Mental Illness in Minority Populations

Diana Charlop
Mental Illnesses in Minority Populations

Background
Mental Illness can be defined as a broad range of medical conditions that interfere with one’s ability to function caused by disorganization of the mind, personality or emotions. This illness is defined by its disruptions of normal thinking, feeling, behavior or interpersonal interactions. In the United States, there is an unconscious idea of the type of people who struggle with mental illness. We have unknowingly created a schema for people who have mental illness – one that does not extend to minority populations. One agency that aims to thwart this schema is the National Institute of Mental Health. They are a federal agency dedicated to researching mental disorders and are part of the U.S. Department of Health and Human Services. At the core of their mission, they aim to transform an understanding of mental health as well as advance research and treatment options. The According to the National Institute for Mental Health,
“members of ethnic and racial minority groups in the U.S. are less likely to have access to mental health services, less likely to use community mental health services, more likely to use inpatient hospitalization and emergency rooms, and more likely to receive lower quality care.”

This statement highlights a growing disparity in mental health care that is often the result of poverty; mental health resources are often associated with higher income neighborhoods because of the expense that it is to seek mental health care.
One of the research endeavors that the NIMH is pursuing right now is trying to reduce mental health disparities globally and domestically. This office is called the Office for Research on Disparities and Global Mental Health. Some of their key endeavors are to do research on Global Mental Health Research, Women’s Mental Health Research, and Minority Health and Mental Health Disparities. As one of the most trusted institutes of Mental Health care, the National Institute for Mental Health provides much of the world’s most updated data on Mental Health disparities in the United States and abroad. They are a crucial entity in understanding many of the facts and data points that surround mental health.

Historical Context: Psychological Treatment of Ethnic Minority Populations
In 2002, Dr. Derald Wing Sue, a professor at the Teachers College at Columbia University, sought to shed some light on the need for cultural competence in mental health practices in America. He studied four Ethnic Minority Psychological Associations to try to understand more clearly the ways that Psychologists and mental health providers can better understand the needs of minority populations. In his book, he looks specifically at The Asian American Psychological Association (AAPA), the Association of Black Psychologists (ABPsi), The National Latina/o Psychological Association (NLPA), and The Society of Indian Psychologists (SIP).
Sue begins his article by examining the diversification of the United States. What was once a country that existed within the context of a white majority, the United States is becoming an increasingly diverse nation through the multitude of immigrants of visible racial and ethnic minorities and the higher birth rates associated with this flux of immigrants; the U.S. Census Bureau predicts that minorities will become the majority by the year 2050, which makes it nearly impossible for mental health practitioners not to confront minority groups in their careers. This statistic and the need for greater mental health intervention in minority groups has been brought to the attention many health care professionals in 2001 at the annual American Psychological Association convention. The Surgeon General of the United States presented key points that summarize the cry for mental health intervention: the mental health needs people of color are still not being met. According to the Surgeon General, we must increase our cultural competence in the delivery of services and understand the cultural and sociopolitical circumstances that effect minority groups. The DSM has even expanded to include sections on cultural variations in clinical settings, tools for clinicians to evaluate and understand the ways that individuals are beholden to their minority status.
His findings reflect a need for more specific care tailored to these individual minority groups. For African Americans specifically, Sue mentions specific cultural biases and disparities within Mental Health practices. He notes that the systems of monocultural and ethnocentric mental health care that we have in place in the United States often lead to implicit biases within health care providers. According to his research, African American patients often feel that they are being invalidated and misunderstood by their providers.

Substance Abuse and Mental Illness
Despite many efforts to bring awareness to the minority groups in Mental Health disparities – specifically in ways that Dr. Sue described – there is still a relatively high rate of minority individuals struggling with mental illnesses. This may be in part to co-morbidity that exists in many populations with mental illness and substance abuse.
In 2016, the Substance Abuse and Mental Health Services Administration produced these statistics about several minority group populations. Though the rates of diagnosing mental disorders are usually low among African Americans, 16.3% were reported for having mental illnesses while 3.8% of African American adults are reported to have both substance abuse disorder and mental illnesses. African Americans make up about 14.2% of the total population with about 44.5 million African Americans in the United States at the time of this survey.
Firstly, it is imperative to consider the percentages of minority groups that exist in poverty. The socioeconomic circumstances are crucial in their access to mental health resources. Additionally, many of these circumstances are results of a lack of education — whether those have lack of funds to access an education or no suitable options for education to take place. This is part of the cycle that perpetuates the overlap between substance abuse and mental illnesses. The way to proceed, notes Sue, is threefold:
“Firstly, clinicians must become aware of their own worldviews, their biases, prejudices, beliefs, and values. Without this knowledge, they are more likely to bring their own implicit biases into the workplace. Second, it is important for therapists to become aware of the worldview of clients and client groups that differ from them, without which, they cannot understand and empathize with their clients. Third, there is a strong need for helping professionals to develop culturally effective helping modalities and goals consistent with the life experiences and cultural values of their culturally diverse clientele. This means that clinicians must be flexible in their therapeutic approaches, play alternative helping roles (advocate, consultant, facilitator of indigenous healing approaches), and be willing to take a systemic perspective in interventions.”

Case Study: Willow Weep for Me
In the memoir Willow Weep For Me, author Meri Danquah articulates an opinion that we often don’t hear. She is able to bring to light her experiences struggling through depression as a black woman – how her experiences are often invalidated and excluded. Her experiences speak to the struggles of three very different communities: the African American, female and mentally ill community. Meri Danquah describes this intersectionality:
“The illusion of strength has been and continues to be of major significance to me as a black woman. The one myth that I have had to endure my entire life is that of my supposed birthright to strength. Black women are supposed to be strong – caretakers, nurturers, healers of other people – any of the twelve dozen variations of Mammy. Emotional hardship is supposed to be built into the structure of our lives. It went along with the territory of being both black and female in a society that completely undervalues the lives of black people and regards all women as second-class citizens. It seemed that suffering, for a black woman, was part of the package. Or so I thought.”

This passage suggests the ways in which society views the suffering body as well. If the suffering body fits into multiple categories of suffering at once, there is some sort of cognitive dissonance that occurs there. In addition to little action taken, Danquah noted that there was often little support from her own people to address mental health. There was a pervading notion that she should be able to handle her illness by herself. As Danquah mentioned, there is a preconceived notion from the people around her that she is supposed to endure hardship as a black woman. This inhibits many people from seeking treatment; they often feel weak if they are not able to deal with their given circumstances. It is important to remember that the stigma of mental illness propels this idea as well.
Though Danquah does not represent the entire umbrella of minority groups, she is an important person in writing about her struggle with mental health while being black. She brings to light intersectionality in a time when is an increasingly hard notion to understand.

Politics of Health and Context
Mental illness exists in all populations; regardless of age and race, mental illnesses are extremely prevalent. When understanding the ways that mental illness plagues minority populations, it is imperative to understand the socioeconomic and cultural struggles of that community. To bring mental health reform communities of minority groups will require a deep understanding of the conditions barring them from getting access to mental health services, or their biases to abstain from mental health care. It is also important to address substance abuse disorder and how they may increase mental health disorders in communities – the comorbidity that exists between these two disorders.
It is equally important for each member of any community to be a responsible participant in understanding the basics of mental illness. Recognizing the warning signs and working to provide support within communities that may not be understood by mental health professionals is equally as crucial. Conversely, it is imperative to seek the help of mental health professionals and try to explain and articulate the way that minority communities are being negatively affected by mental illness in a way that the majority population may not be attuned to. The reform to mental health care can only occur if there is a wider spread understanding and awareness of the way that mental health disorders are affecting minority populations.
Much of the hesitation that exists around pursuing mental health in minority populations is the structural violence that is embedded into the fabric of our mental health system. As Dr. Sue mentioned in his paper, there is a lack of cultural competency that relates to minority populations. To not understand different cultures within the American population is to undermine the care of specific groups. To go to mental health professionals would often decrease mental health conditions, fearing that a misunderstanding of culture and implicit biases and stereotypes may interfere with appropriate treatment options. There is a great divide in the rights guaranteed to citizens of the United States through their biological citizenship. It seems that if a person belongs to a minority group, there is a significantly lower chance that they will receive the health that they deserve. To understand the way that structural violence interferes with biological citizenship is to begin to reckon with the problems in the Mental Health Care system, as they exist today.

Citations:
CDC. Retrieved March 27, 2017, from https://nccd.cdc.gov/PRCResearchProjects/Search/SearchResults.aspx#modalIdString_gvSearchItemsList

Danquah, M. N. (1998). Willow Weep For Me. New York, NY: W.W. Norton & Company.

National Institute of Mental Health (2015). Minority Health and Mental Health Disparities Program. Retrieved March 25, 2017, from https://www.nimh.nih.gov/about/organization/gmh/minority-health-and-mental-health-disparities-program.shtml

National Institute of Health (2014, February 14). Racial and Ethnic Disparities in Mental Health Care: Evidence and Policy Implications. Retrieved March 27, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3928067/

Sue , D. W., PhD. (2002). Psychological Treatment of Ethnic Minority Populations. Retrieved March 28, 2017, from https://www.apa.org/pi/oema/resources/brochures/treatment-minority.pdf

Substance Abuse and Mental Health Services Administration (2016, February 16). Racial and Ethnic Minority Populations. Retrieved March 27, 2017, from https://www.samhsa.gov/specific-populations/racial-ethnic-minority

The Merriam-Webster dictionary. (2016). Springfield, MA: Merriam-Webster, Incorporated.

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