A shameful disparity: Minorities & Mental Illness

Earlier this week, I had the good fortune to attend Pride in the Park, the Lehigh Valley’s annual LGBT festival.  I always bring the family and it’s a blast; it’s interesting, has great vendors, good food and is a great time for the kids.

On our way out, I commented to my wife that everyone at the event always seemed so happy, and how relaxing it must be to attendees to be in a place where you know no one cares who you are.  My wife corrected me: Everyone cares.  Period.

This reminded me of a tragic reality about mental illness in America: If you are a minority, you are more likely to be mentally ill, and less likely to be treated.

Before I go into the statistics, one caviet: “Minorities” is a broader term than you think.

African-Americans
African-Americans make up 13.2% of the U.S. population, and 16% of those have a diagnosable mental illness.  However, the disparity is striking.  African-Americans are 20% more likely than whites to say they suffer from serious psychological issues.  They also feel worse, in terms of sadness, hopelessness and worthlessness, than whites. Stigma-related attitudes are more likely to be held by African-Americans than whites, and cultural competency amoung mental health providers remain a real issue.  Perhaps most significant: 15.9% of all African-Americans are uninsured, compared to 11.1% of whites.

LGBT Americans
LGBT Americans are three times as likely to suffer from mental health conditions than the rest of the general population.  According to the National Alliance on Mental Illness, much of this is due to “minority stress,” including, “social stigma, discrimination, prejudice, denial of civil and human rights, abuse, harassment, victimization, social exclusion and family rejection.”  Suicide is also a major issue within this community, with suicide for LGBTQ Americans aged 10-24 being described as “one of the leading causes of death.”  LGBTQ individuals are four times as likely to attempt suicide than the general population, and 38-65% of transgender individuals experience suicidal ideation.

Rural Americans
Clearly, rural Americans are different than some of the other groups here.  But, that doesn’t change a central fact: They have similar challenges when it comes to mental health than many other groups.  Rural Americans have roughly the same rate of mental illness as the rest of the population.  However, poverty is higher in many sections of rural American, and stigma presents a huge cultural barrier to seeking care. Additionally, rural Americans have problems with accessing care due to practitioner shortages and transportation issues.

American Indians
This is astonishing: The suicide rate among males, aged 15-24, who are American Indian or Alaskan Native, are 2-3 times greater than the suicide rate for whites.  Additionally, 21% of all Native Americans had a mental illness over the past year, and they experience psychological distress at a rate 1.5 times more than the general population.  High levels of poverty, a rural location, poor transportation and low rates of health insurance (33%!!) all lead to low treatment usage.

There is more, but these were just some of the low lights.

I don’t want to necessary explore this from a policy perspective – at least, in this entry.  I’d rather approach this from the personal perspective.  In this sense, I suppose I am lucky; I’m a white, male, young adult, whose only claim to any sort of minority status is that I am Jewish.  That being said, I cannot imagine how difficult it must be – to be a member of one of these communities and have your ability to get and receive care be compounded by factors beyond your control and things that shouldn’t make a difference anyway.

Now, to ignore what I just said: Speaking a a policymaker, it’s pretty clear that there is no one size fits all approach to ending mental health disparities.  A ton of factors play a part, including access to care, stigma, availability of practitioners, cultural competency, discrimination and more.  Mental illness is a huge problem, and an under discussed one.  I suppose that’s why I’m blogging and lending my name to this effort.

We have to do better.