Recent research shows that 42% of U.S. adults are reporting anxiety and depression symptoms - up 11% over previous years. While that is alarming news, many of us are able to reach out to a qualified professional to seek help for mental health conditions if we need it. However, the reality is that the gap between individuals who need mental health care and those who receive it is sizable and grows bigger every year. Certain communities - for example, those who live in rural areas, certain ethnic communities, and even those within the military community - are often unable to find and receive the care they need.
As far back as 1999, the Report of the Surgeon General on Mental Health found that “despite the existence of effective treatments, disparities lie in the availability, accessibility and quality of mental health services for minorities, and those living in some rural and urban areas.” In this article, we look at underserved communities, the reasons why they are underserved, and what can be done about the problem.
Communities that are often underserved
- Ethnic minority communities. Studies show that ethnic minority populations are as much at risk for mental health issues as the population as a whole, but receive substantially less treatment. For example, for individuals diagnosed with depression, 69% of Asian-Americans, 64% of Latinos, and 59% of African-Americans do not access mental health treatment, compared with 40% of the general population.
- Rural communities. Studies have shown that 20% of residents of nonmetropolitan counties in the US have a diagnosable mental health disorder but have significantly less access to care than those who live in metropolitan areas. In this case, the gap is most often due to a chronic shortage of local mental health professionals and facilities.
- Underserved urban communities. The CDC says that individuals living below the poverty level in urban communities were nearly 2.5 times more likely to have depression than those at or above the poverty level. And recent research finds that that depression may be linked to characteristics of the neighborhoods in which they live - poor-quality housing, few resources, and unsafe conditions impose stress, which can lead to depression. Yet, these individuals are less likely to be able to access the quality mental health care they need.
- Veterans. Thousands of returning military personnel struggle with mental health conditions, including PTSD, depression, and substance use disorders. But studies show that only 50% of returning vets receive the mental health treatment that they need. Some of the barriers have included long wait times and mental health stigmas.
- Older adults. Studies show that up to 20 percent of adults aged 65 and over have a mental health condition, yet this population also struggles to get the help it needs - most often due to inability (lack of transportation) to get to treatment, or inability to navigate complex medical insurance systems.
What are the barriers to accessing mental health care?
There are many reasons why certain communities aren’t getting the mental health care they need. These include:
- Lack of local availability and resources. Underserved city neighborhoods and rural areas often lack the resources needed to maintain necessary community services, and private treatment facilities tend to locate in areas where they can guarantee a steady income stream - which may not be the case in these areas. Hence the chronic lack of mental health facilities and providers.
- Transportation issues, including difficulty finding childcare or taking time off work.
- Cultural stigmas about mental health. Even when resources are available, cultural stigmas about the nature of mental health prevent many individuals in some communities from seeking proper care when needed.
- Racial/Ethnic implicit bias. Unfortunately, multiple studies found levels of implicit bias between patient-provider interactions and health outcomes. Concluding that a more rigorous examination should be conducted as it may be contributing to health disparities for people of color.
- Language barriers and an insufficient number of providers who speak languages other than English.
- Lack of adequate health insurance coverage. Despite the reduction in the number of uninsured Americans since the ACA was implemented, there are still 28 million lacking any type of health insurance. As well, even for those with insurance, high deductibles and co-pays sometimes make care difficult to afford.
What can be done to address behavioral health access issues?
Interest from academics, practitioners, communities, patients, and families to address the gap in mental health care is growing - and that’s promising. Here are some of the ways we can address the problem (note that none of these will change the problem overnight - all of these suggestions need additional research and validation):
- Expanding outreach efforts outside of clinic walls with mobile clinics and technologies like digital and virtual treatment. Technology for telebehavioral health services has shown to help break down barriers, remove stigmas, and increase access
- Creating local marketing and communication campaigns designed to reduce mental health stigma and educate communities about treatment options.
- Inviting feedback from individuals about their mental health needs and obstacles to care, in order to better understand the issues.
- Encouraging mental health organizations to include underserved community members on staff or boards of directors.
- Contacting legislators—both local and federal—to support efforts to improve access to and the quality of mental health services in local areas.
- Improving payment options
Whether you have personally experienced the challenges associated with mental health care access, or whether you’re advocating for a better mental health system, all of us can help make a difference.
If you need help with mental health issues, consider contacting a qualified mental health professional
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