Raising Awareness on Patient Care: Minority Mental Health
By Dr. Roger Ayres [MD] & Dr. Aldo Morales [MD]
“At the root of this dilemma is the way we view mental health in this country. Whether an illness affects your heart, your leg or your brain, it’s still an illness, and there should be no distinction.” – Michelle Obama
As a medical professional, what mental and emotional struggles do you find to be most predominant in minority communities?
Dr. Ayres: The struggles are the same but heightened due to both overt racism and less obvious internal biases. For example, it is common to make presumptions before an initial council session which can stigmatize and then create tensions and/or micro-aggressions. Members of minority communities might also feel the stress to be “better than” and achieve higher just to receive equal recognition of their work. Finally, there is often a lack of education and understanding from others when it comes to cultural differences which can result in frustration and anger.
Dr. Morales: Although the rates of mental disorders are not higher (surprisingly, they may actually be lower) psychological symptoms do tend to be higher among minorities and the poor. Access to high-quality care, insurance coverage, education, and socioeconomic status can also affect the delivery of proper care.
With the current social and civil unrest, what do you foresee to be the greatest mental health struggles that minorities will face, but especially black men and women?
Dr. Ayres: There will be an initial hope of future change, but if it does not materialize, then many will experience severe disappointment and rejection. Action must be followed by words or else the status quo will continue to marginalize minority communities, but especially black men and women who have historically suffered the greatest degree of discrimination. There may also be increased instances of depression due to a sense that their lives are worth less than others.
Dr. Morales: The black community, as a whole, due to socioeconomic factors and the way our healthcare delivery is structured, do not receive first-rate medical care. And that includes drug/alcohol and mental health care.
Statistically, members of the LGBTQ+ community are more inclined to suffer from a mental illness. What, in your opinion, are the roadblocks to care for this community?
Dr. Ayres: The LQBTQ+ community has often had a weaker support system because many members have been rejected by family and friends, which results in isolation and a fear of asking for help. An LGBTQ+ individual may feel like he, she or they are broken and cannot be fixed due to past discrimination. Especially in more rural areas, there is a lack of providers who are themselves LGBTQ+ and can both empathize, as well as, provide a safe space for treatment.
Dr. Morales: The LGBTQ population has a higher incidence of depression, compulsive and phobic disorders, violence, suicidality, substance use and post-traumatic disorders. They may be less likely to seek help based on prior discrimination experiences, or even less likely to discuss their sexuality for fear of such discrimination. Cultural competence among healthcare providers is essential in order to bring effective treatment to every population.
What changes need to happen in the world of treatment when it comes to the proper patient care of minority communities?
Dr. Ayres: There needs to be increased access to care at the community level that is affordable. Members of minority communities often feel ignored and less likely to be taken seriously when it comes to their mental health issues. Providers need to check their implicit biases, not be dismissive, and not undertreat or ignore patient concerns. Finally, there needs to be a nation-wide effort to recruit minorities into the mental health field because increased diversity will mean more inclusion and better care.
Dr. Morales: Our training institutions–colleges, medical schools, training programs, etc.–are all beginning to address the cultural competence required of practitioners since we anticipate that in twenty or so years half of the US population will consist of what we today call minorities. Practitioners must be proficient in their understanding of cultural diversity and how it impacts patients’ presentation to treatment as well as in the delivery of healthcare.