Challenges in mental health for minority communities

Kisha Hartwick, MD

Psychiatry

Maintaining mental health is a common challenge, but for members of minority communities, these challenges can feel even more insurmountable. Psychiatrist Kisha Hartwick, MD, spoke about disparities in caring for mental health in minority communities, including her own journey.

A personal perspective from Dr. Hartwick

“As an African American physician, I thought it would be easy to talk about the difficulty of seeking mental health treatment as a person of color,” said Dr. Hartwick. “However, when I tried to match my personal experiences to the data and research, I found myself asking, ‘Was it just me?”

Dr. Hartwick grew up in a lower middle-class family without health insurance. “It was discouraged in my family to go to a doctor unless we were really sick,” she said. “Part of that was a desire to avoid high medical bills, and part of that was due to a distrust for the medical community.”

She said they also didn’t talk about stress. “Life was not always easy, and there were times when we did not have even our basic needs met, but I never once heard my parents talk about feeling stressed or overwhelmed. It doesn’t mean that they weren’t. I could look on their faces and see that they were.”

In many minority communities, there is a perception that you need to “just work harder” and figure difficulties out on your own.   “This is a concept sometimes called John Henry-ism,” Says Dr. Hartwick.  “The very act of using single-minded determination to cope with stressors often creates a barrier to accessing support when it is most needed.” 

Sometimes symptoms of depression and anxiety, such as difficulty with sleep, changes in appetite, feeling easily overwhelmed, or decreased desire to engage with people or in activities that you once enjoyed, are not recognized as an opportunity to get additional help.  “One of the roles we play as psychiatrists is to educate patients not only about the use of medications and psychotherapy in the treatment of mental illness, but also the importance of social support, positive activities, spirituality and healthy choices in restoring mental wellness.”

Is mental health worse among minorities?

A national study showed that although African Americans and Caribbean Blacks have lower current and lifetime rates of major depression than Caucasians, once depressed, both groups were more likely have more persistent, severe symptoms and were less likely to receive treatment.

There is also evidence of worsening mental health challenges among minority youth. Although children and teens of all walks of life are struggling with increasing problems with mental health, those in minority communities face unique challenges. Studies have shown:

• Native Americans have the highest rate of suicide, and there have been marked increases in suicide rates among young Hispanic and Black youth populations.
• Suicide is the third leading cause of death for Blacks aged 15 to 24.
• High levels of negative racial stereotyping remain toward non-white populations by adults who work or volunteer with minority children and teens.

What are some challenges faced by minority communities when it comes to finding mental health care?

“One challenge that members of minority communities face when trying to access health care is unconscious bias,” said Dr. Hartwick. These biases can mean that a health care provider may interpret symptoms reported by minority patients as more or less severe than they really are, leading to differences in the types of treatment solutions offered.  “This is why it is important for both providers and patients to become aware of implicit biases or stereotypes which often stand in the way of giving and receiving effective care.” said Dr. Hartwick.

According to the American Psychiatric Association, some barriers to mental health care include:

• Lack of insurance, underinsurance
• Lack of diversity among mental health care providers
• Lack of culturally competent providers                
• Language barriers

What can be done to improve mental health in minority communities?

There are steps you can take on your own to improve mental and physical wellness overall, but if these are not effective, it’s important to schedule an appointment with a doctor.

Advocate for yourself with your medical provider and consider bringing a trusted loved one (maybe a friend or family member) to help make sure your needs are met and your voice is heard.

”It’s okay to recognize and say that you’re not okay,” says Dr. Hartwick.  “Mental health providers are here to help, and you deserve access to the care you need.”   Schedule an appointment with a physician or therapist to discuss your symptoms and concerns.