Pediatric Minority Mental Health: 5 Barriers to Getting Care & How PCPs Can Help
Note: This blog post is specifically focused on racial & ethnic minority mental health in honor of Minority Mental Health Awareness Month. Last month, we released an article on the mental health of those in the LGBTQ+ community; please refer there for further information and resources regarding this community’s mental health.
Pediatric Minority Mental Health in 2024
Despite relatively consistent rates of mental illness across racial and ethnic groups, only 13% of minority youth receive mental health treatment, compared to the 31% of their Caucasian peers. When racial and ethnic minority youth are able to get help, they are may receive reduced quality care, putting them at risk for lifelong consequences linked to poor or nonexistent treatment for mental illness. These consequences include:
- Increased mental distress
- Deviant behaviors and crime
- Poor academic performance
- Dropping or failing out of school
- Abuse of drugs, alcohol, and other substances
- Unsafe sex and teen pregnancy
- Unemployment and inconsistent employment
While connecting these youth to mental health services may seem like a relatively straightforward solution, systemic barriers can complicate access. Here are just a few of the most prevalent barriers that exclude racial and ethnic minority youth from the mental health treatment they need.
Five Barriers to Minority Mental Healthcare
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Low Rates of Diversity Among Providers
Most healthcare providers (and mental health professionals!) are Caucasian. However, this trend is not consistent with racial and minority groups. For example, even though African American people represent 13% of our population, they make up only 5% of the physician workforce. This can cause complications with communication and diagnosis accuracy with minority patients, who tend to see better outcomes and higher levels of trust with providers who reflect them and their communities.
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Higher Rates of Uninsured or Underinsured Patients
Across America, members of racial and ethnic minority groups are more likely to be uninsured or underinsured than their Caucasian counterparts. This gap was significantly reduced by the introduction of the Affordable Care Act (ACA) in 2014, but it still persists today. Health insurance is key to receiving care, since many providers will not take patients without insurance or without certain kinds of insurance, which often have higher premium costs. If a patient pursues healthcare without insurance, they often pay high out-of-pocket fees. Unfortunately, this means that children living in families without insurance are much more likely to experience treatment delays or go without care entirely.
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Presence of Mental Health Stigma
Mental health treatment is often surrounded by stigma, or a series of untrue beliefs. Stigma stands as a barrier between someone with a mental illness and the treatment they need by making them feel judged by themselves, society, or others for getting help. Stigma can be higher in racial and ethnic minority groups, who may experience social adversities such as poverty and discrimination within policies and institutions, and is linked to a multitude of negative outcomes, including treatment avoidance and worsening mental health. Children and adolescents are particularly vulnerable to stigma, which can prevent them from receiving the early interventions they need for their best chance at recovery.
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Distrust in the Healthcare System & Healthcare Providers
Racial and ethnic minority youth and adults alike experience reluctance and fear about getting help from a healthcare provider or mental health specialist. Unfortunately, it’s not unfounded. Throughout modern history and still today, rates of misdiagnoses and biased diagnoses, care complications, and other poor health outcomes are significantly higher in minority populations. Many minority communities have also experienced historical exploitation in the name of medical research. This has resulted in less participation from these communities in modern medical studies, leaving them largely underrepresented in research outcomes.
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Criminalization over Symptoms of Mental Illness
Regardless of race, people living with mental illness in America are ten times more likely to be incarcerated than hospitalized. It’s estimated that more than 70% of people in jails and prisons in America are living with at least one mental illness, substance abuse disorder, or both. To make matters worse, the jail and prison populations in America disproportionately reflect our nation’s population. African American people make up only 13% of the American population but constitute 33% of the sentenced prisoners. In contrast, Caucasians account for 61% of the nation, but represent 30% of prisoners.
This is not something that only impacts adults—researchers continue to find that mental health issues in minority youth often result in punishment or incarceration instead of healthcare and treatment. Even as early as preschool, African American children have higher rates of suspensions, expulsions, and other disciplinary action than their Caucasian peers.
How PCPs Can Support Pediatric Minority Mental Health
Even though these disparities existed long before you meet your patient and their family, PCPs treating patients 21 and under play a pivotal role in addressing them. This is especially true when it comes to mental health, since many patients visit their PCPs first for symptoms of mental illness before they connect with a mental health professional.
Download the infographic on the right by the Center for Health Care Strategies for a great summary on how you can directly engage patients and families in transformation efforts. See below for ideas on how you can foster a more culturally sensitive environment!
Note: As you read the tips below, keep in mind that it can also be helpful to consult with community members, leaders, and other people who have experienced barriers affecting racial and ethnic minorities when you’re considering how to create a culturally sensitive practice.
Don’t be afraid to admit what you don’t know.
If you are not a part of a racial or ethnic minority group, practicing cultural humility and sensitivity has been shown to increase connection and communication with patients who are part of these communities. This is done by reflecting on what you don’t understand about your patient’s racial or ethnic background and being willing to learn, listen, and validate their experience. Check out the Anti-Racism Action Guide for Pediatricians, which details how to talk about topics of race and ethnicity with patients at every age.
Recruit staff that reflect the patients you serve.
Make a concerted effort to hire staff that are representative of your community and your patients.
Review cultural awareness guidelines from professional organizations.
The American Medical Association, American Psychological Association, the Center for Disease Control & Prevention, and National Association of Social Workers all have released patient care standards and guidelines regarding cultural awareness and health equity.
Take a training to increase your cultural sensitivity.
Many organizations offer trainings specifically designed for providers who want to become more informed and create better experiences for their racial and ethnic minority patients. Here are some you might be interested in:
- ACP CME Cultural Competency Trainings
- ABP CME Diversity, Equity, & Inclusion Education
- HHS CME: A Physician’s Practical Guide to Culturally Competent Care
- Nationwide Children’s CME Trainings
Utilize free resources on health equity.
The American Academy of Pediatrics (AAP) has developed a series of Health Equity Resources for pediatric healthcare professionals. From patient care tip sheets to resource repositories for both you and your patients, this is a great place to get started!
Provide inclusive mental health resources.
Mental health awareness, especially for those in racial and ethnic minority groups, isn’t something that’s limited only to one month of the year. Make sure you have resources to direct your patients to when they need them. The American Foundation for Suicide Prevention has an index of mental health resources for those in minority communities, and you can also check out the printable resources below to hand out to patients and their families.
We hope this article and the resources linked above have helped you feel more prepared to support your pediatric patients. As always, if you need additional support with the mental health of a patient under the age of 21, you can call the VMAP Line for a free consultation and care navigation!