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“We want people to be aware that people of color are not being treated fairly when it comes to medical care,” said Linda Tyson, founder and CEO of the Kiamsha group, which is starting a series of health care forums this fall.
“We don’t ask questions when it comes to our health and we’re not encouraged to. We let [medical personnel] tell us things and then just walk away.”
Tyson and other participants in the upcoming forums said one of the first things they want to address is mental health.
“It should be the number one priority,” said Lekeisha Sumner, Ph.D. who is a psychobiology research fellow at UCLA’s Semel Institute for Neuroscience and Human Behavior.
“Unfortunately mental health wasn’t part of a lot of doctors’ training so they may not understand. I mean they should because the research is so abundant.”
For example, she explained, depression is really high among people with chronic diseases like heart disease, diabetes, cancer and AIDS.
“We know that people with untreated depression (coupled with the chronic disease) tend to have the worst outcomes,” she said.
So then, why isn’t mental health being addressed when it may be key in helping people manage their physical health better and in turn cutting back on exorbitant health costs? For Blacks there may be several reasons, said Sumner.
“People who don’t have insurance would be one thing,” she said.
A U.S. Department of Health and Human Services report released in 2000, lack of health insurance is definitely a barrier to seeking mental health care.
“Nearly one-fourth of African Americans are uninsured, a percentage 1.5 times greater than the White rate. In the United States, health insurance is typically provided as an employment benefit. Because African Americans are more often employed in marginal jobs, the rate of employer-based coverage among employed African Americans is substantially lower than the rate among employed Whites...”
The cost really depends also on what kind of treatment you’re seeking. Psychiatrists and Psychologists, who have had more training would tend to cost a little more, Sumner explained although she could not give specific price quotes.
“We also know that there is some literature that suggests the nation perceives African Americans as being people from a lower socioeconomic status. And, sometimes [doctors] may believe that they are not going to adhere to what they tell them to do. Therefore, that may influence the treatment that they offer them...”
But, Sumner continued, lack of health insurance isn’t the only problem.
Cultural and Social Stigma
Cultural and social stigma frequently cause minority groups to view depression and other mental illnesses as personal flaws or signs of weakness, say the results of a study released earlier this year by Mental Health America.
“[It] prevents far too many African Americans and other minority groups from seeking help for mental health problems. And those who do get the treatment they deserve often do not get it until their condition is most severe,”said Dr. Raymond Crowel, Psy.D., vice president of research, practice and policy at MHA.
“When a person has a medical illness,” said Sumner, “ it’s overwhelming because it changes every aspect of their life. A lot of people who were very independent may have to leave their jobs or they may not be able to enjoy (once normal activities). Sometimes they become socially isolated... [which can compound the problem.”
Lack of Knowledge and Understanding on How Mental Disorders Work
“African Americans may not understand the mind body connection and how seeking mental therapy might help them feel better,” she said..
In order for a patient to even begin talking to his or her health provider about their needs they would have to recognize what their symptoms mean, she added.
“Sometimes they may not even know they’re depressed. We think of depression as just being really sad. But some people may be more irritable than sad and they may not even know they’re depressed.. People who have a physical condition coupled with depression are more likely to report higher levels of pain.”
It’s not just the patients. Physicians also need to get more information on mental health.
“African Americans may present with different symptoms of depression than other people. It’s the same thing with anxiety. For example, for a long time African Americans were more likely to be diagnosed with severe mental illness, like psychosis when really they had post traumatic stress disorder. You need to make sure that whoever it is that you’re going to see is aware of the cultural influences of mental health.”
“African Americans may have a different experience when it comes to chronic stress, because of racism and discrimination and having to contend with that. That plays a role in mental health disparities as well,” said Sumner.
According to the 2001 Surgeon General’s report on mental health, “the prevalence of mental disorders was believed to be higher among African Americans than among Whites, and African Americans were more likely than Whites to use the emergency room for mental health problems. African Americans with depression were less likely to receive treatment than Whites (16 percent compared to 24 percent). Only 26 percent of African Americans with diagnosed generalized anxiety disorder received treatment for their disorder, compared with 39 percent of Whites with a similar diagnosis...”
Depression is prevalent in people who have medical illnesses and that some studies have been done to show that discrimination can actually predict depressive symptoms, according to medical experts. Physicians need to be on the look out for depression among African Americans, especially with chronic illnesses. Another thing is making sure people have adequate social support.
“That’s very important,” said Sumner.
“People who are socially isolated and depressed, don’t do well in responding to their treatments as and are more likely to die sooner.”
Despite the obstacles there is hope said Sumner and other medical experts.
“One thing people can do is seek out social support groups with other people who have their illness. A lot of hospitals have them. They’re really good for providing a lot of information as well as support.
“Another thing is that you really can’t beat meditation and spirituality. It really gives you a better way to cope.”
More inexpensive and accessible techniques include meditation, prayer, counseling/ therapy, group therapy/ support groups and the patient surrounding his or herself with positive influences. Making sacrifices may have to be considered also. Foregoing a twice a month hair appointment or shopping trip may pay for much needed care.
“It’s really a choice. You have to make an investment in yourself,” Sumner said.