Social, Economic Health Inequities Drive Mental Health Disparities Among Marginalized Groups

Dr. Dayna LePlatte

| 4 min read

Dr. Dayna LePlatte is a medical director in utilization management at Blue Cross Blue Shield of Michigan.

Mental illness affects people of all ages, genders, races and backgrounds. However, there are significant disparities and inequities in access to mental health care and the quality of treatment – which are driven by multiple social and economic factors.
These factors – called the social determinants of health – are the environments where people are born, live, learn, work, play and age that affect a wide range of health, function and quality-of-life outcomes and risks. Factors including economic stability, neighborhoods and physical environments, education, food security, community safety and health care literacy, coverage and access all play a role in a person’s lifelong mental and physical health.

Racism and discrimination affecting marginalized groups

Social determinants of health can be affected by racial prejudices, discrimination, and social injustices. This disproportionally impacts members of the African American/Black, Native American and Hispanic and Latino communities in Michigan; as well as rural community members, persons with disabilities and members of the LGBTQ+ community.

The result: disparities in the ability of individuals to access quality, affordable mental health care at the right place and right time. For example:
  • Approximately one in 10 Hispanic Americans with a mental health disorder use mental health services from a general health care provider, while only one in 20 receive these services from a mental health specialist.
  • When compared to the white population, African Americans are less likely to receive evidence-based care and are more likely to visit emergency rooms or primary care doctors instead of receiving help from mental health specialists.
Some of the barriers communities of color and other marginalized patients face when they are seeking mental health care can include:
  • Health care coverage and costs: Studies show African Americans, Hispanics and some Asian populations have lower levels of health coverage compared to white counterparts.
  • Language: Communication is a critical part of any doctor-patient relationship. When a language or cultural barrier exists, it can be difficult to build trust with a care provider and/or discuss personal health information.
  • Mistrust: The relationship between marginalized communities and health care providers is strained. In the past, members of marginalized communities have been mistreated, misinformed and in some cases denied basic medical services. This has led to a longstanding concern regarding physicians’ intent and capabilities.
  • Stigma: In some cultures and racial groups, acknowledging mental illness is considered a sign of weakness or cause for shame. Some fear it will impact how others view them, or believe it will lead to being treated differently at work, at home or among their peers.
  • Discrimination: We have decades of research showing that when people are chronically treated differently or unfairly, it can have a range of effects. It can lead to low self-esteem and there is a higher risk for developing stress-related disorders like anxiety and depression.

Strategies to overcome barriers

Barriers to mental health care look different for everyone. Overall, there are some strategies that can help move the needle specifically for people that belong to communities of color and other marginalized groups:
Addressing mental health in the primary care setting: By adding mental health care into the primary care practice, providers are better able to identify the need for mental health care during regular check-ups and can address preventive steps.
Expanding the network: Health care coverage must be inclusive of doctors, hospitals and clinics serving marginalized groups.
  • Increasing affordability: Quality, affordable care is necessary to those with limited resources.
  • Promoting diversity: Understanding different cultures, traditions and religious beliefs is an important step to build trust within communities of color and other marginalized groups. It’s also imperative to employ a diverse staff representative of multiple ethnic groups and language capabilities. We must also take the time to understand bias and be able to discern when bias is present.
  • Raising awareness: A key way to combat mental health stigma is through education and professional guidance.
  • Focusing on policies: It is important to reflect on federal, local, and even individual clinic policies that may unintentionally promote exclusion and not inclusion. Also, making sure policies aim to address social determinants of health in small ways and big ways.

Finding free or low-cost mental health care

Quality, affordable care is available to those with limited resources. Individuals without insurance can access free or low-cost mental health services through the following:
  • Community mental health: Michigan Department of Health and Human Services oversees community-based programs located in counties throughout the state.
  • Federally Qualified Health Centers: These facilities provide health care for people with mild to moderate mental illness.
  • Free or low-cost care locations: This Help with Care directory lists local free or low-cost facilities that provide dental and behavioral services. It’s a regional directory that can be downloaded or ordered by mail, at no charge.
  • Safety net clinics: Many statewide clinics connected to non-profits, community organizations and faith groups can offer mental health services or patient referrals.
 For more information on health insurance in Michigan, visit https://mi211.org/. A person can also call 844-875-9211, dial 211 or text their zip code to 898211.
Dayna LePlatte, M.D., is a medical director of utilization management at Blue Cross Blue Shield of Michigan.

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