Awareness and integrated care are key to connecting people of color with mental health care
Nationwide, less than 20 percent of people of color who need mental health care will seek it out. It’s not just Black men and women, but also Latinx and Native Americans. Racial minorities often suffer from poor mental health due to multiple factors, including lack of awareness about mental health, and, as in Steve’s case, cultural stigma surrounding the issue.
Another layer of this cultural disconnect is a general lack of understanding about what mental illness is. Some people think that you see a therapist only if you are “crazy.” They don’t understand the difference between feeling down and being clinically depressed and don’t realize that their feelings stem from a disorder that can be diagnosed and treated.
Even when they manage to hurdle these barriers, people of color face further obstacles. Many don’t have insurance that covers mental health. Rentas says, "challenges that many patients do face when trying to connect with a psychiatrist are many, that including obtaining wrong numbers from their insurance provider, finding that practices are full and are not accepting new patients, or simply facing unanswered calls." This phenomenon is not unique to patients, but also a challenge for primary care physicians who cannot obtain outpatient mental health services for patients who need them. When they finally do connect, transportation can be a challenge. Telehealth is closing the distance in many of these cases, but many who are poor don’t have the technology or broadband for online appointments. And in the Latinx community, in particular, language barriers between them and the therapist or clinician can be a final thorn after they’ve come all this way.
Despite these myriad obstacles, Providence has made great strides in educating people of color about mental health and removing the stigma in these communities. They have also sought to improve care delivery by onboarding more people of color as practitioners and ensuring they provide care in the relevant locations.
This model has worked particularly well for Providence in Alaska, where Native Alaskans face many hindrances when it comes to mental health. There, the providers work in teams — a primary provider, a case manager, a support person, and a certified medical assistant — that are consistent throughout each customer’s experience. That builds the patient’s trust in the team.
“We’ve integrated behavioral health providers into the primary clinic,” says Melissa Shein, a family medicine specialist in Anchorage. “Behavioral health is just an extension of the team. This helps reduce the stigma by not making it some secretive thing. Rather, we normalize it. It’s just another part of our overall health, a natural part of the whole person’s wellness.”
Michelle Baker, senior director of the Behavioral Services Division at Southcentral Foundation Nuka System of Care in Anchorage, says they work to build on those relationships outside of the clinical setting by getting out into the community when possible. They attend school and civic events and invite speakers to talk about behavioral health and raise awareness.
“The greater relationship we have with them, the greater the trust,” says Baker. “Once trust is established, no matter if they are a young kid or a tribal member on St. Paul Island, they’ll open up.”
Providence also realizes that one of the keys to establishing trust is greeting these patients with staff, physicians, nurses, and clinicians who look and talk like them and share the same background. That’s why they are onboarding more people of color as practitioners to help bridge these cultural gaps.
If you or someone you know is in need of assistance with mental health concerns, please visit work2bewell.org/wellnessresources. Please know there’s always help available whenever you need to talk to someone. Reach out to the Crisis Text Line (Text TALK to 741741) or the National Suicide Prevention Lifeline at 1-800-273-TALK to talk to someone who can help.
In many cultures, there is a negative stereotype that if you have a mental illness, you are unpredictable, different, or weak.
When Steve* was a junior in high school, one of his best friends died by suicide. Steve struggled with the loss. He didn’t want to go to school, didn’t want to be around people. He didn’t even want to play football. He just wanted to sleep. He tried to put on a smile and pretend everything was okay, but it wasn’t.
Steve couldn’t talk to his classmates, who he felt were making it all about themselves. His parents kept asking how he was doing, but he thought his father was more concerned that this would impact his play on the football field. Steve felt like he had nowhere to go. He couldn’t turn to his friends or family, and he didn’t dare talk to a counselor, teacher, or psychiatrist — strangers who didn’t really know him. He felt like, in their eyes, he was supposed to be a tough football player who could just shake this off. And he was a young Black man.
NATIONWIDE, LESS THAN 20% OF PEOPLE OF COLOR WHO NEED MENTAL HEALTH CARE WILL SEEK IT OUT
“In many cultures, there is a negative stereotype that if you have a mental illness, you are unpredictable, different, or weak,” says Dr. Karen Rentas, a Spanish-speaking clinical psychologist with Providence Health who was born and raised in Puerto Rico. “People also have a preconceived belief or fear that they’ll get in trouble, that they might lose their children. And some of them were raised to believe that it’s wrong to air your dirty laundry outside of their family or faith community. Talking with an expert is out of the question.”
In order to raise mental health awareness among people, especially youth, Providence is partnering with celebrity influencers. Snow Tha Product, a California-raised bilingual rapper and proud Latina, has been working with Providence as an advocate, working to remove the stigma around the topic of behavioral health.
“I think it’s because we don’t know who to talk to about it and who is going to not judge you for feeling that way,” she says. “I tell my fans, don’t be afraid to talk about it. Suppressing it makes you live in your head, and it makes you feel like you’re alone. Talking to someone about your issues helps you understand that you’re not the only one.”
Providence has also made progress in tackling all of those cultural obstacles through an emphasis on integrated care. Across the system, providers and clinicians are incorporating mental health by adding onsite behavioral health specialists to work side by side with primary care physicians, pediatricians, and pain management specialists. For instance, when a person comes to the general practitioner for their routine checkup, the doctor will ask about depression and anxiety right along with the typical questions about sleep quality and diet. If an answer or a certain behavior strikes the physician as significant, they can call the behavioral health specialist just down the hall for a more thorough screening.
That’s what finally helped Steve open up and talk about his grief. His mom learned that, through her insurance, he could see someone at Providence.
“My therapist was Black like me,” says Steve. “He’d been an athlete and had gone through depression. He was someone I could relate to. That mattered a lot.”
*Steve's name has been changed to protect his privacy.
Challenges that many patients do face when trying to connect with a psychiatrist are many, that including obtaining wrong numbers from their insurance provider, finding that practices are full and are not accepting new patients, or simply facing unanswered calls.