3 Ways to Make Mental Healthcare More Equitable

By Maria Morran Black (My Soul Balm)

Over at My Soul Balm Blog we’ve talked pretty thoroughly about racial inequality in the US Mental Healthcare system.(Check out our expose on Scientific Racism in the Mental Health Community here)

Now it’s time for the next step in the process. Learning what we all can do to help fix the inequality. This post is specifically for mental health practitioners. However, the principals listed here can be followed in every day life as well.

Clarification on Equity vs. Equality

I’ve referenced this in a few posts but wanted to touch on it again here. Equity is not the same thing as equality (see below)

But, let’s dive deeper this time. True equity should be based on the ideals of Proportionate Universalism. This anthropological perspective encourages policies that are universal. So they meet the needs of the many. At the same time, they should also be flexible; informed enough to proportionately meet the needs of an individual.

So mental healthcare equity would look something like this: providing relevant services based on the specific economic, social, and physical needs and experiences of the individual. However, these services would be governed by universal law; law that protects the interests of people (instead of corporations).

Why is it Important to Make Mental Health Equitable?

Former Canadian Prime Minister Pierre Trudeau

“The Just Society will be the one in which the rights of minorities will be safe from the whims of intolerant majorities.”

— Pierre Trudeau

It’s important to make mental health equitable for BIPOC and other minorities because it is an important step in building a more Just Society. This is a world where basic necessities like housing, healthcare access, and mental health are prioritized for all people, not just the the most or least advantaged portions of society.

A society based on equity and proportionate response to need works more efficiently, has a higher average GDP, and provides individuals with unmatched grow opportunities. A more just society is better for us all.

But even without all that, providing equity in healthcare is just the right damn thing to do. So let’s find out how we can make a change!

So without further ado, here are Three Ways to Make Mental Healthcare More Equitable!

Three Ways to Make Mental Healthcare More Equitable

1. More Multilingual Mental Health Practitioners and Services

According to the Department of Health and Human Services, language is one of the biggest barriers to achieving mental healthcare in the US. Having limited English proficiency (LEP) has also been linked to longer duration of treatable mental health conditions.

The US is a multilingual country — meaning that a pretty hefty chunk of our population has a native language that’s something other than English.

Contrary to common belief, English is NOT the official language of the United States. We actually don’t have one at all. However, English dominates services, signage, forms, and daily interactions. Which can be a HUGE problem for those who have LEP and need mental healthcare.

So what can practitioners and mental healthcare providers do to help LEP patients gain access to care?

1. Provide services, forms and signage in the 8 most spoken languages in the US: English, Spanish, Chinese, Haitian Creole, Polish, French, Vietnamese, and Arabic OR use this map to find out the top languages spoken in your state or area.
2. Remember that ASL is also a language and be able to provide interpretation services to deaf clients
3. Hire multilingual staff based on the language needs of your area
4. Gain at least a basic knowledge of the most spoken languages of patients you see in your area
5. Use a Medical Interpreter Service and check out this important guide on how to interact with patients while using an interpreter. (Pro tip: don’t ever use patient’s children to interpret).

2. More Culturally Informed Mental Healthcare Practices

I can’t express how critical it is to provide culturally and experientially relevant mental health care. So I’ll let the World Health Organization do it for me:

Mental health and many common mental disorders are shaped to a great extent by the social,
economic, and physical environments in which people live.

-The Social Determinants of mental Health (W.H.O)

This means that a person’s environment has everything to do with their mental health. Therefore, their treatment needs to address issues created by those factors in order for healing to occur. So a one size fits all approach to mental healthcare just isn’t going to cut it.

Unfortunately, with such a vast need for mental healthcare, that one size fits all approach occurs way more than we’d like to think. This monoculture of treatment can alienate members of certain communities and prevent them from receiving appropriate care.

Here’s what practitioners can to do to make their practice more culturally informed:

1. Incorporate fact finding on cultural traditions, values, and ideals of a patient on intake forms
2. Ask patient background questions about family, economic, and social circumstances and use those to inform further treatment
3. Adapt treatment plans to patient’s particular needs instead of strictly to their diagnosis
4. Build links with other culturally informed organizations so you can provide effective and appropriate wraparound services to patients of the BIPOC, LGBTQ+, and Migrant communities
5. Strive to keep yourself informed, educated, and up to date on cultural and societal issues that may affect your patient’s emotional state

3. Make Services Easily Accessible to All

You may be saying, “of course my practice is accessible, people can walk right in the door or call for an appointment.”

But guess what? That access is really only available to a slim margin of people. First of all — calling and getting through the anxiety of dealing with a lousy bored receptionist (and insurance forms) is a turn off for anyone seeking mental health care. But it’s especially rough on BIPOC patients who already have cultural reservations about calling a therapist in the first place.

Second, there’s the gatekeeping. Gatekeeping is when a service, community, or workplace attempts to exclude an individual because of their appearance, mannerisms, ethnicity, race or socioeconomic status. (Think of that scene in Pretty Woman. You know the one where Julia Roberts gets treated horribly by a boutique owner because of her appearance as a sex worker). Many members of non-white communities are subject to gatekeeping when it comes to mental health services.

And last there’s the issue of physical access. Yes, your building is accessible but not to people across town who don’t have a car. Sure people can call you to set up an appointment — but what if they don’t have a working phone? Then, after all that there’s, the matter of affordability.

So what can practitioners do to combat inaccessibility in their practice?

1. Support Mental Health Parity Laws and Reform (I’ve said it once, I’ll say it a million times).
2. Provide a sliding payment scale, scholarships, Care Credit, or even pro-bono work for patients who can’t afford to pay huge rates or don’t have insurance.
3. For the love of God, please hire kind, courteous, and understanding office staff. It really goes a long way in preventing gatekeeping.
4. Enlist the aid of a non-emergency medical transportation service to help shuttle clients to services. There are so many companies to choose from nationwide. Plus many states and municipalities already provide this service FOR FREE.

Wrap Up — How Can You Personally Make Mental Healthcare More Equitable?

Even though this article was geared towards MH professionals; we can all learn something from it. Things like gatekeeping, cultural misinformation, and language barriers affect the everyday mental health of many BIPOC.

We can help prevent all that by being informed and working to change the systems we live and work in. Include others in your social groups, watch out for casual injustice in the workplace, and develop a greater sense of cultural empathy with others.

Together, we can make a more just mental health system and a more Just Society in the process.

Much Love,

MB

This post is originally hosted on My Soul Balm Blog

Maria Morran Black for My Soul Balm