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Is mental health care truly equitable?

A Q&A with Delta Air Lines on inequities in mental health care, the importance of cultural sensitivity, and how employers can help.

Big Health 06.02.2021

Despite an upswing in awareness around the importance of mental health care, most people still aren’t receiving the care they need. The problem is even worse among marginalized groups, for whom it’s harder to access and receive quality care because of long-standing systemic oppression and discrimination within the United States. In fact, fewer than one in four Black Americans who need mental health care actually receive it. 

It’s one thing to know a problem exists; it is quite another to solve it.

To shed light on how to reduce inequities in mental health care, Big Health’s Co-founder and CEO Peter Hames moderated a Q&A discussion at the Business Group on Health's Annual Conference — watch the full conversation. The event featured insights from Jae Kullar, General Manager of Global Health and Wellbeing at Delta Air Lines and Dr. Juliette McClendon, Big Health’s Director of Medical Affairs and a nationally known expert in mental health equity and the role racism and discrimination plays in shaping racial and ethnic inequities in mental health.

"There are disparities in unmet mental health needs because people of color are more likely to delay seeking treatment, have higher rates of unmet mental health care needs, and are less likely to stay in treatment than white adults." 

Peter Hames: Based on your research looking at racial and ethnic disparities in mental health care, how would you describe the mental health care gap?

Dr. McClendon: There are multiple gaps in mental health and mental health care, including disparities in some disorders like post traumatic stress disorder (PTSD) and schizophrenia, which are diagnosed more often among people of color. In addition, there are disparities in unmet mental health needs because people of color are more likely to delay seeking treatment, have higher rates of unmet mental health care needs, and are less likely to stay in treatment than white adults

Some of those care-seeking disparities are related to cost, stigma, and scheduling challenges. Accessing traditional mental health care involving an in-person appointment can be challenging for a person who doesn’t have insurance, can’t take time off from work, or is concerned about social or professional consequences of seeking care.

Peter Hames: It sounds like the gap is fed in part by a mixture of capability like time, money, and feasibility as well as cultural relevance. Jae, how have you seen this problem manifest in the Delta Air Lines workforce?

Jae Kullar: We see all of the barriers and gaps Dr. McClendon mentioned. For example, we see a lot of stigma, though it is different for everyone. People come to work with a whole history behind them, and mental health is a difficult topic across the board. Financial worries are almost always a factor, but so is time and finding relatable mental health care solutions that inspire people to engage.

Peter Hames: Financial concerns are an interesting element because it’s hard to pull apart whether it is a mental health concern or a life problem. How do you characterize them?

Jae Kullar: Once we started peeling away why people were stressed, we discovered that financial concerns were so prevalent — and highly tied to stress and anxiety — that we began offering financial counseling for difficulties found across salary grades. We also used these high touch, face-to-face financial coaching sessions as an opportunity to communicate about the “high tech” mental health benefits we offer. This initiative helped people connect the dots between concerns over finances with how they were feeling emotionally. It was a broad approach aimed at helping our employees where they are.

"Once we started peeling away why people were stressed, we discovered that financial concerns were so prevalent — and highly tied to stress and anxiety — that we began offering financial counseling for difficulties found across salary grades."

Peter Hames: That’s a great segue into the point of bringing mental health care to people where they are in their journey. How does the integration of “high tech” with “high touch” support fit with that?

Jae Kullar: While it can be challenging, it is an important problem to solve. We have a diverse employee population that spans over 60 countries, so the more opportunities we offer to engage with mental health care, the better. For example, someone might come in for a face-to-face financial counseling session and say they aren’t sleeping well, only to discover they have some deep-rooted anxiety they never even considered until they were introduced to those words. If we can offer them a "high tech" digital therapeutic on the spot, it might be the front door into mental health care, whether it stops there or goes further.

"If we can offer them [employees] a "high tech" digital therapeutic on the spot, it might be the front door into mental health care, whether it stops there or goes further."

Peter Hames: If you cast your glance ahead, what sort of solution would you wish for to help bridge the inequities in mental health care?

Jae Kullar: I wish that we had even fewer barriers to deliver digital or traditional mental health resources to the whole household, so people could learn these skills earlier — including children. One day, they will be employees and parents and colleagues, so wouldn’t it be wonderful if they developed good mental health skills earlier.

Dr. McClendon: My hope is we’ll do a better job of meeting people where they are so they move into the pipeline of using solutions that work for them. Some research suggests that for people who are less likely to seek therapy, like folks from marginalized groups, having access to non-traditional methods of engaging with care — such as digital therapeutics like Sleepio and Daylight — is important.

We also need to find ways to communicate about traditional therapy and digital therapeutics in ways that are meaningful and clear to them. If people understand how something works, the reasons why it’s helpful and believe confidentiality will be kept, they’ll be more open to using it.

Peter Hames: While the pandemic has caused enormous suffering, a silver lining is that it has given us a springboard to address inequities in mental health care and the opportunity to be a catalyst in making a sea-change in how effective we are in providing care to marginalized populations.

If you want to hear the full conversation check out a recording of the session by filling out the form to the right! Or for more insight into how to create mental health equity in the workplace read Dr. McClendon’s advice for employers striving to support the needs of all employees. 


Disclaimer: In the US, Sleepio and Daylight have not been cleared by the FDA for use in diagnosis or treatment of a disease or condition, such as insomnia disorder, generalized anxiety disorder or major depression disorder.

Topics: Equity