Mental health services are underutilized in minority communities. Counseling is a Western concept that, with time and acculturation, seeps into the lives of first- and second-generation immigrants. Regardless, minority communities are not immune to traumatic events and mental health struggles. After two years of the pandemic and the rise of consequential mental health concerns, we need to reevaluate advocacy efforts to fit the latest needs. Research from Boston University revealed that depression, early on in the pandemic, jumped from 8.5% to 27.8% of the population, and continued to rise to 32.8 in 2021 (McKoy, 2021).
Barriers to Mental Health
There are several barriers to mental health care in minority communities. The American Psychiatric Association (2017) identified several potential barriers to care for African American and Hispanic patients including lack of trust in health care providers and the system of health care, lack of diversity in providers, limited access to insurance, and mental health stigma. Cultural perceptions and biases against treatment can impact healthcare access (Busing & Gary, 2012). Systemic barriers also exist (Jones, 2000).
Black adolescents’ mental health needs are ignored and considered behavioral, leading to punitive intervention in schools (Bussing & Gary, 2012). Hindrances in the Asian community include acculturation stress, stigma, age, language proficiency, and preference for alternative support. They’re three times less inclined to seek mental healthcare (Hays & Erford, 2017), which can lead to inadequate care.
Minorities are also underrepresented in research (Bussing & Gary, 2012), so responding to needs is difficult. These barriers are coupled with the mental health illiteracy in minority clients. A lack of education about mental health struggles can lead to significant underutilization of mental health services. Shukla (2022) cites limited awareness of mental illness as one reason for the poor accessibility of mental healthcare in minority communities.
Without awareness, little can be done to address the problem. Waumans et al. (2022) conducted a study on treatment seeking barriers in adults and found that mental health illiteracy was a major theme. Elgenhuis et al. (2021) found that health literacy led to improved treatment-seeking and illiteracy acted as a barrier in adolescents and young adults. Lack of awareness can decrease the likelihood of help-seeking.
Call to Competence
These concerns are heightened with traumatic experiences that often leave a mark on our bodies – marks that can trigger symptoms related to the original experience. For individuals who lack access to and understanding of mental health, it may be near impossible to confront trauma and address it in a way that lends well to healing.
The Multicultural and Social Justice Counseling Competencies (Ratts et al., 2015) break down the developmental domains of competence into four major layers – counselor self-awareness, client worldview, counseling relationship, and counseling and advocacy interventions. The first three begin with addressing the attitudes and beliefs of the individual before any work towards competence.
Therefore, counselors are obligated to operate sensitively to fit their needs. If awareness is stunted, trauma processing may use different verbiage. There may be fear or discomfort attached to the processing for clients unaware of the impact of trauma in their lives. Therefore, the first mandate is a call to competence in the client’s worldview. This sensitive approach to healing will inevitably impact treatment efficacy.
Call to Action & Advocacy
The Ethical Foundation of Advocacy
The fourth developmental domain in the MSJCC is Counseling and Advocacy Interventions (Ratts et al., 2015). Advocacy is an ethical mandate (American Counseling Association, 2014). However, it varies based on the needs and values of the individual. In minority communities facing numerous barriers to mental well-being, practitioners must advocate at multiple levels.
Ratts et al. (2015) discuss the need for community interventions that honor individuals’ beliefs and values, even those that pose potential barriers to growth. Cultural competence precedes the awareness and actions required to tackle the barriers in minority communities. Awareness, then, precedes action.
Multilevel Advocacy in Practice
On the intrapersonal level, counselors will tailor therapy to meet any lack of awareness, assess the role of values on their attitudes and beliefs, and improve literacy to improve self-advocacy in the client for long-term change irrespective of counseling.
On the interpersonal level, counselors will consider the power dynamics, the differences in culture and values, and the needs in the counseling relationship before change can be pursued.
On the institutional and public policy levels, counselors will explore the client’s needs outside of themselves and in their environments, seek ways to push for support in their spheres of influence – religion, politics, community leaders – and work towards fighting systemic barriers petitioning policymakers.
Finally, at the community level, counselors can immerse themselves in the community of the client, understand the strengths and values, and move towards well-being within the community of influence (Hays & Erford, 2017).
Particularly for minority clients whose cultural communities are significantly supportive, working within those confounds and bringing community (extended families, religious systems, etc.) into the treatment process may all be beneficial. Counselors must consider ways to educate their communities and the population at large.
This includes reaching out to community leaders with a platform for education, having regular conversations about what a word means for the client, and even workshops to promote community mental health awareness. Researchers must consider ways to make participation accessible across systemic limitations – geography, economics, age, etc. (ACA, 2014). This requires additional effort to improve accessibility for minority communities.
Professionals must meet each group within their comfort zones, like in community or religious centers (Avent & Cashwell, 2015), to improve access to mental health services. School counselors can take the initiative to address mental health verbiage often used by students to help clarify meaning. Schools can have resources and consistent conversations surrounding mental health for students and families alike.
Counselors must consider integrating evidence-based treatment to appeal to groups that value logical reasoning. They may need education on the use of mental health benefits in their health insurance. Each person’s unique preferences require consideration for when client counselor matching is possible as research supports (Kim et al., 2005).
Counselors can advocate for the availability of scholarships for those who may not otherwise be able to afford a master’s program in the counseling field. This would offer support for minority representation in a predominantly white career (Gleeson, 2023). Similar to the incentives for employees obtaining physical examinations each year, counselors can consider ways to advocate for regular mental health checks.
Seeking help is especially hard in minority communities (Hays & Erford, 2017), so counselors have a lot of opportunities to support the mental well-being of many who suffer in silence.
Toward Sustainable Change and Healing
It all starts with self-awareness, which is fueled by education and propelled by advocacy. It is high time that we support the communities with the greatest disparities to mental health access (Cook et al., 2017) and poor representation in research (Pedersen et al., 2022) as we advocate for their well-being.
Understanding the difficulties of trauma processing, counselors must be committed to fostering safety which will guide an individual’s steps towards healing. Education leads to competence, which leads to advocacy, which then propels action. It is a privilege to be a part of societal and personal shifts driven by trauma-informed clinicians committed to meeting the unique needs of multicultural clients.
Referneces
American Counseling Association. (2014). 2014 ACA code of ethics. https://www.counseling.org/docs/default-source/default-document-library/2014-code-of-ethics-finaladdress.pdf
American Psychiatric Association. (2017). Mental health disparities: African Americans. https://www.psychiatry.org/psychiatrists/cultural-competency/education/mental-health-facts
Bussing, R. & Gary, F. (2012). Eliminating mental health disparities by 2020: Everyone׳s actions matter. Journal of the American Academy of Child and Adolescent Psychiatry, 51, 663-666.
Eigenhuis, E., Waumans, R. C., Muntingh, A. D. T., Westerman, M. J., van Meijel, M., Batelaan, N. M., & van Balkom, A. J. L. M. (2021). Facilitating factors and barriers in help-seeking behaviour in adolescents and young adults with depressive symptoms: A qualitative study. PLoS ONE, 16(3). https://doi.org/10.1371/journal.pone.0247516
Hays, D., & Erford, B. (2017). Developing multicultural counseling competence: A systems approach (3rd edition). Pearson.
Jones, C. P. (2000). Levels of racism—a theoretic framework and a Gardener’s Tale. American Journal of Public Health, 90, 1212-1215.
Kim, B. S. K., Ng, G. F., & Ahn, A. J. (2005). Effects of client expectation for counseling success, client-counselor worldview match, and client adherence to Asian and European American cultural values on counseling process with Asian Americans. Journal of Counseling Psychology, 52(1), 67–76.
McKoy, J. (n.d.). Depression Rates in US Tripled When the Pandemic First Hit—Now, They’re Even Worse. Boston University. Retrieved April 30, 2022, from https://www.bu.edu/sph/news/articles/2021/depression-rates-tripled-and-symptoms-intensified-during-first-year-of-covid/
Ratts, M. J., Singh, A. A., Nassar-McMillan, S., Butler, S. K., & McCullough, J. R. (2017). Multicultural and Social Justice Counseling Competencies: A Leadership Framework for Professional School Counselors. Professional School Counseling, 21(1b), 2156759X1877358. https://doi.org/10.1177/2156759X18773582
Shukla, D. (2022, April 20). Mental healthcare for marginalized groups: Barriers to access. https://www.medicalnewstoday.com/articles/why-mental-healthcare-is-less-accessible-to-marginalized-communities
Waumans, R. C., Muntingh, A. D. T., Draisma, S., Huijbregts, K. M., Balkom, A. J. L. M. van, & Batelaan, N. M. (2022). Barriers and facilitators for treatment-seeking in adults with a depressive or anxiety disorder in a Western-European health care setting: A qualitative study. BMC Psychiatry, 22(1), 1–15.