Over the past 10 years, communities all over the U.S. have used Minority Mental Health Awareness Month as a springboard to talk about the unique struggles people experiencing marginalization face regarding mental health care in this country.
In 2008, the U.S. House of Representatives officially designated July as Bebe Moore Campbell National Minority Mental Health Awareness Month. Since then, it has been used to start conversations around communities that are frequently under-served and under-represented when seeking mental health care.
At the Mental Health Center of Denver, we continue to see the courage and resilience of people in these communities. We recognize they may have had or continue to have trouble accessing services for their mental health and well-being due to various social and/or structural barriers. We are committed to helping people of all different backgrounds, including but not limited to people from different ethnicities, abilities, sexualities, gender identities and nationalities.
In the spirit of fostering conversations around Minority Mental Health Awareness Month, we asked a diverse group of staff across the Mental Health Center of Denver to share their thoughts. The following staff members shared from their own lived experiences and/or their experiences working with people experiencing marginalization:
Mercedes Blea-Davis, Site Coordinator, Dahlia Campus for Health & Well-Being
Margaret Brugger, LCSW, Child & Family Therapist, Child & Family Services at North Federal
Amanda M. Daniel, MA, LPC, Program Manager, El Centro de Las Familias
Gloria Farr, LCSW, ASL Mental Health Therapist, Deaf & Hard of Hearing Services
Steven Haden, Peer Specialist, 2Succeed
Anna Sihon, LCSW, Behavioral Health Consultant & Care Coordinator, Integrated Care – Green Valley Ranch Medical Clinic
1. What would you want people to know about the unique struggles of people experiencing marginalization who are seeking mental health services?
ANNA: A little bit of listening and empathy goes a long way. For most persons of marginalized groups who I have worked with and who have previously reported a negative experience with mental health services, it was because the location and persons they were having interactions with were triggering trauma and talking and acting in a way that the person perceived as discriminatory.
Many have never had a mental health professional really include in the intake or get-to-know-you sessions questions about their background and what is important to them. Many haven’t had a mental health professional teach them psycho ed about how aspects of their mental health symptoms and treatment options intersect with their cultural and religious practices.
MERCEDES: The fear of being judged by those closest to us is often the biggest plague we face. With many not fully understanding the meaning and difference between mental illness and mental well-being, this has caused a hindrance in the progression of a culture. Those needing services are embarrassed to seek assistance based off of the appearance they must uphold to their peers. There can be a strong sense of pride within these groups—that if at any moment a sign of weakness is shown, they may feel as if their reputation has been tarnished and they can no longer fully co-exist with their peers without feeling backlash and judgment.
MARGARET: Under the current administration’s changing immigration policies, I have heard stories of many immigrants and refugees living without documentation that the fear and anxiety to engage in services has gone up. It’s important for us to be mindful that some people are reporting to be afraid to even leave the house, let alone engage services they feel may not be able to treat them in a culturally sensitive way.
GLORIA: The system does not always provide services that fit everyone. Simply seeking mental health services can be re-traumatizing for these individuals. It is highly likely that by the time the person contacts mental health services, they already had to break down barriers. We want to try to acknowledge that, and not to minimize or compare their experiences. We also want to keep intersectionality in mind – and to ask what they would like in the services they receive.
STEVEN: The LGBTQ+ community is diverse. While the L (lesbian), G (gay), B (bisexual), T (transgendered), and Q (queer) are tied together, suggesting homogeneity, each letter represents a wide range of people of different races, ethnicities, ages, socioeconomic status and identities. What binds us together as social and gender minorities are common experiences of stigma and discrimination.
Here’s a statistical snapshot:
- Approximately 10 million Americans identify as LGBTQ+.
- One in three people in the LGBTQ+ community will experience mental illness this year.
- Nearly 30 percent of the LGBTQ+ community abuse substances, compared to 9 percent of the general population.
- For LGBTQ+ people aged 10 to 24, suicide is one of the leading causes of death.
- Of homeless youth, nearly 40 percent identify as LGBTQ+.
- Only one in two people in the LGBTQ+ community who need help will get help.
AMANDA: Practically speaking, some of the struggles for people seeking treatment are the cost, distance to a provider, language barrier, timing of appointments, and lack of child care and transportation. Other than the practicalities, stigma and fear of the unknown are probably the top reasons why people don’t seek help.
For those who are Spanish-speaking only, another big concern is being understood—literally and figuratively. When I walk in, will someone speak my language? Will they judge me? Can this really help? Are they going to hurt me? Call the police? Report me to immigration? Take my kids? These are all concerns that we hear from people newly in treatment.”
For anyone who has not been in therapy before, there are a lot of misconceptions from the media, movies, TV and just ‘stories’ people have heard. I don’t think I have ever seen therapy portrayed accurately in movies or on television. As mental health professionals, we are also still living down the history of how people with mental illness have been treated historically, including lobotomies, institutionalization and a plethora of experimental ‘treatments’. As a field of endeavor, we have come a long way since those days. However, some of that still haunts the profession.
Questions I have heard during initial intakes include if they would have to live at the clinic, get shock treatment, get injections or just generally have something forced upon then against their will. People fear what they don’t understand, so it is our role as mental health professionals to first set people at ease and then explain what therapy actually is and how it can benefit them. During an intake evaluation, one of my goals was to get the person/family to at least smile and hopefully laugh at some point during that first appointment. If that happened, then the therapeutic relationship was off to a promising start.
2. How would you ease the struggles of people experiencing marginalization who are seeking mental health services?
ANNA: The Integrated Care team is a great way to create an ease of Access. Many go and see their doctor for a headache or some other ache and pain and then end up talking to me because the provider heard something that felt like a behavioral health match. There is still so much lack of understanding of what mental health disorders are, as well as a lack of capacity, especially for persons needing services in a language other than English.
Knowledge about the health care systems in the countries our immigrant and refugee communities are familiar with are ways to create alternative visit types and scheduling, which helps with integration, building community, and engagement in support services.
I believe the current set up for most adult mental health services is not culturally appropriate for the family-oriented cultures we have in our communities. Many of our under-served populations would be better served on a child and family team who is used to engaging and set the expectation that family will be involved in the treatment of the identified person needing support. Childcare and scheduling are also a barrier as many have work schedules that do not allow them the ability to make appointments during regular business hours, and many do not have childcare resources.
STEVEN: Clinicians and staff should be informed about LGBTQ+ issues for several reasons. First, there is a long history of anti-LGBTQ+ bias in healthcare which continues to shape health-seeking behavior and access to care for LGBTQ+ individuals, despite increasing social acceptance. Until 1973, homosexuality was listed as a disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Second, although there are no LGBTQ+-specific diseases, clinicians should be informed about the health of the LGBTQ+ community because of numerous health disparities which affect members of the community.
MARGARET: I work hard to understand my own privilege and how it affects interactions. I also try to stay up to date with community resources so that when someone comes to me, I feel like I have more to offer than therapy alone. And maybe what I have to offer isn’t going to fix everything, but at least I can point them to the right community resources.
I also practice serious self-care. I lead trainings on self-care because it’s so important for providers, especially those working with marginalized groups. I believe the healthier we are, the more present we can be with people.
GLORIA: I try to acknowledge privileges and show a willingness to unpack. The individuals I see continue to challenge the privileges and biases that I overlooked. I recognize that flexibility is important in order to fit to their preferences and needs, and to overcome any barrier that they may have faced. I believe that in most cases it is generally better to overestimate than to underestimate abilities. I also try to maintain a sense of ‘one-down’ approach and noticed that it makes a significant impact on their willingness to engage in services.
AMANDA: At El Centro de Las Familias, one thing we have going for us is that we are in located in a community with a large population of Spanish speakers and Spanish speaking businesses. Everyone who works here has some level of Spanish and an interest in working with Spanish-speaking and bilingual people. We hire people who either are from the culture or who have experience with the culture of those we serve. We are intentional about creating a warm, welcoming and nonjudgmental environment from when people walk up until they walk back out.
Providing excellent service is the best way to get people in the door. If someone comes in and has a good experience, they tell someone who is struggling with something similar and encourage them to call us for help. We get a lot of people who say they decided to call us because of a friend or family member’s recommendation.
I had someone tell me once that her brother told her that the place on the corner (El Centro) is where ‘crazy people’ went. She said she corrected him and told him that that is a place where you go when you need help with your emotions or with your child’s behaviors. That it is actually a place where people go to get help. The people we serve are El Centro’s best ambassadors back to the community.
MERCEDES: Providing familiar faces would allow for an easier transition when trying to reach groups in which appearance and image is EVERYTHING. If we held outreach events in locations where these minority groups are the majority, this would allow our reach to go far beyond our scope and gain a greater acceptance in these communities. By meeting the communities where they are we would be able to have a more thorough understanding of how to adapt our services to meet their needs and interests.
3. Is there are a more empowering way to refer to these groups other than “minority” groups (is there a better term to use, e.g. marginalized, under-represented, under-served, etc.)?
ANNA: Semantics. Clients, patients, people we serve, marginalized, underrepresented, under-served… Frankly, all of these labels are only useful to and used by providers and development staff filling out grants and describing the groups of people we work with. Statistical truths about disparities in access to care is not going to change how you describe it academically or for funding.
The problem comes when you use them as a label. Like we have moved away from calling people by their diagnosis and are becoming more mindful of non-binary genders, we also need to be aware and really treat others as unique individuals. They will sense if you are stuck in academic thought, and that will not lead to a good interaction. ‘Under-represented’ and ‘under-served’ are better than ‘marginalized’ and ‘minority’ when you talk about empowering.
STEVEN: I like the term under-served as it points to the disparities that exist in terms of services and resources available to individuals not often associated as part of the majority.
MERCEDES: Under-served or under-serviced community/population would be a better way to address this group. Because even if resources are readily available, how are these individuals prepared to find and access these resources? When one is unsure of which path to take, they may seek information from those who have also been misguided or misinformed. Also, at times, the groups providing the information are unable to directly relate and this will cause discomfort and a sense of disconnection for those seeking services.
AMANDA: This is a really tricky question. Over the past 20 years, I have seen terms change many times. I heard a story years ago on NPR when ‘mental retardation’ was changed to ‘developmental disability’—the reporter asked someone from this group what he preferred to be called and he said ‘Bill’. That has stuck with me.
In the U.S., we have such a preoccupation with classifying and pigeon-holing everything. For expediency and research purposes, it is important that we gather data in a concise way so that we can show how certain groups are doing and get initiatives funded.
On a day-to-day level, I personally see everyone as an individual with their own unique wants and needs that can’t be assumed just because they belong to a particular group. We can extrapolate trends and tendencies about groups at a population level, but at the end of the day we are all unique and want to be seen for who we are, not what we are.
See statistics, studies and resources:
- Understanding Barriers to Minority Mental Health Care
- Reaching Immigrants & Refugees Through Faith Communities
- Challenging Multicultural Disparities in Mental Health
- Mental Health Disparities: LGBTQ
- Family Culture in Mental Health Help-Seeking and Utilization in a Nationally Representative Sample of Latinos in the United States: The NLAAS