Lower-income communities of color have fewer mental health providers. That has implications

These areas need care, but experts say the key is finding the right providers to cross language and cultural barriers.

Saturday, May 20, 2023
Lower-income communities of color have fewer mental health providers
Underserved communities need more mental health providers, but experts say the key is finding the right providers to break down language and cultural barriers.

LOS ANGELES (KABC) -- In a brightly-painted, mural-filled room at Tessie Cleveland Community Services in South Los Angeles, Sylvia Ramirez, the director of development and special projects, remembered the time she knew she was on the right track.

It was at an awards ceremony where the founders of the non-profit mental health center were given an award. But that award wasn't the moment she knew. It was when another student received a scholarship at the ceremony.

"And before he thanks his family or anyone else...he says, 'I just want to thank Tessie Cleveland Community Services because I used to be a client,'" Ramirez said.

"So we're at our table, goosebumps, almost in tears," she continued.

After 10 years at a center that provides mental health substance abuse services to children, families and adults, "it took that one individual" for Ramirez to know she was making a difference.

Tessie Cleveland now has about 50 providers from therapists and substance abuse counselors, to case managers and peer specialists across Southern California. But, Ramirez said they still need more.

"I think we should be at about 70. So we're a little shy," she said.

Ramirez spoke with Eyewitness News at Tessie Cleveland's South L.A. location, where they are one of just a handful of providers in their zip code.

There are fewer mental health providers per 100,000 people in lower-income zip codes with a higher percentage of people of color, compared to higher-income, whiter zip codes, according to an ABC7 analysis of the federal government's health care provider database.

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For example, in zip codes where the median annual income is less than $60,000, there are about 116 mental health providers per 100,000 residents. That's compared to zip codes with a median annual income of more than $110,000 where the number of mental health providers per 100,000 people is about double, at 238.

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And there's a similar pattern looking at zip codes by the percentage of people of color. Zip codes with less than 25% people of color have more than four times the mental health providers per 100,000 people compared to zip codes with more than 75% people of color.

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"One of the concerns with not having enough providers in certain communities is that people don't get the help that they need, and maybe that they want," said Dr. Erlanger Turner, an associate professor of psychology at Pepperdine University and the founder of Therapy for Black Kids.

"And so we know that for a certain disadvantaged, underserved, underprivileged, marginalized communities, that they also experience other stressors that maybe those that may be more wealthy may not experience, and so that also puts them at a much higher risk of having some type of mental health challenge," Turner said.

Yet, research shows people of color can be less likely to seek mental health services, and Turner said this is yet another barrier.

Ramirez said many clients served by Tessie Cleveland have stress from trauma.

"You're seeing higher percentages of adults in this community with depression," she said. "And so it becomes really difficult to try to provide the services to these clients when you're you don't have the staffing levels to do so."

According to Ramirez, with more people to serve and fewer providers, it's a recipe for burnout.

"If I have to see more clients, I get more tired. Compassion fatigue is real," she said.

The need for culturally competent care

More staff is important, but the right staff is even more important. It's what the health care industry calls cultural competency.

"When we say culturally competent services, we're not only referring to language, we're referring to people who look like the community," explained Ramirez.

"If I see that the community is 70% Latino, 50% monolingual Spanish, my next step is to hire people who can speak Spanish, and who look like the people that they're serving," she continued.

Having a mental health care provider that looks like or is from the community they are serving helps clients feel more comfortable.

"It also makes it less likely that the client is going to have to provide some education to the therapist in terms of their own background and history," said Turner.

But it can be hard for nonprofits like Tessie Cleveland to hire all the mental health workers they need.

"We can't compete with hospitals and school districts who can pay more, who offer a nine to five job," Ramirez said.

"We're field based, we're in the community, we want to meet clients where they are," she continued.

Funding is another challenge.

"If there is a grant or proposal that comes out and you've got 50 people applying, how many of those individuals or individual providers are going to get awarded a contract? And that's where it becomes difficult," Ramirez said.

The pros and cons of telehealth

Providing care virtually, or telehealth, can be one solution to gaps in mental health care availability in communities.

"If we have providers that can provide therapy through the computer or Internet, that helps to increase the availability of people who may not be, sort of, locally connected to someone," Turner said.

But it's not a catch-all solution. Some providers may hot have the availability. Some clients may not have reliable internet access.

Other clients may need in-person services, like young children or people who need exposure therapy, Turner said.

He also pointed to a longer-term solution: exposing students to mental health careers before college.

"Maybe high school, middle school, where we can begin to provide that sort of interest in helping people explore that this actually might be a viable path for them as a career," he said.

Not knowing where to start

When it comes to finding care, Turner said many people don't know where to start. His organization, Therapy for Black Kids, provides a mental health care directory to help combat this barrier.

Ramirez and her team at Tessie Cleveland have outreach events, many targeted towards kids and young adults featuring things like a video game truck and a coffee truck.

Staff will often go into communities after a traumatic event and offer mental health services to community members, just in case they need or want to talk about what happened.

Ramirez said she just wants to continue providing quality services to her community.

"That's what they deserve. Good quality mental health services that's gonna get them from point A to a sense of, 'I met this goal, I'm OK,'" she said.

Mental health resources:

Substance Abuse and Mental Health Services Administration Helpline: 1-800-662-HELP (4357)

Health, human and social services number: 211

988 Suicide & Crisis Lifeline

Therapy for Black Kids

Tessie Cleveland Community Services