,15 contact your local representative or Congress person, and stay informed.
Concluding Thoughts
Although the general media and research narrative focus on disparities, much attention should also be paid to emphasize each groups’ strengths and resiliencies and current efforts to promote equity. Carefully considered, targeted, and collaborative efforts are needed at individual and systemic levels to address underlying causes of mental health disparities. Only when we commit to creating individual changes will we be able to create changes at a larger scale together.
Dr He is a practicing adult psychiatrist with special interests in health disparities and public health. She completed her residency training at George Washington University Hospital and received her Master of Public Health from Yale School of Public Health.
References
1. Overview. National Institute on Minority Health and Health Disparities. Updated May 5, 2021. Accessed June 29, 2022.
2. Behavioral health disparities. National Conference of State Legislatures. December 20, 2017. Accessed June 29, 2022.
3. Ndugga N, Artiga S. Disparities in health and health care: 5 key questions and answers. KFF. May 11, 2021. Accessed June 29, 2022.
4. Mental health disparities: diverse populations. American Psychiatric Association. Accessed June 29, 2022.
5. Barksdale C, Pérez-Stable E, Gordon J.
6. McGuire TG, Miranda J.
7. Behavioral health equity data. Substance Abuse and Mental Health Services Administration. Accessed June 29, 2022.
8. Yang K, Rodgers C, Lee E, Lê Cook B.
9. FitzGerald C, Hurst S.
10. The Mental Health Parity and Addiction Equity Act (MHPAEA). Centers for Medicare & Medicaid Services. Accessed June 29, 2022.
11. What is mental health parity? National Alliance on Mental Illness. Accessed June 29, 2022.
12. NIMH’s approach to mental health disparities research. National Institute of Mental Health. Accessed June 29, 2022.
13. Alegría M, Zhen-Duan J, O’Malley I, DiMarzio K.
14. Disparities in suicide. Center for Disease Control and Prevention. Accessed June 29, 2022.
15. Mental health policy and advocacy organizations. National Center on Domestic Violence, Trauma & Mental Health. Accessed June 29, 2022.
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