Providing equitable mental health care in an unequal world

October 10th is World Mental Health Day, and the World Federation for Mental Health is challenging all of us to take a hard look at how inequities impact access to high-quality mental health care worldwide.

A survey of over 2,000 Americans — conducted in August 2021 by OnePoll — shows that the federation’s theme of “Mental Health in an Unequal World” is of critical importance.* The survey findings align with an array of data that suggests traditional mental health care is inequitable, and that the mental health of people from marginalized communities has been disproportionately affected by the pandemic. In this blog, we define what we mean by mental health equity, use the survey results to illustrate current inequities, and shine a light on how we can foster more equitable mental health for all.

What is mental health equity?

Mental health equity is derived from the broader concept of health equity, which is defined as the attainment of the highest level of mental health for all people. Achieving equity requires providing individuals with the resources they need based on their specific problems, social identities, and backgrounds, as well as historical and ongoing injustices and inequities.

In plainer terms, this means that all people are equally deserving of good mental and physical health — but due to the way our society is structured, not everyone has equal access to it.

Equality — the idea of equal treatment — is important. However, equality carries the assumption that equal treatment will always result in equal outcomes. As we can see in the image below, this isn’t always the case.

On the left you see equality: Everyone’s treatment is equal in that they all have the same level of support. On the right, we see equity: The level of support each person receives is responsive to their unique needs. Only equity results in equal outcomes.

Pandemic-related stress

The pandemic has widened pre-existing mental health inequities. Results from the OnePoll survey shows that Americans of Asian and Pacific Islander descent were more than twice as likely (52%) as white Americans (23%) to strongly agree that 2020 was the most stressful year of their lives. This increase in stress for Asian American and Pacific Islander communities is in part due to xenophobia and bigotry made worse by the pandemic. According to the American Psychological Association “even before the deadly Atlanta-area spa shootings in March, Asian Americans and Pacific Islanders (AAPI) had faced nearly 4,000 hate incidents since the pandemic began, a 149% rise over the previous year.”

Barriers to mental health care

1. Financial hardship

Despite experiencing greater stress, people from marginalized groups, such as those with lower incomes, are less likely to have access to mental health care due to financial barriers. For example, compared to those in high-income households, survey respondents who made less than $30,000 a year were twice as likely to cite expenses as a barrier to receiving professional mental health care. Furthermore, only 39% of those from lower-middle income households (earning between $30,000 and $59,999 annually) have sought mental health care during the pandemic, compared to 57% of high-income earners (making $150,000 or more annually).

2. Stigma

Stigma is yet another barrier people from marginalized groups face more acutely, making it even harder to access mental health care. The survey revealed that Asian Americans (76%) and African Americans (68%) were the most likely to say they face stigma from their community around seeking help for mental health issues, compared to just 57% of white Americans. The clinical literature supports these findings and suggests that stigma is particularly strong among communities of color, in part due to their reluctance to take on an additional stigmatized identity (e.g., “mentally ill”), distrust in mental health care systems, and cultural norms around help-seeking.

Digital medicine: One way to improve inequity

To correct these inequities, we must reimagine our mental health care system. The practice of traditional therapies, including cognitive behavioral therapy (CBT), the gold standard treatment for many mental health conditions, was initially developed to accommodate a clientele with discretionary income and time to meet regularly face-to-face with a therapist. And despite its promise to increase access, telehealth perpetuates these inequities.

The recent growth of digital therapeutics (DTx) — or digital medicine — for mental health has begun to bridge the divide. With software as its modality of intervention, rather than humans, DTx’s structural advantages of patient-directed 24/7 access, personalized care at scale, and affordability are delivering, in increasing numbers, an effective therapeutic alternative to traditional mental health care. Due to its cost-effectiveness, scalability, and impact on outcomes, DTx represents a new generation of mental health care that can increase access for traditionally underserved communities.

Taking the first step towards greater equity

Companies have the potential to play a large part in helping address mental health inequities, but doing so can feel like an insurmountable challenge. The Mental Health Equity Assessment can help. After answering a series of questions, you will get a score and personalized recommendations that can help you make progress towards greater mental health equity for your employees. With this knowledge, you will be empowered to be a change leader for marginalized groups.

We know meaningful change doesn’t happen overnight, but we hope that World Mental Health Day gives you the opportunity to reflect on our current mental health care system, examine your company’s mental health policies, and consider ways in which you can create mental health equity in an unequal world.

*This was a random double-opt-in survey of 2,001 Americans commissioned by Big Health between 3 and 4 August, 2021. It was conducted by market research company OnePoll, whose team members are members of the Market Research Society and have corporate membership to the American Association for Public Opinion Research (AAPOR) and the European Society for Opinion and Marketing Research (ESOMAR).