Discussion By Sarah Ortner, LMFT,  Regarding Minority Mental Health

July is Minority Mental Health month,  which is an excellent opportunity for us to educate ourselves on what  particular behavioral health challenges exist in among various minority populations, what challenges exist to accessing quality mental health, and how we as providers can use research and intention to provide the most useful, competent and relevant behavioral health services to all of our patients.

But first, we recognize that neither behavioral health challenges nor behavioral health services exist in a vacuum, but are reflections of and impacted by the larger culture. Anyone reading the news will recognize that right now many different minority groups are experiencing a growing  lack of safety, and in some cases, outright attack in our culture. From a historical perspective, we also know that racism, sexism, and classism have existed in our culture at every level since it’s inception, from legal systems (fully recognized constitutional rights for Black Americans, Native People and Women lagged far beyond recognition for white male owners), financial systems (redlining real estate districts to prevent certain races from buying property), and even (and sometimes especially) medical systems.  Historically, and even in many cases today, research has been conducted on white educated males, and their experiences became the norm against which all other experiences were judged against, and, to the extent that other experiences differed, those experiences were judged as abnormal.

While tremendous strides have been made to address these systemic inequalities, generations of people have experienced the multiplying stress of these systemic inequalities.  And while we have made great strides, a daily look at the news shows that prejudice, hate crimes, and implicit bias continue to create ongoing distress in the lives of many different members of minority groups.  Additionally, every individual has different experiences, and may be a member of more than one group, and thus experiences intersecting experiences. For example, a transgender person who is Latinx may not only experience gender related bias (and a higher likelihood of gender related violence than any other group) , but also may experience discrimination based on their ethnic identity, and may additionally experience stresses related to having to manage both identities, and feeling pressure from either identity to show group loyalty.

As providers, it is important that we recognize that higher incidence of mental health diagnosis in minority groups is not the outcome of some inherent flaw of that group, but rather the understandable and predictable outcome of ongoing, systemic negative external stressors. It is also critical that we are constantly aware that we are part of our culture, and are embedded with the same messages. Studies show that patients do not benefit, and in fact can be harmed from, practioners who maintain a “color blind” stance, as it can minimize the very real lived experience of disparity that minority groups experience.

Rather, here are some concrete steps we can take to better serve minority populations.

• Begin being aware of our own biases, and doing the brave work to recognize they exist and how they inform our judgment and practice, then working hard to consciously undue them. This work can be challenging- it acknowledges that we are not wholly in control of our hard wired responses- but it is essential to provide the care we wish for our patients to have. Additonally, many of us are also members of minority groups- it is important we do the work of recognizing how we have been impacted and attend to this ourselves.
• Seeking out and educating ourselves on the different systemic inequalities that are experienced by different groups in our country- but do not expect our patients (or colleagues) who are members of minority groups to do the educating.
• Listening to patients whose experiences are different than ours, and believe their experiences.
• Demonstrating dedication to honestly addressing and witnessing patients lived experiences and acknowledging elements of systemic oppression and inequalities.  Recognize that each patient has their own different experiences and also may exist within several subgroups.
• Validate and acknowledge the strength and resiliency patients show in surviving, and validate the toll this takes.
• Engage in collaborative care rather than in taking stance of expect.
• Bring our best research and therapeutic tools.
• Practice humility and self forgiveness when we make a mistake, and recognize that we will make mistakes.  This is an incredible complex undertaking.  Every day is a chance to try again, and none of us will get it perfect.

Ultimately, as providers we are in positions of great power- too often, and often times unintentionally,  providers have failed to understand how to best use this power, and have resulted in well intentioned but invalidating behaviors.  By approaching our patients with openness, a willingness to listen to and validate their experiences and to become partners with them to address the impacts of systemic bias, we can transform our practice and play our part as allies in creating a more just world.