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A Minorities’ Struggles: Mental Health Equity Literature Review

Melissa Velar

Spalding University

EDD 902 Systems Theory and Leadership

April 16, 2023

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Abstract

Immigrants in the US face a lot of discrimination when it comes to the access of services. These

social injustices result in poor mental health such as depression, anxiety and substance use

disorders and. Immigrants face hardships irrespective of their socioeconomic status. Although

there is much evidence about the mental health problems of minorities, policies must be

formulated to deal with such social injustices and a lack of access to culturally competent care.

Such policies would facilitate an effective cultural assimilation and create a conducive living

environment for minorities across the board.

Definitions:

Cultural Assimilation: the process in which a minority group or culture comes to resemble a

society's majority group or assimilate the values, behaviors, and beliefs of another group whether

fully or partially.

Equity: refers to fairness and justice. recognizing that we do not all start from the same place and

must acknowledge and make adjustments to imbalances. The process is ongoing, requiring us to

identify and overcome intentional and unintentional barriers arising from bias or systemic

structures.

Social Justice: fairness as it manifests in society in terms of the distribution of wealth,

opportunities, and privileges within a society.

Cultural Competence: Cultural competence is the ability of a person to effectively interact, work,

and develop meaningful relationships with people of various cultural backgrounds.

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A Minorities’ Struggles: Mental Health Equity Literature Review

Mental Health Equity Through Cultural Competency of Providers

Mental health is one of those topics that continues to grow in discussion and has been

known to have a negative stigma around those who live with diagnosis’. These mental health

issues are often looked down upon by society and are viewed in a separate manner when

compared to other health issues. Health equity is a subject that needs to be fully understood in

order to reach a full understanding of mental health equity. As stated by Braveman et al., (2017)

“The Robert Wood Johnson Foundation provides the following definition: health equity is every

person having a fair and just opportunity to be as healthy as possible.” According to Healthy

People article from the Center for Disease Control (2020), it has been established that there are

several objectives to help improve health in the United States. One of those objectives and topics

that is focused on in HP is mental health and mental health disorders. The end goal is to help

reduce mental health disparities through several techniques that consist of treatment expansion,

professional guidance, access to health professionals, and prevention (Centers for Disease

Control and Prevention, 2020). The goal of this literature review is to bring to light the mental

health disparities, other emerging issues that are related to mental health disparities, preventative

actions, and resources to improve mental health disparities by focusing in on three primary

domains: The field of mental health, education and information dissemination (Access) as well

as cultural competence and diversity training of available providers (DEIB).

Disparities Amongst Minorities in Mental Health Care: Mental Health Domain Domain
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It has been brought to the attention of society over the last few decades how prominent

mental health disparities have become. Along with the mental health disparities are also

substance use disorder (SUD) disparities. Safran et al., (2009), states “mental health disparities

are disparities of health, health services, or health determinants” (p. 1963). Unfortunately, those

who fall victim the most to mental health disparities are those who are gender, sexual, racial, or

ethnic minorities (American Psychiatric Association, n.d.). Not just in regard to mental health

but there have been studies shown that those who are minorities are more likely to experience

disparities. According to McGuire & Miranda (2008), minorities are more prone to the

disparities due to the fact that they often put off or fail to pursue their mental health care, have

less adequate mental health care and they give up and stop following up on their mental health

care. To try and eliminated any disparities remains a common challenge that is seen amongst

mental health professionals. Corbett et al., (2020) expressed that there are over 47 million

Americans who experience some type of mental illness every year while 9.2 million suffer from

mental health or SUDs. It is evident with these numbers, there needs to be a shift in psychosocial

systems in order to help and support all persons regardless of demographic, cultural background

or socioeconomic status.

When it comes to mental healthcare, there are two barriers that may alter an individual’s

ability to seek the care that they need, the cost of services and the number of providers (Shi &

Singh, 2017). Based on the text from the American Psychiatric Association (n.d.), “racial/ethnic,

gender, and sexual minorities often suffer from poor mental health outcomes due to

inaccessibility of high-quality mental health care services, cultural stigma surrounding mental

health care, discrimination, and overall lack of awareness about mental health.” There is a stigma

that revolves around minorities that those who are of minority descent often suffer from financial
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barriers which affects their ability to seek mental health services as well as the inability to find

providers that they can culturally identify with (University of Southern California, 2020). When

understanding the concepts of mental health equity, it is important to know that there are still so

many issues that are in relation to the discrepancies. Some of these discrepancies include the

quality of research that is being done, invalid biasness with diverse groups and diagnostic

treatment, and the cultural diversity in healthcare.

Diversity, Inclusion and Cultural Competency: DEIB Domain

Cultural Assimilation and Barriers The issue of cultural assimilation and barriers is one

of the main challenges facing immigrants in the US. The idea of personal cultural identity is

often a hotly debated topic in the US, because of the country's very diverse ethnic makeup.

However, immigrants face significant challenges when it comes to this issue. It has often been

argued that the immigrant population in the United States is quite diverse and eclectic. One study

points out that a person needs to look at the different cultural backgrounds of countries such as

China, Brazil, Russia, Canada, and elsewhere to prove this point (Szaflarski & Bauldry, 2019).

While this may hold true on an individual level, on a national scale there very significant

challenges facing immigrants in the US in regards to these issues of cultural assimilation and

barriers. Many immigrants face significant challenges with regards to their personal social

identity. According to Lancee (2021) another challenge faced by immigrants in the US is finding

a job that fits their skill set, given the significantly different style of education they have been

used to. Many countries around the world have a very rigid style of educational functioning with

regards to developing students according to their abilities and interests. In the US however, there

is much less emphasis on such practices. The study points the lack of cultural fluency in
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American society as a major challenge faced by immigrants. This has led to a low level of

acceptance and cultural assimilation on the immigrants. According to Di Stasio, Lancee, Veit and

Yemane (2021), when people are used to particular culture, they find it challenging to get

assimilated into the American culture. Such results in the loss of personal identify as the people

struggle with cultural barriers and assimilation into the American culture. The loss of personal

identity could be challenging on some people and in some cases, results in the depression and

other related mental health conditions. These sources provide an outline of how challenging it is

for immigrants in the US to assimilate into the US culture. The challenge is faced in the

educational, social and work scenarios. An Immigrant has a role of finding means to effectively

assimilate into the new culture to avoid the associated challenges such as the development of

depression.

Discrimination is one of the social injustices facing US immigrants. The discrimination

occurs in different sectors of life such as securing jobs, housing and medical attention. One study

argues that discrimination impairs the ability of immigrants to pay for their own health care

(Szaflarski & Bauldry, 2019). The study points out that the immigrants have a less chance of

receiving affordable and quality healthcare than Americans. The challenges in receiving quality

healthcare are also reflected on their mental wellbeing which in turn, facilitates the development

of various mental disorders. One study by Esses (2021) points out that discrimination is regarded

as a barrier to obtaining employment, housing and healthcare in the United States. This study

indicates that some individuals find it easy to dislike those who are not native to the country they

live in. In this case, discrimination tends to be the main determinant of how the native

individuals treat immigrants. . The study concludes that discrimination is one of the core

challenges immigrant face when integrating into any society (Esses, 2021). Another study by
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Stone, Lukaszewski, Krueger and Canedo (2020) outlines that unfair treatment against

immigrants can be described as the negative feelings towards immigrants, prejudice, and

discrimination. The study further shows that there is an absence of theoretical and empirical

work that has been conducted in this area. This study tries to help fill the gap by providing a

model regarding factors that are thought to influence unfair discrimination against immigrants in

organizations. The discrimination in organizations creates an inconducive work environment

thus subjecting the immigrants to depression. It also makes it challenging for them.

As of late the topic of mental health research and stigmatization of seeking out support

has been center stage, however, the quality of the research is one issue that continues to emerge

and shine through. The lack of quality research is a large factor that contributes to mental health

services and outcomes for minorities. According to the research, minorities’ health is influenced

by social, environmental, and economic factors and that 80% of health outcomes are credited to

these social determinants of health (Moore et al., 2020). The lack of research comes from the

ideology that minorities cannot afford the appropriate mental health services, those who are

minorities are often excluded from research which enables the research to give accurate evidence

for future outcomes. Moore et al., (2020) stated “developing interventions that improve mental

health for everyone is critical to achieving equity, but there are often challenges in recruiting

communities who have been historically mistreated by the medical field” (p. 571). The best way

to improve the research and to get it as accurate as possible is to try and get those who are in the

minority category to participate in research studies.

Along with the additional emerging issues within mental health equity, another issue is

the way in which diagnosis and treatment are being concluded in those diverse groups.
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“Research demonstrates that most health care providers have a negative implicit bias against

marginalized groups. Implicit bias can harm the health of socially disadvantaged communities”

(Moore et al., 2020, p. 571). Any type of bias can seriously endanger those who may be suffering

from mental health disparities, but especially those who are minorities, it could determine life or

death for them. Sudak et al. (2020) stated that “diagnosis and treatment of marginalized groups

contributes to mental health inequity. Through educational initiatives in cultural and structural

competency may improve mental health equity” (p.555). Based on this information, it is evident

that there needs to be additional and excessive training for medical professionals. This training

needs to be focused on being able to identify any bias that may be in front of them based on the

case, in return this will be able to help centralize the correct diagnosis and treatment options in

those diverse minority groups.

When classifying land, the U.S. Census deems that rural and urban criteria is designated

by landscape (U.S. Census Bureau, 2021). There are five characteristics that are necessary to

classify an area as a rural location and those factors seem to have a large impact on those who

cohabitate on that land. These characteristics include economic stability, education, social and

community context, health and healthcare, neighborhood and built environment (Centers for

Disease Control and Prevention, 2020). When there is a lack of economic stability, those who

may be suffering from those financial struggles are not only more likely to fault to try and

support their basic everyday life essentials, but also it drastically impacts their ability to purchase

and access adequate foods, medication, and medical services such as mental health services.

Hence, there are social determinants that give wind to the fault of mental health. Another

one of those social determinants is education, which has a large impact on those who reside in
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rural areas compared to those who reside in urban areas. Obtaining a job and career is stressful,

and it can drastically affect the physical and mental health of individuals. There are times in

which other factors fall into place where it is not possible to complete an educational program

such as college or even high school for that matter.

Those who live in rural areas or marginalized communities at large, often face the

challenge of distance from their home to the facility that they may need to go to or access to the

transport or connectivity to access the necessary services. There is a shortage of primary care

physicians in these small rural towns or quality practitioners in many of these marginalized

communities. Doctors want to go reside in the urban and large metropolitan areas of the country.

This plays into the situation with mental health equity, those who decide to live in a rural area or

those whose circumstances keep them in marginalized communities may not have the access or

ability to get to appointments where treatment is necessary. According to Reilly, (2020), the

research shows that those who live rural areas are more likely to suffer and end up in worse

health conditions compared to the health of those who live in urban areas. The disparity comes

from the absence of health professionals as well as the quality of health services.

Physical health is such an important factor when considering mental health. According to

the Department of Agriculture (2012, p.6), Americans in urban communities are likely to live

within a 10-mile radius of stores that could provide essential life materials, such as food. The

neighborhood and built environment are an essential prospect at keeping those in a healthy

mental state.

Cultural Diversity the Missing Piece for Access: Education Domain

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The beautiful mix amongst today’s society is that we are a diverse cultural pool. “Many

factors, such as affordability, access, and diversity in the healthcare system, influence care and

outcomes, creating challenges that make the task of eliminating health disparities and achieving

health equity daunting and elusive” (Williams et al., 2016, p.33). Healthcare professionals are

responsible for managing the health of all individuals within a population, when it comes to the

cultural diversity our healthcare workers must be able to adjust and adequately treat the patients

based on their diverse backgrounds. Based on the research, “Cultural competence training is an

effective intervention that enables healthcare providers to give culturally competent care that

increases satisfaction of patients from minority groups.” (Govere, & Govere, 2016, p. 402).

When addressing this disparity, the goal is to create educational prompts that will help assist

medical professionals in both cultural and structural competency which could hopefully lead to a

drastic reduction in mental health disparities, especially within a minority group (Sudak et al.,

2020). It is then very much evident that the issues in healthcare are multifaceted. These issues are

some that can to some extent be easily fixed, they do require the “want” or desire or willingness

to continue to learn about cultural competency, including trainings and the desire to continue to

expand diversity amongst providers.

Interventions & Resources in Regard to Mental Health Disparities and Education of

Providers and The Minority Comunities

Immigrants in the US face a lot of challenges such as discrimination when it comes to the

access of resources. In order for immigrants to be able to access these public services in a stable

manner, there are many policies that need to be implemented that encourage people's

participation in society. This can be anything from a fair access to education, workplace rights
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and policies that make sure that people are paid for the work that they do. In order for these

policies to be effective, there needs to be data on the challenges faced by immigrants (Perreira

and Pedroza, 2019). The studies outlined above give some insight into how immigrants face a

number of challenges in their daily lives but there are many more barriers which need to be

studied and supports considered to ensure equitable and just access to quality mental health care

for all persons regardless of minority status.

The efforts that continue to drive forward to improve the care for mental health will be

challenging but not impossible. An option that should be taken into consideration is to continue

to support the communities, specifically by funding those education systems that are in

underserved communities. Those with a solid education system could be the first steppingstone

in a positive impact when in relation to the success of minority students. This could potentially

lead into the further development when that student is ready to go to a college or university. “Our

country's international competitors are improving faster than we are educationally, and many are

having greater success in closing achievement gaps—which remain stubbornly wide in the

United States. Structural barriers, including inequitable funding systems, impede our progress”

(U.S. Department of Education, n.d., para. 3). With the correct form of action, policy change,

and the drive to want to help improve the stigma surrounding mental health, these interventions

and resources need to be taken seriously.

There are professionals that are specialized all in different categories of medicine. It is

important to use all resources that are available, and with that, it is important to express and

promote the unconditional collaboration between healthcare practitioners. Those who are in the

general practice and those who are centralized in mental health. This would give the opportunity
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to continue to grow and learn together and new studies become known to the public. The support

amongst healthcare providers is essential in treating patients that may be under the diverse

culture, ““integrated care programs support primary care providers in addressing behavioral

health conditions commonly seen in primary care settings by co-locating behavioral health

clinicians and/or having behavioral health clinicians collaborate off site” (Jackson-Triche et al.,

2020, p. 502). The implications for integrating healthcare and providing culturally competent

training across the board to ensure ALL healthcare needs are being met for any and ALL

individuals are revolutionary.

The stigma that surrounds mental health is always going to be prominent, however, the

way that society reacts to it is a whole different story. There is way to improve this stigma and

help those who are suffering from mental health, including those who are minorities or are of a

diverse culture. There is so much more to learn but the first step is going to be to be continuing

to learn and understand the disparities that have been in front of us for decades. There are several

options that we have in our reach so that we can help reduce these disparities. Through

collaboration, policy changes, political leaders, and constant support from one another, there is a

way to ensure every person has access to the help that they need and beyond this, to the support

they deserve.
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