Unseen Struggles: Addressing Mental Health Gaps in Marginalized Youth

In December 2021, I released a Surgeon General’s Advisory on Youth Mental Health that outlines the policy, institutional, and individual changes it will take to address long-standing challenges, strengthen the resilience of young people, support their families and communities, and mitigate the pandemic’s mental health impacts.18 I have seen firsthand the dedication and efforts that young people, parents, schools, community-based organizations, and other entities have taken to support the mental health of children, adolescents, and young adults. During the pandemic, many detention facilities for young people substantially reduced their mental health services, which limited access to counselors and treatment programs and enforced 23-hour periods of isolation to prevent the spread of coronavirus, halting family visitation.14 These mitigation measures substantially affected young people’s mental health, which is concerning given that approximately 70% of young people in detention centers or correctional settings have a preexisting mental health disorder.15 The authors said it was notable that that there were no disparities in teens’ receipt of mental health services from support groups or peer support specialists and recovery coaches. The study found that white teens were far more likely to access mental health care than racial minority teens. Adolescents belonging to racial minority groups are significantly less likely to receive mental health care than white adolescents, according to a new study led by Harvard T.H. Chan School of Public Health.

Mental Health Facts for Diverse Populations (.pdf)

This discrepancy is even more pronounced among youth. About 33% of Hispanic adults with mental illness receive treatment each year, compared to the U.S. average of 43%. That’s a staggering gap in treatment. Yet, they’re also less likely to receive appropriate care.

The state of mental health in minority communities

Systemic racism also encompasses social and cultural norms influenced by racial prejudices, which can lead to unconscious or implicit biases. The intergenerational effects of lack of homeownership have resulted in a persistent wealth gap between Black and white residents. The concept of structural racism describes the inequities that exist due to the interaction between institutional and broader sociocultural factors that continue to operate with stereotypes and racial discrimination at their core. Individuals from marginalized communities who live with a mental illness are also more likely to be misdiagnosed or underdiagnosed and receive a lower quality of care. Moreover, mental illnesses are more likely to cause disability in people from historically marginalized ethnic groups. Although the prevalence of mental disorders is lower in Black people than in white people in the United States, the impact of these disorders tends to be more severe in marginalized communities.

As evidence of racial and ethnic disparities in SAFE Project Latinx mental health resources mental health care access continues to rise, efforts have been made to better understand gaps and limitations in the way that minority children’s mental health services are provided. School-based mental health services, and particularly SBHCs, can promote health equity, reduce racial and ethnic disparities in access to care, and enhance engagement in mental health services among youth who face significant barriers to care. Despite health care reform, critical disparities persist in access to mental health services among low-income ethnic and racial minority youth in under-resourced communities.

Others serve all youth, but try to be inclusive of gender and sexual diversity. Health care providers should only share details about these identities if a young person gives them explicit permission to do so. Under most circumstances, a health care provider must keep all aspects of a young person’s visit confidential. There is no general age of consent to treatment or counselling; instead, the issue depends on whether the young person is capable of consenting.

• Brief Strategic Family Therapy, an evidence-based family intervention, has been developed and tested with Latino and African-American youth.68 Ethnically specific programs for American Indian youth based on traditional values and rituals/ceremonies have also been developed and evaluated.69, 70
• Lastly, to facilitate generalizability, studies were excluded that focused exclusively on homeless adolescents or adolescents in child protective services custody, juvenile detention facilities, or foster care.
• Health and social support services provided by peers have the potential to reduce disparities in outpatient service use among minority transition age youth (youth ages 16–24, hereafter youth) with serious mental illness who remain underserved by the public mental health system (Alegria et al. 2016).