Breaking Down Diversity Barriers in Mental Health Services

Mental health professionals are working to make themselves more available to people of color and provide treatments tailored to their cultural and ethnic backgrounds.

By Rocío Fortuny
Featured image illustrated by Stephanie Macrinos

It was February of 2018 when Brandie Carlos, a web designer and digital strategist from Los Angeles, California, lost one of her best friends to suicide. She was devastated and mourned the following months after, always asking herself what she could’ve done differently to help him and change the outcome of what happened. When she noticed how her friend’s passing affected her mental and emotional state, Carlos knew it was time for her to get professional help. But she realized she couldn’t just turn to anyone. She felt that she’d be more comfortable unpacking her feelings if she met with another Latino woman from a Mexican American family who shared a similar background as her. She searched non-stop for a Latina counselor in the Los Angeles area, but still struggled to find one.

In the United States, only 16% of active psychologists are people of color, according to a 2016 report from the American Psychological Association. However, around 75% of all adults who experience mental health issues are in a racial or ethnic minority group, according to the National Alliance on Mental Illness. And even though the ratio of psychologists in a racial or ethnic minority group has almost doubled in the last 10 years, there’s still a diversity gap in the counseling profession, making it harder for people to find counselors who can identify with them culturally and understand their specific mental health needs.

When Carlos heard about Therapy For Black Girls, an online directory started in 2014 by licensed psychologist Joy Bradford that helps women of color find local therapists, she was inspired. She says she wanted to give the Latino community the same opportunity of easily finding a counselor they connected with and felt understood by. So in May of 2018, she launched Therapy For Latinx, an organization based in Los Angeles that assists Latinx individuals and families in finding bilingual therapists and accessing resources like crisis hotlines and mental health screenings. Today, their online directory features nearly 400 counselors and therapists in 25 states who identify as Latinx or a person of color or have worked closely with communities of color.

After creating Therapy for Latinx, Carlos started having conversations with people who reached out through the website, the linked Facebook group she created, or in person. Carlos says she realized people did want to share their experiences and sought help. She was amazed by the responses. “The organization creates a sense of community and for many people, it is the first time they are seen or heard,” Carlos says.

Meanwhile, in Onondaga County, New York, mental health issues ranked second as the biggest health problem communities face, according to a 2016 community engagement survey of nearly 3,000 respondents ran by the Onondaga County Health Department. According to the report, there were no responses received on the Spanish-language version of the survey despite numerous outreach efforts, further showing how the state of mental health in multicultural communities is still vaguely known.

A Clinic That Welcomes All

To help combat those issues locally, Abraham Masara, a psychiatric-mental health nurse practitioner who started a private practice in Syracuse three years ago, launched a clinic in 2017 called I-Mobile Health Mission. The clinic is located in the city’s North Side neighborhood, where high populations of immigrants and refugees live. Masara, who is originally from Harlem but has Dominican roots, explains that if mental health professionals distance themselves from minority populations culturally and physically, those communities are less likely to get the treatment they need. “I really wanted to bring my services to them,” Masara says. “And I provide culturally-tailored mental health treatment.”

Masara says that the culturally-tailored care he offers focuses on how mental health problems and solutions to them can look different from culture to culture. For example, certain cultures may see mental illness as completely incurable, while others may not consider Western medicine as a preferred treatment, according to the National Institute of Health. Masara’s attention to his patients’ culture even extends to how he decorates the clinic. Inside, Masara hung up African and Caribbean art to make sure his clients feel welcome. He also hired a bilingual woman, who speaks English and Spanish, to work as a clinician, which he says will hopefully break the language barrier between their staff and the Latinx population they serve. As Carlos says, this is one of the main things Latinx individuals look for when searching for a counselor — to be able to express themselves in their mother tongue.

I really wanted my community to understand that it’s okay to seek therapy, it’s okay to seek care.

Sameerah Owens, Social Worker at I-Mobile Health Mission

Today, a majority of Masara’s clients are either African American or Latinx, he says. He says that individuals in a racial or ethnic minority group, similar to the clients he serves, are often reluctant to seek professional mental health treatment because it’s considered taboo to discuss in their culture or because they don’t have the money or time for it.

Mental Health Barriers for People of Color

Derek Seward, the chair of Syracuse University’s Counseling and Human Services department, says that people of color face systemic barriers that keep them from receiving mental health treatment. These barriers range from the lack of health insurance to pay for treatments to the availability of mental health professionals who can offer affordable treatment to their communities. He also says people of color may come across problems if their counselor can’t understand the cultural and racial nuances of their situations. “[People of color] tend to be misdiagnosed and tend to leave treatment early due to a lack of satisfaction with the treatment they receive due to feeling misunderstood by their counselor,” Seward says.

Back at I-Mobile Health Mission, Sameerah Owens, a social worker who started interning at the clinic to complete her hours for her master’s degree coursework at Syracuse University, understands the importance of having a counselor that looks like her. “The population of [African Americans] that I work with doesn’t trust easily or they’re not likely to seek care whether it be counseling, medicine, prescriptions, or anything of that nature,” Owens says. “They are not going to go get help. It’s just mainly, ‘We’ll figure it out, we’re gonna pray about it,’ and I really wanted my community to understand that it’s okay to seek therapy, it’s okay to seek care.”

Owens says she has seen women of color working in her field, but it’s not as much as she would like. Working at I-Mobile Health Mission lets Owens see her work’s impact on her community because she’s able to connect with her clients on a deeper level, she says. “My story is not as different as theirs, and even for myself, I’ve been able to relate and say, ‘I get that, that makes sense to me,’” Owens says. “I think overall, people respect that and are more likely to open up to someone who is willing to listen to them and who look like them and come from where they come.”

Increasing Diversity in the Mental Health Field

When it comes to counseling and therapy, Seward says it’s important for the therapist to build rapport with their clients. He explains that rapport is about establishing a professional relationship with the client where the client feels the counselor is genuinely concerned about their well-being and is ready to help them in any way. The client should feel understood as a person, Seward says.

Seward also says that in order for a counseling program to be accredited, it must train students in social justice and multicultural awareness, advocacy, and skill development. He says it’s been the norm for counseling, but it’s just starting to bleed into other mental health fields like psychology and social work. Carlos says professional organizations such as the American Psychological Association and the National Latinx Psychological Association have also taken proactive measures to support mental health professionals of color and improve treatments for people of color. For example, APA started hosting diversity conventions and initiatives to ensure they’re publishing psychologists from different backgrounds. Meanwhile, NLPA launched educational trainings to inform others of issues specific to the Latinx community, such as how death affects the lives of undocumented immigrants.

Being culturally competent is not about knowing slang or phrases, but about the provider being transparent and a great listener.

Abraham Masara, Founder of I-Mobile Health Mission

Training both white and non-white psychologists and counselors to understand issues that minority groups may face, such as microaggressions, oppression, and racism, is vital to supporting culturally-diverse clients, Seward explains. For example, when working with culturally-diverse people, Seward says counselors must see themselves as a cultural being first. This means they must be aware of the preconceptions they bring to the table and the way they see the world. Then, they’ll have a better understanding of how to welcome their clients and where to draw the lines of comfort for the client and themselves.

“It’s really about the full complexity of diversity. And actually, that includes anything from geographic region, nationality, social class, ability or disability, and LGBTQ [issues],” Seward says.

For Masara, cultural competence is key to working with minorities dealing with mental health issues, especially since those issues don’t look the same for everyone. Two different people may have the same diagnosis but their symptoms could manifest differently depending on their background.

“Being culturally competent is not about knowing slang or phrases, but about the provider being transparent and a great listener,” Masara says. “The therapist should say, ‘Wow, I’ll be honest with you, I couldn’t even imagine walking in your shoes.’”

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