
DISCLAIMER: Minorities refer to multiple people groups, based on sexuality, gender, race, ethnicity, and more. In this article, I will be focusing on minority people groups related to race.
July is national minority mental health month (aka BIPOC mental health month)! As you might know now, I like to focus these monthly blogs on mental health and what we can do to improve our own wellbeing, and the wellbeing of others around us. So drawing attention to the fact that minorities often face things like systemic racism and lot of other factors in terms of seeking medical care (mental health care included!!), I want to talk about the reality of minorities in the US and mental health.
First, some basic information. In 2015, the American Psychological Association stated that 86% of American psychologists were white. The US population in 2015 was only 62% white. And you might think “oh! That was 8 years ago! Surely things have changed significantly!” Though the percentages have changed slightly (psychology’s workforce is now only 84% white), there’s still a huge rate of white psychologists.

As a therapist, during my Master’s, I took classes that really emphasized the fact that we need to be understanding and validating of diverse people groups. We have to understand cultural differences and respect them. I was lucky enough to go to a diverse school, so we got lots of different worldviews and perspectives, and I had plenty of classmates and professors who were not white, and not from the US. This was something that was extremely beneficial to me.
That doesn’t mean the learning is over, nor does it mean that the racism and issues within therapy and psychology is over. Different minorities are affected at different rates by certain mental illnesses. Some of this stems from significant historical trauma. Some of this stems from the consistent oppression that people groups have faced, and ongoing racism. For example, in 2018, a Black American was 2.4x more likely to be diagnosed with schizophrenia than a white American. That is hugely significant. A diagnosis of schizophrenia is by no means the end of the world, and plenty of people with this diagnosis go on to live a happy, healthy life. But it is still a serious diagnosis: one that has to be monitored throughout one’s life.

You might wonder why this is. Is it because Black Americans “just get” schizophrenia more? I think it’s absolutely critical to look at the reality of bias in diagnoses, and how living conditions affect people, too. One article linked here looks into the fact that Black Americans are sometimes more cautious of medical providers and worried about their results (this makes sense– think of the Tuskegee experiments!), which some therapists or doctors could think of as paranoia, a symptom sometimes linked to schizophrenia. This article also talked about the possibility of how living conditions (our environment) impacts mental health. Often, people with less access to healthcare, safety for their kids, safe housing and safe jobs have high chronic stress. Chronic stress can lead to a variety of mental illnesses– schizophrenia included. And trauma influences this, too– not just for Black Americans, but all people. 21% of Black Americans live in poverty (and 25% of Native Americans). Poverty directly correlates to worse mental health.
Something else to really draw on here is that white Americans are the most likely to receive mental health care. Affordability, access, and a variety of other factors contribute to this. This doesn’t feel or look right: how could Black Americans, who are diagnosed with something like schizophrenia at a much higher rate than white Americans receive less care? Racism, affordability, access to healthcare, poverty rates, and trauma all relate to this. Further, lack of trust, being at risk of being uninsured, differences in culture in terms of help-seeking, and differing perceptions of mental health/illness are also important.
The thing is, though, these factors can get ignored easily, especially by white healthcare providers, who may have never had to face these issues personally or with friends or family.
Let’s look at the rate of Major Depressive Disorder (MDD). This is a disorder that’s fairly well known and understood by the general population. In Black and Hispanic communities, this mental illness is likely underdiagnosed. Part of this is due to inaccessibility, insurance issues, costs, and not being prescribed medications. The CDC found that in reality, MDD rates are likely similar to white Americans. But it’s easier to diagnose and treat in people who are able to seek the care that they need, and are understood by their providers. More often, these are white Americans. Hispanic and Black Americans are seen to be more likely to rely on help outside of mental health providers because of the lack of trust due to the history of healthcare in the United States. And that’s not on them– that’s on the healthcare providers to work on. That’s on the mental health providers to learn about cultural impact, the history of racism in the United States, and how to best incorporate family, friends, and religion into the treatment of each client.
Now, let's look into more detail why Black Americans are diagnosed with schizophrenia at higher rates than white Americans, but underdiagnosed with MDD:
Because of racism. The view of psychosis in a Black American vs. a white American, and the greater likelihood that Black Americans will be seen as paranoid, when in reality, they might be more cautious of the medical/healthcare system. Oh, and Black Americans are more likely to be incarcerated than white Americans who have a mental health diagnosis like schizophrenia or bipolar disorder.
The accessibility of treatment and how environment impacts mental health (looking at rates of poverty). Those in poverty face more mental health conditions, and have less access to care to get the help they need.
Overlooking mood disorders in Black Americans when symptoms of MDD present, and paying more attention to symptoms that resemble psychosis. Again, due to racism and perceptions of the healthcare provider.

Here are some more statistics to think about, in terms of minority mental health month:
In 2019, death by suicide was the second highest cause of death for Hispanics and Latinos between the ages of 15 and 34. Hispanic-American/Latina-American girls in grades 9-12 were also more likely to try and commit suicide than white girls.
These statistics aren’t meant to scare us. They're also not a reason to assume that the person of color you meet has a mental illness. These statistics are meant to bring to light the reality of mental health care in the United States– and what we need to be doing to get people the services they need and reduce the racism, oppression, and stigma so many people of color face in their daily lives. We need to make mental healthcare accessible to all people. Yes, in the past it was geared towards white Americans, but that should never have been an option. What we, as a society, need to do is look into the importance of multiculturalism, the history of racism, and what we can do for outreach in our communities.
Things aren't hopeless. The fact that so many can now access mental health over teletherapy is a huge step in the right direction– it reduces the problem of inaccessibility. Another great step we’ve taken as a society is implementing multiculturalism classes into every counseling program for future therapists and mental health professionals (I’ll argue that it’s not enough, of course, but it’s a start!). Society has also become more enlightened as to what minority groups have been facing for hundreds of years in the United States. Should it have taken this long? Of course not. But it is one step at a time, and recognizing the history of racism and intergenerational trauma takes us closer to understanding the discrepancies in minority mental health.
Another thing that I personally recommend, is to read. Read as much as you can about minority mental health. Even if you aren’t a healthcare provider, it’s important to be aware of why this is the reality of mental health in the United States. And take it a step further– read books like How To Be Antiracist by Ibram X. Kendi for not only an enlightening point of view, but also a bit of a “how-to” when it comes to recognizing the struggles of minorities in the US. Click on the hyperlinked articles in this blog, too, if you have time, for a deeper understanding of minority mental health. And remember that every struggle is unique. Minority groups must understood by majority groups, other minority groups, and society as a whole to better the mental health of our world.
JB
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