July 28, 2017
Overcoming Barriers: Improving Mental Health for all Virginians
July is National Minority Mental Health Awareness Month and an important time to reflect on what we can do as a community to improve mental health care for all Virginians and for people of color in particular. While the conversation surrounding mental health has garnered more attention in recent years, the specific health needs of people of color have rarely been talked about at the state level. Despite having lower rates of mental illness than white Americans, people of color, particularly Black and Latinx populations, have less access to mental health care and Blacks experience worse outcomes from treatment than those of whites. Although the factors leading to these discrepancies are deeply rooted, there are steps we can take at the state level to close the gap.
A primary reason for poorer mental health outcomes among Black and Latinx Americans is a lack access to mental health services, which places general practitioners and emergency services as the first step in mental health treatment, rather than mental health specialists. For people of color, scarcity of health care providers who reflect a similar racial or ethnic identity can create a trust gap. And this is sometimes made more challenging by language barriers. These cultural barriers have led to Black and Latinx communities relying much more heavily on community leaders such as pastors for help with mental health care. Although community leaders can certainly be useful as a supplement to care, they may lack the training and experience of certified health care providers.
As we’ve seen in the past in Virginia – in the tragic case of the son of Senator Creigh Deeds – access to certified mental health professionals and same-day access to mental health services can be the difference between life and death. Black and Latinx communities are less likely than whites to have the resources to seek private care when faced with long wait times in the public mental health care system. Virginia during the past legislative session added nearly $5 million to improve same-day access to care at Community Service Boards (CSBs), but that was only sufficient funding to implement the program at 18 of the 40 CSBs this year. There are plans to fully fund same-day access services in all 40 CSBs in the next budget, but that is far from guaranteed.
The lack of access to mental health care can be addressed by improving the ability of Virginians of color to afford mental health care and increasing the number of practitioners who are people of color. Expanding access to coverage through a mechanism such as Medicaid expansion would have an outsized impact on communities of color and in turn could reduce utilization of emergency room and general practitioners for mental health conditions that could be more efficiently treated by a specialist. An organized effort to create a pipeline from historically Black colleges and universities would grow the number of mental health practitioners. This in turn could create more trust between communities of color and mental health care providers. Other industries have worked deliberately to increase people of color in specific occupations; the education field is a good example in Virginia
State policymakers seeking to improve access to care for Virginians of color have a ready mechanism at hand. The Joint Subcommittee Studying Mental Health Services in the Commonwealth in the 21st Century, a general assembly subcommittee created in 2014 for the purpose of studying the delivery of mental health services in the state, has advocated for increased funding for a specific set of recommendations. These recommendations, such as increasing access to same-day care, crisis services, and outpatient mental health care, are vital to improving health outcomes, and additional work should be done to identify and recommend ways to close Virginia’s gaps in mental health outcomes by race. Adequately funding the efforts will also be critical – the estimated cost of implementing all of the subcommittee’s recommendations would total $184 million, with many costs occurring on an annual basis.
The state has a role to play in closing racial outcome and access gaps when it comes to mental health care. There should be concerted efforts to improve access, train providers in cultural competency, and create a pipeline of diverse mental health practitioners, within a framework of a plan to reduce disparities by race. With few market incentives for these changes to occur naturally, it is incumbent upon us and our legislators to take National Minority Mental Health Month as a call to action to put these changes in motion. The Joint Subcommittee Studying Mental Health Services in the Commonwealth in the 21st Century provides perhaps the best platform for advocates and legislators to come together and start working on closing racial gaps in mental health care.