The stress of COVID fractured a system that was already cracked
For more than 25 years, Richard Youins struggled to find help with his drug addiction. Youins is from New Haven, Conn., home to both Yale University and a number of less affluent neighborhoods—his community has been shaken by murders and drug-related crimes during the pandemic. Substance use clinics and treatment sites were available, but he felt the care they provided overlooked who he was as a person. The needs “of our community weren't being addressed,” says Youins, who is Black.
Now experts in the mental health field are acknowledging that they must confront ugly truths in the American health-care system, including structural racism and classism.
The obvious solution to expanding access in the U.S., Shim says, is establishing universal health care, which would assure coverage regardless of someone's ability to pay. Until that happens, however, mental health organizations that are designed by and serve marginalized communities can play a meaningful role in overcoming cost-related and social factors that reduce access to care. “We need to be at the table, making decisions,” Youins says.
In rural America, stigma is hardly the only issue: even when people want care, they often cannot find a therapist. As of March 2022, more than 35 million Americans in rural areas lacked access to a mental health provider. Researchers agree that to focus on the inequities of marginalized groups, it is critical to gather data on their experiences. “People in Congress do not see a problem when there [are] no data,” Jha says. But a data set is useless if it is not collected in a culturally sensitive way, and current research tools are not always sensitive enough to gather information about nonwhite populations.
Community Healing Allowing communities to be engaged in their own care may be the most important step toward achieving mental health equity. “When a community is empowered to solve their own problems, they're often very effective,” Shim says. Felts later joined CAHOOTS because it provided a nonviolent, unarmed response to mental health crisis calls, did not bill its patients and prioritized comprehensive care—everything from medical aid to connecting people to food and shelter. It aims to “meet people where they are and be sensitive to the intersectionality of our patient population,” Felts says.
In October 2021 Dominguez and other mental health clinicians working for Kaiser Permanente in California and Hawaii voted to strike when the provider rejected their union's proposals to increase staffing. Some locations are still without a contract. Kaiser, however, has spotlighted La Clínica as a diversity and inclusion success story to be replicated.
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