Stigma and Systemic Barriers

These inequities have resulted from historical exclusion and racism that continues to pervade our education, criminal, housing, and health care systems. Experts anticipate increased mental health needs in the wake of COVID-19, which heightens the need to address stigma and systemic barriers that create disproportionate access to mental health care for people of color.

Mental health stigma is a persistent challenge for many. Nearly half (47.3%) of Coloradans who said they did not get needed mental health care cited stigma as a reason in 2019. There are countless reasons a person can be reluctant to seek care, but for people of color, cultural factors can make the stigma around mental health especially difficult to overcome.

While the experiences of different racial and ethnic groups and individuals are unique, some harmful notions about mental health can be magnified for people of color. These mental health myths create additional hurdles to seeking care.

• Myth: A mental health condition is nothing compared with the hardships experienced by previous generations.
• Myth: A mental health condition is a sign of weakness.
• Myth: A mental health condition is shameful.

Compounding mental health stigma is the system of oppression that exists from centuries of racism and discrimination.

Systemic barriers prevent people of color from accessing care and treatment.

For as long as the U.S. has existed, people of color have faced race-based exclusion from accessing health, educational, social, and economic resources. Today, disparities persist and are reflected in lower rates of health care access and treatment. 

Data from the Centers for Disease Control and Prevention (CDC) show that white adults were significantly more likely to have received mental health counseling in the past 12 months than Black or African American, Asian, or Native Hawaiian/Pacific Islander adults (see Figure 1).

Good health is not equally distributed, and systemic problems continue to negatively impact health outcomes for people of color.

Abuses within the medical system have created deep mistrust in many people of color.

Mistreatment of people of color in the health care system is rooted in U.S. history, such as the Tuskegee syphilis study and the forced sterilization of Native American and Black women. And today, negative experiences, misdiagnoses, and inadequate treatment persist.

• Compared with white patients, African American and Black patients are misdiagnosed at a higher rate with schizophrenia spectrum disorders and are less likely to be offered needed antidepressant therapy, even when they have access to insurance or financial resources.
• The soundly disproven stereotype that Black people have a higher pain tolerance continues to pervade the health care system, negatively affecting pain management for Black patients.

There is a shortage of culturally and linguistically competent providers.

The racial and ethnic diversity of the country is increasing. About 40% of people in the U.S. identify as non-white. However, representation in the medical field has not kept pace. For example, only 16.0% of the U.S. psychologist workforce is non-white. Beyond racial and ethnic diversity in the medical field is cultural competence. Aging of the current workforce, low rates of reimbursement, and lower salaries in community-based behavioral health positions create a workforce shortage that contributes to the lack of health care providers who are linguistically and culturally competent.

Cultural competence displays empathy, compassion, and mutual respect for a patient which can address issues of mistrust. Culturally and linguistically competent providers are critical to delivering effective, patient-centered care. They can overcome language barriers and are more familiar with the ways people can describe physical symptoms to avoid talking about their mental health. Failing to pick up on these nuances can lead to misdiagnoses and ineffective treatments, and it could explain the lower reported prevalence of some mental health conditions among non-white groups.

Decades of mistreatment and discrimination have created daunting barriers for people of color to engage with the health care system, in Colorado and across the country.

This system of oppression will continue to create disparities unless the legacy of unequal treatment and harmful stigma is dismantled equitably at all levels of the health care delivery system — from reducing bias through medical school education to implementing community-based interventions, and increasing funding for mental health research that is inclusive of people of color. These systemic changes are critical to building a foundation of cultural competency and trust.

Leveraging protective factors among communities of color can help address the stigma that contributes to mental health myths and break down some systemic barriers to care.

These opportunities — and examples of how many Colorado organizations are supporting communities of color — are detailed in CHI’s forthcoming report, Resilience and Protective Factors: Avenues to Improving Mental Health and Reducing Health Disparities.