The broken mental health system is affecting us all, but it’s even worse if you’re Black

If you’ve read the recent top 10 healthcare trends for ’23 from Slalom, then you know it’s time we fix our broken mental health system. With 50 million Americans currently experiencing mental health illness, the extent of the problem is finally being recognized in all walks of life; from school systems to places of work, and in how we show up for our personal lives. We are all realizing it may be time we fix our broken mental health system.

So, why now? Aren’t we late to the game? If you’ve been in the healthcare industry for a period of time, you’re aware of the lingering crisis that has only been exacerbated by COVID-19. Our “sages of the system” may even find it laughable or sad that the private sector seems to be finally weighing in on age-old problems which include:

• Issue 1: A failure to recognize individuals experiencing mental health issues in a timely manner, and/or improperly diagnosing individuals, which only furthers complicates their path to care.
• Issue 2: Our continued failure to ensure individuals can seek treatment in a way that is self-determined, promotes human dignity, and is above all culturally competent.
• Issue 3: Affordability!

You may be thinking that all of these issues can affect anyone seeking mental health treatment, and you’re right. But all these issues, if experienced from an equity perspective, have a disproportionate effect on Blacks.

Let me speak frankly. If you’re Black, your mental health outcomes don’t look good. The reality is that we as a group are more likely to delay seeking mental health treatment, with only about 25% of Black people who need help seeking treatment, as compared to 40% of whites.

Institutional racism long assumed Blacks were not sophisticated enough to develop mental health issues, and instead blamed stress, laziness, or our ‘poor genetics’. Combine that with years of stigma and decades of mistreatment by the medical industry, and the mistrust within the community is palpable. When you add industry-wide issues like network adequacy, delayed credentialing process times, and underfunded service rates; getting care that is timely, appropriate, and affordable is a burgeoning issue.

And let’s say you do get care. Your chances, as a Black individual, to be properly diagnosed and receive appropriate care are not much better. On average, Blacks are more likely than their white counterparts to be under-diagnosed, misdiagnosed, or over-diagnosed. Despite this reality, Blacks are often under-diagnosed when presenting with symptoms across several mental health issues such as eating disorders, anxiety, and/or depression. And to top it all off, we see misdiagnoses play on historic racially charged stereotypes that perpetuate a reality that Black individuals are ‘angry’. Why does this matter?

Consider these facts:

• Black men presenting with trauma symptoms are often misdiagnosed as being schizophrenic and their display/visible emotive behavior is more frequently documented as psychotic.
• Black women are also not safe, with Black mothers being at a greater risk for postpartum depression, but less likely to receive or be offered treatment.

The resulting consequence of this breakdown is a group of people who are already grappling daily with the trauma of being marginalized (often referred to as race-based traumatic stress) and are attempting to navigate a system which continues to fail them.

Layer in things like the lack of Black mental health providers or lack of mental health providers who understand how the Black psyche plays into mental health services (see misdiagnoses stats above), one could argue that the mental health system as it currently stands is harmful to Blacks.

How do we solve this?

The first step to meaningful change is to recognize institutional racism in the mental health space as a problem. Too frequently when we talk about health equity, we don’t address health equity as it relates to mental health. We need to start elevating and normalizing conversations about mental health while also doing the following:

• Increase access: Demand more coverage from employers and our government, so that we might start addressing access issues.
• Diversify our recruitment pipeline: Analyze how Blacks are being recruited into the field and identify solutions which increase the percentage in the pipeline. Require that educational systems teach culturally-appropriate care that recognizes self-determination.
• Optimize back-office activities: Partner with payers, TPA, and BPO organizations to remove barriers for providers entering the mental health marketplace by streamlining credentialing and network management activities.
• Increase education efforts: Further efforts to educate individuals on the significance of mental health in primary care and chronic disease management and provide those seeking treatment seamless access to in-person and tele-mental health services.

The wrap-up (aka jumping off my soap box)

I don’t have all the answers. But as a mental health advocate (and consumer) I know it’s time we do something different. I have the privilege of being a healthcare consultant and the son of a counselor, and yet I struggle to navigate the industry and all too frequently have to advocate for culturally-appropriate and affordable care. So while I don’t have all the answers, I think we can all agree it’s time we do something differently.

Samuel Swarbrick is a senior consultant for Slalom based out of New York City. Samuel is former foster youth and a first-generation college student who has pursued a career focused on social justice, health equity, and community advocacy. His piece is the first in our Voices of Slalom content series on the Daily Dose, which highlights thoughts and perspectives from the talented individuals who make up our global team.