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Mental health equity: Barriers and solutions

An equity expert explains how employers can ensure they are supporting the mental health of all employees.

Big Health 04.22.2021

Despite the very best intentions, traditional mental health care services exclude, disadvantage, and leave behind the majority of people in need of care. Employers, providers, researchers, and vendors must come together to mitigate the barriers that drive this inequity.

Dr. Juliette McClendon, a clinical psychologist and a nationally known expert on the role of racism and discrimination in shaping racial and ethnic mental health disparities, recently spoke with Dr. Jenna Carl, Big Health’s VP of Clinical Development & Medical Affairs, about mental health equity in the workplace (psst... they will be continuing the conversation on May 12th at 11am PT).

Barriers to mental health care

Traditional mental health care is inequitable. It’s designed to serve a small percentage of the population who possess the resources to afford it, the flexibility to schedule appointments, and a comfort level with the traditional model of meeting one-on-one with a medical professional.

As a result, fewer than one in four Black Americans who need mental health care actually receive it — far fewer than people who identify as white. While people from all backgrounds face barriers when trying to access mental health care, people in marginalized groups are disproportionately affected.

"As a result, fewer than one in four Black Americans who need mental health care actually receive it — far fewer than people who identify as white." 

Dr. McClendon thinks about these barriers in two buckets: systemic and cultural. “When you consider that one of the biggest drivers of health outcomes is the zip code you’re born into, it becomes more apparent how systemic racism and other forms of discrimination have led to marginalization.” Systemic and cultural barriers that acutely impact marginalized groups include:

Systemic barriers:

  • Less access to health insurance
  • Less financial means to afford therapy
  • Lower trust of the health care system due to past negative experiences 
  • Lack of availability of culturally responsive treatment that takes into account a person’s specific needs and cultural background
  • Shortage of mental health providers who are people of color (e.g., 4% of psychologists are Black/African American)

Cultural barriers:

  • Pronounced stigma in marginalized communities* 
  • Reliance on trusted community and spiritual leaders which may deter someone from seeking evidence-based care with a less well-known or trusted provider
  • Belief that mental health care is “for” middle class or white people

Research → access → care: The vicious cycle of inequity 

While evidence-based mental health care is the gold standard, Dr. McClendon says inequities in research, access, and care create a vicious cycle that has led to access barriers that are tough for marginalized communities to break through. 

That vicious cycle starts with research that underrepresents individuals from marginalized groups. Much of the information and scientific data we have to support the efficacy and effectiveness of traditional, evidence-based therapies comes from samples that are predominantly white and middle class. Therefore, we don't know definitively whether these treatments help individuals from marginalized communities.

“Care may not be as appealing because it’s perceived as being for people from a dominant culture.”

Exclusion from mental health research impacts engagement. Dr. McClendon explains that “People of color are more likely to drop out of an-evidence based therapy, but if they finish it they have similar outcomes to their white counterparts.” As a result of being left out of research, individuals from marginalized groups often receive a lower quality of care because it wasn’t designed with their needs in mind, and this impacts the appeal of engaging in that care. Dr. McClendon further explained, “Care may not be as appealing because it’s perceived as being for people from a dominant culture.” The more we continue with the traditional way we have provided care, the more we reinforce this vicious cycle of inequity.

Dismantling inequities

Helping marginalized people better engage with and access mental health care is key to dismantling the deep-seated inequities that leave people behind. The question is, how can an employer do that? Dr. McClendon believes there are many ways, including: 

  1. Build and offer nontraditional and flexible mental health solutions. People with inflexible work schedules need services and solutions that can be accessed anytime, anywhere, such as digital therapeutics (e.g., Sleepio and Daylight).

  2. Improve cultural responsiveness and accessibility of therapies. It’s important to offer therapies that can be delivered for people across the education spectrum, in different modalities and languages, from a variety of therapists, and in ways that integrate the cultural experiences of those receiving it.

  3. Repair mistrust in mental health care and research.This means, in part, engaging with marginalized communities, normalizing mental health, reducing stigma through communication, and asking whether resources are meeting the needs of all people.

As benefits leaders strive to make mental health care more equitable, Dr. McClendon highlighted a powerful lens through which to evaluate efforts: “Equality is giving everyone the same thing. Equity is giving everyone what they need, specific to their own unique needs.”

To hear a more in-depth discussion of mental health equity, sign up for the next conversation between Dr. McClendon and Dr. Carl on May 12th.

*Stigma surrounding poor mental health is pervasive within the U.S., but research suggests that it is particularly strong among communities of color, perhaps in part due to their reticence to take on an additional stigmatized identity (e.g., “mentally ill”), distrust in mental healthcare systems, or cultural norms around help-seeking.