Mental health inequality

Mental health inequality refers to the differences in quality of mental health and mental health care for different identities and populations. Mental health can be defined as well-being and/or the absence of clinically defined mental illness.[1] There are social economic factors that influence individuals or groups of people of a certain demographic. This can be a factor to mental health care access. Inequalities may include presence of mental health, access to mental health care, quality of mental health care, and mental health outcomes between populations with different race, ethnicity, sexual orientation, sex, gender, socioeconomic statuses, education level, and geographic location.

Predictors

Socioeconomic status disparities

Socioeconomic status is both a strong predictor of mental health status and a key predictor of mental health inequalities across populations. Socioeconomic status and mental health problems have an inverse relationship, as socioeconomic status decreases, mental health problems increase.[2] It seems clear how the stressors associated with poverty and low socioeconomic status, can compromise an individual's ability to maintain a positive sense of well-being and the absence of mental health problems. Data shows that the effects are strongest for children, but effects reach adults and adolescents as well.[2] Socioeconomic status is not only a predictor of development of mental health problems but also an important determinant of access to positive and proper mental health care and resources. Utilizing proper resources to maintain positive mental health is not only costly and therefore unaffordable for specific populations, but the resources are also not properly distributed between regions and communities.[3] Communities living in the deepest poverty have the highest need for mental health resources, but have the least amount of access to them.[3] Access means many things in this case, including the physical presence of resources, the legitimacy of resources, the affordability of resources if they exist, ability to get to such resources (i.e. transportation), and level of comfort reaching out to resources due to stigmas. For example, in terms of legitimacy, in a poor community, there may be an affordable mental health care provider that the community has access to but that care provider may not provide proper mental health services.

Education disparities

While education and mental health seem mutually exclusive, there is a significant parallel between the inequities. Educational disparities can be defined as unjust or unfair differences in educational outcomes that can be a result of difference in treatment of certain minority groups in schools, varying socioeconomic statuses, and varying educational needs.[4] These disparities in education can ultimately lead to issues of mental health. When this happens, less privileged groups get looped into the cascading effects of inequality.

The disparities that arise in education do not happen by chance. There are definitely predictors that factor into these inequalities. Some common ones are socioeconomic status, immigrant status, and ethnic/racial status.[4] Socioeconomic status plays a large role in the difference in access to educational resources. School districts are split geographically. Because the current funding for public schools comes from local property taxes, there is more incentive for high-status individuals to narrow the boundaries to not include lower income families from their school districts.[5] Because each school district is then only encompassing one socioeconomic group, the programs and quality are affected. This is where we begin to see the dramatic differences between school districts. While some schools offer amazing guidance departments, advanced classes, and phenomenal facilities, other areas struggle to find qualified and motivated teachers to teach basic classes. Although public education is something that is supposed to be a right for all, an individual's socioeconomic status can greatly affect the quality of that education.

An individual's immigration status also affects the quality of education received. While there are some immigrant groups which do well after immigrating to the United States, many do not have the same level of success. There are many barriers that prevent the academic success of immigrant children. These barriers include but are not limited to the fact that most parents of immigrant children do not understand the United States educational system, inadequate English as a Second Language programs, and segregation. There are also differences in outcomes across immigrant generation, with first-generation immigrants performing better than subsequent generations. This is termed the immigrant paradox. These issues along with the psychological effects of acculturation (e.g., adapting to a whole new country, language, and culture) amplify educational inequality.[4]

Seemingly obvious, ethnic and racial status also play a large role in how these immigrant students are able to adapt to a new educational system. See Ethnic and racial disparities below.

Spatial disparities (geographic location)

Further research observes that those minority races living in areas of low-poverty have more and easier access to mental health services than those in high-poverty neighborhoods. There is a pattern of people in high-poverty areas being unable escape this cycle. Due to these conditions, inequality remains and they are unable to gain access to mental health care which can be very beneficial to those who may be suffering from stress due to lack of resources and money.

Many minorities including African Americans, Hispanics, and Asian Americans inhabit these poverty filled neighborhoods due to factors being not in their favor in certain aspects of society. These neighborhoods lack resources such as offices with psychiatrists or health clinics with good doctors who are trained to help those in need of mental health care. It would also be beneficial to make specific services just for those in high-poverty neighborhoods who lack the resources so we can encourage those in need to get the help that they deserve. With adjustments made to meet these circumstances, the spatial disparities can be lowered and allow those who need the help to get it.

Ethnic and racial disparities

There is inequality in mental health care access for different races and ethnicities. It is known through much research that even poor minorities have less access to mental health care than poor non-Latino whites.[6] In addition, it is also known that blacks have even less of a chance to access to mental health services and care than those who are white.[6] Many of these minorities may confront an issue directly resulting in the search for mental health care support, yet they don't have the same access as other people.

After surveying people of different races over years we observe that African Americans, Hispanics, and Asian Americans gain less access to the same type of mental services that non-minority whites get access to.[7] With this research there was a piece that stated:

"This theory postulates that Whites have a greater propensity to avoid living in poverty communities because they are more likely to enjoy social and economic advantages. Only seriously mentally ill Whites suffer from steep downward mobility and come to reside in high-poverty neighborhoods"[7] (Julian Chun-Chung Chow, Kim Jaffee, and Lonnie Snowden).

This has been a problem for minority races that need the same services. It is an issue because African Americans, Hispanics, and Asian Americans need the services more in certain areas due to how biologically certain minority races are more likely to be diagnosed with a mental illness than whites.

LGBTQ disparities and predictors

Sexuality plays a large role in the prediction of mental illnesses and overall mental health. Those who identify as lesbian, gay, bisexual, transgender, and/or queer have a higher risk of having mental health issues, most likely as a result of the continued discrimination and victimization they receive at the hands of others. Members of this population are confronted with derogatory and hateful comments, whether through face-to-face communication or through social media, which affects their self-worth and confidence, leading to anxiety, depression, thoughts of suicide, suicide attempts, and suicide. These mental health effects are most commonly seen among adolescents, however, they are also prevalent among adults of all ages.[8][9] The sources of discrimination and victimization that the LGBTQ population suffers from can be both external and internal. While parts of society today are not accepting of the LGBTQ community and make public statements to advertise their discontent, an identifying LGBTQ can also have low confidence and a lack of self-worth that furthers these negative mental health effects.

The most notable predictor of mental health illnesses among the LGBTQ population is family acceptance.[8] Those of the LGBTQ population who receive little or no family support and acceptance are three times more likely to have thoughts of suicide than those who do have a strong family support system behind them. Oftentimes, the lack of familial support is more conducive of detrimental behaviors, such as drug and illegal substance abuse, which can cause further harm to the individual. Multiple aspects of lifestyles, including religion, can affect family support. Those who have strong family ties to religion may be less likely to seek support and help from family members due to fear of a lack of acceptance within the family, as well as within the religious community.[9]

Sex and gender disparities and predictors

While gender differences among those with mental health disorders are an underdeveloped field of study, there are gender specific aspects to life that cause disparities. Gender is often a determinant of the amount of power one has over factors in their life, such as socioeconomic status and social position, and the stressors that go along with these factors. The location of genders and sex within the social construct can be a great determinant of risks and predictors of mental health disorders. These disparities in gender can correlate to the disparities in the types of mental health disorders that individuals have. While all genders and sexes are at risk of a large variety of mental health illnesses, some illnesses and disorders are more common among one sex than another. Women are twice as likely as men to be diagnosed with forms of depression, whereas men are three times more likely to be given a diagnosis of a social anxiety disorder than women.[10]

Sex can also be a determinant of other aspects of mental health as well. The time of onset of symptoms can be different dependent on one's sex. Women are more likely to show signs of mental illnesses, such as depression, earlier and at a younger age than men. Many believe this to be a correlation with the onset time of puberty. As a result of social stigmatisms and stereotypes within society, women are also more likely to be prescribed mood-altering medications, whereas men are more likely to be prescribed medications for addictions.[10] Further research on the mental health disparities among sex and gender is needed in order to gain a deeper knowledge of the predictors of mental health and the possible differences in treatments.

Disparities in success to mental health care

Over the past decade, many of the disparities regarding mental health stem from differences in racial/ethnic groups. Mental illness is one of the highest health burdens for minority groups.[11]

In many minority groups, certain mental illnesses are under and over diagnosed. For example, schizophrenia is over diagnosed in African Americans while mood disorders, depression, and anxiety are under diagnosed.[12] This is due to a variety of reasons. The recognition of mental illness is often thought of in conjunction with stereotypes regarding African Americans. Those who present symptoms exhibiting depression and mood swings may be mistaken as stereotypically violent.

While the diagnosis of these minority groups is vastly different, the care they receive also varies between whites and minority groups. This is not only due to external factors and facilities but also the way in which these minority groups choose to proceed with treatment. African Americans generally do receive care from lower quality facilities, but they are also more likely than whites to terminate treatment prematurely.[13]

Finally, health care plans are also a major contributor to the inequities in mental health care access. Provider discrimination involves health care providers unfairly using stereotypes to decide how to distribute diagnoses. Physicians often rely on common stereotypes of individuals in deciding treatment, which ultimately leads to minority groups not getting the specialized treatment required to diagnose and treat mental illness.

Disparities in quality of mental health care

There is a growing unmet need for mental health services and equity in the quality of these services. While these services often advertise themselves as being a support system and caregiver for any and all who need treatment or support, oftentimes certain aspects of an individual's life, such as race, ethnicity, and sexual orientation, will determine the type of care that they are given.

Due to a growing level of socioeconomic inequality among races, African Americans are less likely to have access to mental health care and are more likely to have lesser quality care when they do find it.[14] African Americans and Hispanics are more likely to be uninsured or have Medicaid, limiting the amount and type of access that they have mental health outpatient sources. In one study, of all those who received mental health care, minority populations reported a higher degree of unmet needs and dissatisfaction with the services they were given (12.5% of whites, 25.4% of African Americans, and 22.6% of Hispanics reported poor care).[15]

The LGBTQ population, while still open to the same disparities as racial minority groups, is often confronted with the problem of being denied mental health treatment because of the gender they identify as or their sexual orientation. In a study conducted by The National Center for Transgender Equality and the National Gay and Lesbian Task Force, 19% of the LGBTQ sample reported being denied the healthcare they needed. In addition, 28% of the sample reported being harassed or even physically assaulted during the health visit.[16] While denial of treatment and harassment during treatment are large causes of the disparities among mental health care quality, the lack of knowledge is also of concern among the LGBTQ population. As it is such a newly developing field of study, there is very little knowledge or research conducted that relate specifically to LGBTQ health and healthcare. Because of this, about 50% of the LGBTQ population report having to teach aspects of their health and treatment to the health care providers.[16]

Suggestions on how to achieve better mental health equality

Because mental health inequality is largely due to disparities in health insurance, ways to improve mental health equity must come from changes in healthcare policies. While much of mental health disparities comes from improving access to healthcare for the underprivileged. The biggest reason why people are not obtaining mental health care is because they cannot afford it. Also, changing the content of healthcare literature to include mental health is equally important. The United States has made massive strides to break down the stigmas surrounding mental health. Given that, mental health is still not considered to be a main part of basic health care plans. In order for individuals to receive the treatment necessary for mental illness, it must be acknowledged as an illness.[12]

See also

References

  1. ↑ World Health Organization (2003) Investing in mental health. Geneva, World Health Organization (http://www.who.int/mental_health/media/investing_mnh.pdf ).
  2. 1 2 Reiss, Franziska (2013-08-01). "Socioeconomic inequalities and mental health problems in children and adolescents: A systematic review". Social Science & Medicine. 90: 24–31. doi:10.1016/j.socscimed.2013.04.026.
  3. 1 2 Saxena, Shekhar. "Resources for mental health: scarcity, inequity, and inefficiency". The Lancet. 370: 878–889. doi:10.1016/S0140-6736(07)61239-2. Retrieved 2017-03-28.
  4. 1 2 3 "Ethnic and Racial Disparities in Education: Psychology's Contributions to Understanding and Reducing Disparities" (PDF). American Psychological Association. 2012.
  5. ↑ "Study examines how district boundaries exacerbate school segregation". thenotebook.org. Retrieved 2017-04-02.
  6. 1 2 Alegría, Margarita; Canino, Glorisa; Ríos, Ruth; Vera, Mildred; Calderón, José; Rusch, Dana; Ortega, Alexander N. (2002-12-01). "Mental Health Care for Latinos: Inequalities in Use of Specialty Mental Health Services Among Latinos, African Americans, and Non-Latino Whites". Psychiatric Services. 53 (12): 1547–1555. doi:10.1176/appi.ps.53.12.1547. ISSN 1075-2730.
  7. 1 2 Chow, Julian Chun-Chung; Jaffee, Kim; Snowden, Lonnie (2017-04-07). "Racial/Ethnic Disparities in the Use of Mental Health Services in Poverty Areas". American Journal of Public Health. 93 (5): 792–797. ISSN 0090-0036. PMC 1447841. PMID 12721146.
  8. 1 2 Ryan, Caitlin. "U-M Weblogin". Journal of Child and Adolescent Psychiatric Nursing. 23: 205–213. doi:10.1111/j.1744-6171.2010.00246.x.
  9. 1 2 Mustanski, Brian S.; Garofalo, Robert; Emerson, Erin M. "Mental Health Disorders, Psychological Distress, and Suicidality in a Diverse Sample of Lesbian, Gay, Bisexual, and Transgender Youths". American Journal of Public Health. 100 (12): 2426–2432. doi:10.2105/ajph.2009.178319. PMC 2978194.
  10. 1 2 "WHO | Gender and women's mental health". www.who.int. Retrieved 2017-03-30.
  11. ↑ Cook, Benjamin Lê; Trinh, Nhi-Ha; Li, Zhihui; Hou, Sherry Shu-Yeu; Progovac, Ana M. "Trends in Racial-Ethnic Disparities in Access to Mental Health Care, 2004–2012". Psychiatric Services. 68 (1): 9–16. doi:10.1176/appi.ps.201500453.
  12. 1 2 Barclay, Laurie (August 26, 2009). "Disparities in Access to Mental Health Services by African Americans: An Expert Interview With Annelle B. Primm, MD, MPH". www.medscape.com. Retrieved 2017-04-02.
  13. ↑ McGuire, Thomas G.; Miranda, Jeanne (2008-01-01). "Racial and Ethnic Disparities in Mental Health Care: Evidence and Policy Implications". Health Affairs (Project Hope). 27 (2): 393–403. doi:10.1377/hlthaff.27.2.393. ISSN 0278-2715. PMC 3928067. PMID 18332495.
  14. ↑ Cook, Benjamin L.; McGuire, Thomas; Miranda, Jeanne (2007-12-01). "Measuring Trends in Mental Health Care Disparities, 2000–2004". Psychiatric Services. 58 (12): 1533–1540. doi:10.1176/ps.2007.58.12.1533. ISSN 1075-2730.
  15. ↑ Wells, Kenneth; Klap, Ruth; Koike, Alan; Sherbourne, Cathy (2001-12-01). "Ethnic Disparities in Unmet Need for Alcoholism, Drug Abuse, and Mental Health Care". American Journal of Psychiatry. 158 (12): 2027–2032. doi:10.1176/appi.ajp.158.12.2027. ISSN 0002-953X.
  16. 1 2 "National Transgender Discrimination Survey Report on health and health care" (PDF). National Center for Transgender Equality and the National Gay and Lesbian Task Force. Check date values in: |date= (help)
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