The Overlooked Treatment Gap & Its Impact on BIPOC Mental Health

Medically reviewed by Ivy Kwong, LMFT

We know that when we feel sick, we need medicine. We also know if medicine doesn’t work or our symptoms persist, it may be time to go see a doctor. However, a world of wellness exists beyond this basic knowledge—this is where health literacy comes in.

Health literacy is a term developed in the 1970s that refers to one’s understanding of health maintenance. Health literacy not only involves knowing when to get help when we’re experiencing either physical or mental health symptoms, but it also looks at the complex system that exists when it comes to getting support for our well-being. An individual and community’s health literacy impacts their ability to find, understand, and utilize services and resources to make health-related decisions and take action for themselves and others.

Having proficient health literacy encapsulates the degree to which people can comprehend different medical and mental health conditions and treatment options, navigate insurance coverage and medical billing, find alternative ways to access and pay for therapy, and know when it’s time to seek additional help. It also involves being able to find, understand, and choose which resources will best be able to provide care for you when you do seek out treatment.

Unfortunately, research shows there are low rates of health literacy in BIPOC communities (aka communities of color). This ultimately leads to diminished access to care.

The Minority Mental Health Treatment Gap

To begin to understand why health literacy within communities of color is an issue, we must first acknowledge the minority mental health treatment gap.

Soraya Underwood, MPH, an epidemiologist who conducts disease surveillance and health equity analyses at the Boston Public Health Commission says, “Communities of color (i.e. racial and ethnic minorities) are most affected by a lack of health literacy as these groups are more likely than their white counterparts to have no or limited education and to have fewer English skills.”

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Understand the Minority Mental Health Treatment Gap

The minority mental health treatment gap speaks to the lack of mental health care minority communities receive and have access to. This is a structural issue that is perpetuated by systemic, communal, and interpersonal factors.

The Gap in Mental and Medical Healthcare Stems From Decades of Systemic Inequities in the U.S.

Our nation’s legacy of racism and discrimination has trickled into issues with how mental and medical healthcare is offered to communities of color.

Tristian Mitchell, LCSW

Much like most … systems in this country, the healthcare system (including physical and mental) was not designed to serve BIPOC communities.

For example, there are several factors at play that contribute to poor health literacy in BIPOC communities including:

• A lack of funding for mental health resources

• The dismal quality of care

• Low levels of access to mental and medical care due to under-representation in jobs that provide health insurance

• Little support for policies that would improve access to medical and mental health care

• Distrust of the medical and mental health system due to medical trauma, especially historically with Black Americans

• Lack of information, support, and treatment for racial trauma which significantly impacts the mental and emotional health of people of color

• Minimal community-based services

“Much like most … systems in this country, the healthcare system (including physical and mental) was not designed to serve BIPOC communities,” shares licensed clinical social worker Tristian Mitchell, LCSW. He contextualized this issue using a Critical Race Theory (CRT) tenet called ‘critique of liberalism.’

Hard Work Does Not Always Equal Success

“[Critique of liberalism] speaks to this problematic idea that we can all have the same things if only we work hard enough for them,” he explains. He further breaks down the concept by sharing that CRT challenges this idea of hard work being enough by acknowledging that our country relies on whiteness as an asset that offers immense privileges that are not available to non-white individuals.

In turn, this perpetuates an ongoing pattern of systemic issues that keep minority individuals ill and unable to access or even be aware of proper treatment methods.

Community- and Personal-Level Factors Affecting Health Literacy

Communal factors impacting the minority mental health treatment gap are directly linked to systemic issues:

• Limited access to mental health facilities: If there are no mental health agencies within non-white communities, then folks will have to travel to where services are offered. For some, that may not even be an option due to work schedules, issues with childcare, and a lack of transportation.

• Subpar treatment in places that do provide care: For those who can accommodate seeking services in an area they don’t live in, they are subject to increased stress just to get the support they need as the treatment centers available to them may be of low quality. Many community mental health organizations are underfunded and overworked and are often full with long waitlists for services.

Personal and interpersonal factors speak to the struggles in relationships folks of color may experience when seeking out care. For instance, stigma can serve as yet another barrier to care. Yet, stigma is rooted in a lack of information about mental health.

Robin Dial, LCSW, a licensed clinical social worker, shared that historical mistreatment has led to a distrust of healthcare systems. In turn, there is an understandable skepticism and hesitancy in seeking care. This then leads to communities of color experiencing higher rates of chronic disease, which is only exacerbated by a lack of health literacy.

Related: How to Heal From Intergenerational Trauma With Holistic Psychologist Mariel Buqué

Why Health Literacy Matters—We Don’t Know What We Don’t Know

“As a BIPOC therapist who has worked in community health, I’ve witnessed firsthand how systemic oppression profoundly affects the health literacy of our communities,” explains Dial.

She continued by explaining that those with limited health literacy may struggle to identify signs of a mental health condition. If one isn’t aware that they’re experiencing a mental health issue, they aren’t going to seek out treatment. Then, even if they do decide to seek services, they may not have information on what is available to them and find themselves unable to get treatment.

“Cultural and language differences, along with disparities in education, present challenges in effective communication, understanding health information, and navigating the healthcare system,” Dial continues.

What Happens When People Lack Health Literacy?

When we lack health literacy, we may be left with stereotypes and misinformation, like therapy is only for a certain type of person, or that religion is an adequate replacement for treatment.

How Can We Improve Health Literacy in Communities of Color?

Health literacy is much more complicated than simply handing out flyers or giving local talks. To help a community develop health literacy, we must pay special attention to cultural differences. This may include language, dialect, and community beliefs around mental health.

For instance, Underwood notes that “health literacy can be increased by ensuring that clinicians use certain techniques such as simpler language and visual demonstrations that would allow patients to better understand concepts in the health care sector.”

A Community-Participatory Approach

Engaging community members in developing health initiatives can ensure the voices of the oppressed are heard when creating a solution.

But what exactly does this kind of approach look like? Well, according to Mitchell, a community participatory approach is best. With this approach, those who hold the power and privilege partner with communities that are suffering from the systemic issue at hand to identify and implement solutions. “This is the pathway to effective and sustainable change,” he asserts.

How Does Community Involvement Minimizes Systemic Inequities?

Dial shared that community involvement can increase trust, create meaningful relationships, and ultimately provide targeted health education and resources, thus promoting overall health literacy.

She also suggested campaigns that tackle myths and stigma while providing accurate information about prevalent health issues in the BIPOC community can help individuals take an active role in their own well-being.

How Do We Create Change That Actually Sticks?

Lasting change must include shifts to systemic structures. “Policymakers should advocate for policies that support equitable access to healthcare and funding for culturally appropriate health education initiatives,” says Dial. This approach doesn’t only fall onto mental healthcare professionals.

Those of us with the privilege to vote can exercise our civic duty by voting for policies, both on the local and national level, that advance health literacy for all.

Real and sustainable change occurs when the most privileged (meaning access to socio-economic and educational resources), help uplift their own communities).

Related: CBT May Not Be the Best Fit For Black Patients Seeking Therapy

How to Improve Your Health Literacy

Now that you have an understanding of health literacy and why it’s so important. Let’s talk about how you can boost your health literacy. Let me start by sharing how I improved my health literacy.

Years before I became a therapist, I was skeptical of the idea of mental health treatment, because as a Black woman, going to therapy wasn’t normalized. I thought that therapy was only for times when something was terribly wrong. It didn’t help that I was unaware of what mental illness could look like. In fact, I had no clue that I’d been operating with high-functioning anxiety and depression!

Once I entered therapy, though, I became aware of how much communities of color are harmed by a lack of health literacy. This issue is part of why I became a therapist.

Start Small By Asking Questions and Doing Your Research

Mitchell encourages folks to reach out to their insurance providers to ask what services are available to them.

He also recommends familiarizing yourself with community-based organizations in your neighborhood that focus on health promotion and disease prevention efforts, underscoring the importance of both physical and mental health.

Therapy Options for BIPOC Communities

If you learn that therapy can be beneficial to you, there are several directories people of color can turn to:

If you’re looking for more cost-effective options, the following resources offer therapy funds, meaning you can apply to receive the funding you can apply towards therapy sessions:

Other Resources

What This Means For You

Remember that your healing is your birthright. Everyone’s journey to mental wellness is personal and learning more about the resources available is one of the first steps to improving your health literacy. Remember that you’re never alone and that there are organizations and people who are willing and able to step up and advocate for you.