The Health Divide: Mental health care is harder for Black people to find

Published on
June 26, 2023

The Los Angeles Times marked Juneteenth last week with a series of articles highlighting mental health awareness, suicide and grief, and wellness programs in the Black community.  

“There have always been a number of barriers to Black people accessing mental health care,” writes Times staff photographer Jason Armond. “Finding a competent health care provider who looks like them is an arduous task.”  

Black people are 20% more likely to experience serious psychological problems than the population overall. Structural racism and generational trauma are key factors in those elevated rates.  

“Simply the stressors of being a Black man in America every day can contribute to depression," counselor Andre Jones told Aaron Gettinger of the Arkansas Democrat-Gazette last month.  

The stress from racial trauma and daily discrimination, left untreated, can lead to heart disease and a host of other ailments, reports Kenya Hunter at Capital B News

New guidelines from the U.S. Preventive Services Task Force recommend all adults age 19 through 64 be screened for anxiety. But that could backfire for people of color who may feel higher anxiety at times due to racism or discrimination, leading to overdiagnosis, psychology professor Erlanger Turner warned Lindsey Bever at The Washington Post.

Mental health care can be a frightening concept for some Black people, reported Taylor Wizner for Ideastream Public Mediaearlier this year. “Psychiatric hospitals, asylums were used as punitive places for African Americans throughout slavery and the civil rights era,” said Cleveland psychologist Robyn Hill. 

 In 2021, the American Psychological Association formally apologized for a history of racism and discrimination against people of color.  

Getting care isn’t always easy: Just 2% of psychiatrists and 4% of psychologists in the U.S. are Black. Their patient slates are often full, and many left the field during the pandemic. 

American Psychological Association committees are working to recruit more people of color to train in the field.

On the patient side, there have been a number of initiatives in recent years aiming to normalize mental health care and help people in need use the web to find available therapists who are the right cultural fit.  

Report finds failings in health care for women, people of color 

The 2023 Scorecard on State Health System Performance, released by The Commonwealth Fund last Thursday, finds rising rates of premature death among Black, American Indian and Alaska Native populations during the pandemic years. 

The report blames factors including structural racism and poorer health care. (The Commonwealth Fund is a funder of Center for Health Journalism.)

Women of color were also at increased risk of pregnancy complications due to COVID.  

And as the nation marks the June 24 anniversary of the Supreme Court’s decision overturning Roe v. Wade, the report — which covers data mainly from 2021 — provides a baseline for assessing how women’s reproductive care is changing going forward.    

Many states that already had poor outcomes for women’s health are the same ones implementing additional restrictions on reproductive care. Currently, 26 states have laws that reduce or eliminate abortion access — impacting about one in four womenof reproductive age. (Here’s a map.) These states also contain high numbers of women of color and those with lower incomes, as well as more rural areas. 

States with more restrictive policies are already experiencing a shortage of OB-GYNs, and it’s expected to worsen in coming years, reports Janet Shamlian at CBS News.  

A new Kaiser Family Foundation survey of OB-GYNs found that in the past year, one out of four had seen patients who were unable to get a desired abortion, and one in five felt constrained in the care they could provide for emergencies such as miscarriages. 

Meanwhile, the death of Olympic runner Tori Bowie, a Black woman who died at home while in labor, continues to reverberate through the news. Pregnant Black women are twice as likely as other groups to have serious complications, and three times as likely to die, report Akilah Johnson and Fenit Nirappil at The Washington Post

A $32 million federal program designed to improve maternity care in rural areas is largely missing Black mothers, reports Sarah Jane Tribble at KFF Health News. None of the funded sites are in the Southeast, which has the largest concentration of rural Black communities. 

Women need to be empowered to advocate for care, writes Omare Jimmerson, executive director of the Tulsa Birth Equity Initiative, in a STAT opinion. “It’s also critical for physicians and other health care workers to recognize and check internal biases and cultural stereotypes that contribute to patient oppression and higher mortality rates in women of color.” 

Asian Americans with ADHD go underdiagnosed 

Fewer Asian American children are diagnosed with ADHD than white, Black or Hispanic kids, suggesting an unrecognized group who aren’t getting the help they need, reports Olivia Goldhill at STAT.  

She notes that while ADHD rates average around 6% in Asian countries, the rate is just 2% among Asian Americans. 

That indicates that a big part of the problem is U.S. perceptions of Asian Americans — specifically, the “model minority” stereotype that Asian American children are well-behaved, top students.  

That bias makes it harder for teachers and others to perceive ADHD symptoms, especially if families are good at compensating for attention problems with reminders, schedules, and other assistance. 

Asian American families may also resist the diagnosis because of stigma, said psychiatry professor Niranjan Karnik of the University of Illinois Chicago College of Medicine. 

One Chinese American woman told Goldhill she felt she “wasn’t allowed” to have ADHD growing up. 

Emily Chen, who is pursuing a master’s degree focused on neurodivergent Asian Americans, said her ADHD went undiagnosed for years. Meanwhile, she developed anxiety and depression from trying to keep up academically. 

The implications of race and culture on the pressure to perform just wasn’t on doctors’ “radar,” Chen said. 

A similar ignorance about demographics likely contributes to lower ADHD diagnosis rates in Black and Latino children, Chen said, but Asian Americans are even farther behind. 

Some ADHD studies lump people of Asian descent in with the “other” category, making it harder to understand the issue.   

“Asian children are falling through the cracks,” said psychology professor Patrick Goh of the University of Hawai’i. 

What we’re reading: 

  • “Color Code Podcast: ‘Food apartheid’ starves minority neighborhoods on Long Island,” by Nicholas StFleur, STAT
  • "More than 1 million people are dropped from Medicaid as states start post-pandemic purge of rolls,” by David A. Lieb and Andrew DeMillo, AP News 
  • “Medical exiles: Families flee states amid crackdown on transgender care,” by Bram Sable-Smith, Daniel Chang, Jazmin Orozco Rodriguez and Sandy West, KFF Health News
  • “For women ex-prisoners, food insecurity can trigger catastrophe. Activists want more aid,” by Selene Rivera, Los Angeles Times 
  • "The Supreme Court delivers an unexpected win for Medicaid recipients,” by Andrew J. Twinamatsiko and Lawrence O. Gostin, MedPage Today