Race & mental health: Why people of color may be less likely to seek out services
White SoCal residents are 2.5 times more likely to find a mental health professional that looks like them than people of color.
LOS ANGELES (KABC) -- The holidays can be an especially stressful time. And for some, they can magnify mental health issues.
Research shows people of color can be less likely to use mental health services.
"Those who need it the most are most likely to not get it," said Dr. Cheryl Grills, a psychology professor at Loyola Marymount University.
There are several barriers like cost, stigma and even cultural history, according to experts.
An extended conversation with Dr. Cheryl Grills on race & mental health:
A pair of studies published this summer from UCLA focused on mental health needs in Latino and Asian communities in California. Researchers found the percentage of people who reported symptoms of depression and anxiety was measurably higher than those who said they actually needed help.
"These differences between subjective and objective measures of needing mental health services may indicate that there's a gap in mental health literacy, meaning more work may be needed to reduce stigma and help to normalize the conversation about mental health and the use of mental health services in these communities," said Dr. Imelda Padilla-Frausto, one of the co-authors of both studies and a research scientist at the UCLA Center for Health Policy Research.
But, even those who felt like they needed help had trouble getting it.
Nearly half of Latinos and Asians in the study who said they needed mental health services didn't receive care. Among those experiencing symptoms, but perhaps not knowing they needed help, about two thirds didn't receive care.
According to experts, not getting help can magnify problems.
Dr. Cheryl Grills explained that for most people, the breaking point of stress may be high, but for historically oppressed communities of color, the bar is much higher.
"But now that doesn't mean that because I have a higher level of tolerance for stress and trauma, that it's okay. Having this higher threshold actually still can do harm and damage not only to my mental health, but also to my physical health," Grills said.
Barriers to care
Part of the barrier to mental health services is the cost.
Dr. Grills said seeing a private psychotherapist can easily cost $200 or more per session without insurance. Even with insurance, coverage can vary.
"You can have an insurance policy that includes mental health, but it limits you to six sessions of brief psychotherapy. Well, that may not be adequate for what you need," Grills said.
"It may restrict you to a particular set of providers, which also can be problematic if they do not have a pool of providers that align with your racial, ethnic, sexual orientation, gender identity realities," she said.
Communities of color are also more likely to live below the poverty line.
"In that reality, then, you're stuck with whatever are publicly available sources of support. And the waiting list for that can be extremely long, your ability to qualify can be sometimes dicey and difficult. So not having financial resources and not having insurance that provides the kind of flexibility one needs to find a therapist that works for them means you have a lot of people who are out in the cold without the ability to access needed services."
It's like going shoe shopping
Grills emphasized the importance of finding a mental health professional that you can connect with.
She said most people might be able to get by with a physician who perhaps doesn't have the best bedside manner, but has the technical skills to treat their patients.
It doesn't work the same way for mental health care.
"That's not as easy a thing when you're talking about therapy and you're sharing the most private and vulnerable parts of who you are," Grills said.
She related the experience of shopping around for a therapist to shoe shopping.
"When you go to buy a pair of shoes and you try on the first pair that you saw, do you immediately buy them? No. A lot of people try four, five, six different pairs. They moderate the size of the shoe that they think they like the most. Well, you know getting a therapist that you can actually relate to can require the same level of care and flexibility as one exercises when going shoe shopping," she said.
Lost in translation
Hesitation among people of color to seek out mental health services may also stem from a historical mistrust of the mental health community.
"We've seen mistreatment by the profession in terms of not getting, sort of, the same level of care that their white counterparts may receive," said Dr. Erlanger Turner, a psychologist at Pepperdine University and founder of Therapy for Black Kids.
That is why Turner said many prefer to work with someone from a similar community.
"They have a stronger trust in that person and being able to open up to them," he said.
"When we see a client who is able to make that connection with the therapist, who is from their own community, that strengthens that rapport, that relationship, we see that the clients are more likely to stay engaged in treatment," Turner continued.
In addition to trust, cultural and language understanding is crucial, experts said.
"Things do get lost in translation," said Dr. Grills.
"There are number of concepts in different ethnic, cultural groups for which we don't have equivalent understanding of, or recognition of, in how we look at mental health," she continued.
Grills said a lack of language and cultural understanding by mental health providers can contribute to a misdiagnosis.
"Culture matters, worldview matters, life experience matters, the words one knows matters, the proverbs and analogies that one has available to them matters," she said.
"There's nothing more draining, frustrating, distracting than having to repeatedly explain to a therapist what you mean by something," Grills said.
A legacy of structural racism
Finding a mental health professional from your own community can be more difficult if you are a person of color.
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An ABC7 analysis of Census data shows white Southern Californians are three times as likely to find a mental health professional that looks like them than Latinos and Asians, and one and a half times more likely than Black Southern Californians.
"The root is the legacy of structural racism in education and income inequality and housing and, you know, in job creation," said Grills.
Dr. Turner from Pepperdine said a lack of diversity in psychology programs in schools can lead to a vicious cycle.
"Some students will get into these programs, and then they don't feel supported or feel represented and so that makes them less likely to complete their degrees," he said.
Psychologists see the largest gaps. Nearly 70% of psychologists in Southern California are white, but just 30% of the population is.
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School psychologists have similar demographics. But it's important that school psychologists understand the different lived experiences of students of color, according to Dr. Turner, who studies child psychology.
"We oftentimes see that if kids are experiencing mental health difficulties, if they're experiencing some type of trauma, if they are witnessing stressful living environments, that can show up in terms of academic and behavior problems," Turner said.
Turner also said if schools are just looking at behaviors without understanding the underlying mental health and life experiences leading to the behavior, they will not "be able to adequately address those concerns and the kids are going to be negatively impacted."
The importance of diversity in every specialization
Social workers and counselors, especially those who work in the substance abuse field, are much more diverse. Experts said this is, in part, because of differences in the licenses and education required.
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"There can be a more diverse pool of them," said Dr. Cheryl Grills.
"Who ends up being a drug counselor? Sometimes it's people who have had the lived experience of substance abuse and addiction who then in their recovery and the stability of their recovery they determine that they want to serve," she said.
Grills emphasized that it's still important to have that diversity in every level of the mental health profession because different specializations serve different needs.
"If I have a BMW car would I take it to a...Toyota dealership? Where they may or may not be familiar with the parts? With the machinery? With the fine tuning? With how that particular kind of car works?" Grills asked.
"If we can understand the importance of specialization in all these other areas of our lives, why is it that not that appropriate when it comes to our mental health?" she continued.
Grills said there is a shortage of mental health professionals in general, but community-based support groups, like those that are part of the California Reducing Disparities Project, can help fill the gap and provide a stepping-stone to formal therapy.
Grills is part of the team that developed the model for these groups.
"The last one I observed, I kid you not, it rivaled the best group therapy I think I've ever seen in terms of the level of sharing, the self-disclosure, the level of emotional vulnerability and the level of community and mutual support that people were sharing with each other in the group," she said.
Grills said the mental health field needs to "catch up" to the ways communities of color already use culturally-based strategies to deal with their mental health, like spirituality.
"We need to begin to build our intervention strategies from that space, as opposed to some of these evidence-based practices which were never fully tested on diverse ethnic and cultural communities. And so, they may be evidence for some people, but they're not evidence for everyone," she said.
Her advice to people who might need help?
"Look inside your own culture, and what does your culture provide as a tool to help support your well being?" Grills said.
Mental health resources:
Substance Abuse and Mental Health Services Administration Helpline: 1-800-662-HELP (4357)
Health, human and social services number: 211
National Suicide Prevention Hotline: 1-800-273-8255
