Racial Inequalities Lead to Mental Health Inequalities

It’s time to fix a broken system.

We are heartbroken about the continued deaths of Black men and women due to racial violence, and the impact this has had on the mental health of Black, Indigenous, and People of Color (BIPOC).

When we founded Brightside, we set out to fix a broken health care system–ensuring everyone has access to quality depression and anxiety care. Over the past few weeks, we’ve seen the world come together to demand justice and fix a broken system that has fostered racial inequality and violence against Black people for far too long. When we consider the impact of racism on mental health, it is abundantly clear that these two broken systems are interconnected. Racial inequality leads to mental health inequality–and it’s time for change.

We, our company and our collective society, need to do something about this. Inaction is tacit support of the status quo. At Brightside, we are committed to better ensuring that BIPOC can access affordable, effective, and culturally informed and responsive mental health care.

Racial disparities in mental health care

Although Black Americans have similar or lower rates of common mental disorders than the caucasian population, research suggests that the adult Black community is more likely to experience severe, persistent, and disabling mental health conditions. This disparity is driven by reduced access to care and poorer quality of care.¹ Black Americans also have a higher incidence of chronic health conditions like diabetes, asthma, and heart disease, which increase the likelihood of co-morbid depression and/or anxiety.²

Research also suggests that race-related stress and trauma from repeated exposure to racial discrimination is associated with symptoms of anxiety, depression, and PTSD.^3-4 This can result from major experiences of racism, such as workplace discrimination or hate crimes, or it can be the result of an accumulation of many small occurrences, such as everyday discrimination through remarks, inquires, or behaviors. Racial trauma and race-related stress may also result in issues of self-esteem, self-confidence, and self-worth.⁵

Despite the need, studies suggest that only one-in-three Black Americans who need mental health care receive it.⁶ This happens for a few reasons:

• An overall distrust in the health care system stemming from a long history of systemic racism.
• Financial barriers that prevent BIPOC from being able to afford quality care. This includes lower-income and lack of access to health insurance. About 27% of Black Americans live below the poverty level compared to about 10.8% of non-hispanic whites.⁷
• There is a lack of diversity of mental health care providers and a lack of culturally informed and responsive. Mistreatment by mental health professionals along with concerns about provider competence with their ethnic-racial group may decrease comfort in talking to professionals.^6,8
• Black Americans tend to get lower-quality care, including being less likely to be offered either evidence-based medication therapy or psychotherapy.^8-10
• Concerns, attitudes, and beliefs within the community around mental health and associated stigma; lower openness to receiving mental health care, and preference for religious or spiritual-based coping in lieu of therapy.¹¹

The system is failing them.

Our plan of action

Brightside was founded to fix a broken health care system, making it easy for everyone to access high-quality depression and anxiety care. But when it comes to serving the needs of these communities, we’re still falling short. To date, just 2.5% of our customers have indicated that they are black, and 24% are POC.

We fundamentally believe that everyone deserves high-quality mental health care. For this to be a reality, we need to address the inequalities and barriers BIPOC face within the mental health care system. Now more than ever, we are committed to our mission to make our care increasingly affordable and accessible for everyone, including the Black community. We have work to do, and we won’t stop until we get there.

Our commitment to improving racial equality in mental health care includes three key initiatives:

1. Support mental health organizations created by and for BIPOC. We will be making a donation to two outstanding organizations supporting better mental health care in the Black community by offering culturally informed training and financial assistance to those seeking therapy:
   1. The Black Mental Health Alliance develops, promotes, and sponsors trusted culturally-relevant educational forums, training, and referral services that support the health and well-being of black people and other vulnerable communities.
   2. The Loveland Foundation, an organization created by writer, lecturer and activist, Rachel Elizabeth Cargle, brings opportunity and healing to black communities, including a Therapy Fund that provides financial assistance to black women and girls nationally who are seeking therapy.

   In addition to these donations, we’re also offering Brightside experts as a resource to support the ongoing initiatives of each of these organizations.

2. Ensure our care is culturally informed and responsive. Patients whose mental healthcare providers understand and respect their beliefs, customs, values, language, and traditions are more likely to trust and continue to engage in care, which can, in turn, reduce disparities in healthcare and improve patient outcomes. We will be working with Black and minority mental health organizations to evaluate our offering and suggest modifications to ensure that we are effectively meeting the needs of those communities. This will include the implementation of a training program that ensures all of our providers are able to assess, incorporate, and treat from a culturally-informed lens.We believe in the importance of representation among our providers, both in providing fair, professional opportunities to BIPOC, as well as meeting the preferences and needs of our members. We have work to do. We will be evaluating and updating our recruiting practices to be more intentional about building a diverse network. As part of this effort, we will be focusing on expanding our network to better represent:
   • Providers who identify as Black and other POC
   • Providers with experience working in low-income communities/FQHCs, communities of color, or other marginalized populations.
   • Providers who speak multiple languages

   We will also be evaluating how we promote our open positions, ensuring we have a presence in minority networks.

3. Make our service more accessible and affordable for everyone. Our service can only have the impact we aim to have if we ensure that far more people are able to afford it. We’ve worked hard to make sophisticated tools and expert care as affordable as we can. We’ve come a long way. In traditional care, a psychiatrist appointment tends to cost $350 or more, and therapy is often over $100 per weekly session or over $400 per month. We offer unlimited care from a doctor for medication prescribing and management for $95 per month and unlimited support from a therapist through daily messaging for $160 per month making them much more affordable than existing alternatives. But we realize that these prices are still out of reach for many people who need care. The biggest step we can take to make our care more affordable  is to accept health insurance, including Medicaid. We are actively working on adding this capability. Unfortunately, the healthcare system does not make it easy for new companies and models of care to fit into the existing system, making the process slower and more difficult than we would like. We will continue to push until Brightside is broadly available through public and private insurance plans.

In addition to these three key initiatives, we will continue to do the things we focus on every day: educate people about mental health, fight against stigma, and stand up for better quality in depression and anxiety care for everyone.

We are in this for the long haul

The days of pretending systemic racism doesn’t exist in the US are gone, and words of support aren’t enough. We need to take action. Our mission is, and always will be, to deliver life-changing depression and anxiety care to everyone who needs it. We’re more committed than ever.

 

Sources:

 

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3928067/
2. https://www.cdc.gov/pcd/issues/2005/jan/04_0066.htm
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4358177/
4. https://psycnet.apa.org/record/2017-45389-001
5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4982390/
6. https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201500318
7. https://www.census.gov/library/publications/2016/demo/p60-256.html
8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3928067/
9. https://europepmc.org/article/pmc/1495452
10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4279858/