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Excerpted From: Allyson Crane, Racial Disparities in Mental Health Treatment: How Indiana Misses the Mark in Providing Accessible and Quality Treatment Amidst the Coronavirus Pandemic, 19 Indiana Health Law Review 427 (2022) (314 Footnotes) (Full Document)


AllysonCraneDoctors, organizations, and citizens have expressed the importance of mental health, equating its significance to physical health. Despite the numerous conversations about mental health, treatment continues to fall short. This is especially the case for people of color. People of color are at a significant disadvantage in terms of access to quality mental health treatment. Living in poverty, lacking access to health insurance coverage, and discrimination by providers are just a few examples of how people of color struggle to receive quality mental health treatment.

The coronavirus pandemic has exacerbated people of color's limited access to mental health care. While some providers have offered telemedicine as an alternative to in-person mental health treatment, this is not an accessible option for everyone. Those living in low-income households may lack the required technology to access telemedicine, or the providers within a person's community or health care network may not offer virtual mental health appointments. As a result, many people of color are developing mental health conditions as a result of social isolation and other stressors brought on by the coronavirus pandemic and are unable to receive mental health treatment.

It is imperative that health care providers and government officials review current legislation regarding mental health treatment to address inaccessibility, with an emphasis on inaccessibility for people of color. From there, legislation should be proposed that will better protect people of color and allow them easier access to quality mental health treatment. Programs that address accessibility and quality of mental health care for people of color should also be enacted to help increase the number of individuals who seek treatment. Not only will more people of color be seeking treatment, but they will also experience quality treatment that produces positive outcomes.

A. Issue: RacialDisparities in Mental Health Treatment

While white people experience reasonable accessibility and good quality mental health care, people of color still face great disparity in accessibility and quality. These disparities include being discriminated against by providers, limited access to mental health resources due to being disproportionately poor and experiencing higher rates of persistent and chronic mental health conditions. The coronavirus pandemic has helped to intensify these disparities.

1. Racial Discrimination by Providers

Discrimination by providers against people of color significantly contributes to the disparities in mental health treatment. Many providers have racial bias and are unable to properly treat a person of color in a non-discriminatory manner. Placing time constraints on when a person of color may receive mental health services or limiting the mental health resources for a person of color are just two ways in which providers choose to discriminate against people of color when they are seeking mental health services.

Cultural competence plays a pivotal role in racial discrimination. People of color are less likely to experience discrimination when seeking mental health treatment from culturally competent providers. Cultural competence allows providers to treat patients who are people of color based on their values and needs. Culturally incompetent providers are unable to tailor services to a patient of color's needs, likely minimizing the positive effects of mental health treatment.

2. People of Color Are Limited in Their Access to Mental Health Due to Being Disproportionately Poor

Accessibility to mental health services is limited for people of color. The poverty rate for people of color is much higher than it is for white people. Over 21% of black people and 17% of Hispanic people live in poverty, compared to 9% of white people. People of color living in poverty often do not have access to health insurance, or to other resources that would make mental health treatment a feasible option for their household. and ethnic minorities may not have access to health services, may have to wait a long time to receive services, or may not receive the correct services that would create a positive mental health outcome. People of color cannot benefit from receiving quality mental health care if they cannot access it.

3. People of Color Are More Likely to Suffer from Mental Health Illnesses

A person of color's mental health is greatly affected by provider discrimination and their limited access to mental health care. Research has found that black people experience higher rates of anxiety and depression as a result of provider discrimination, living in poverty, and their limited access to mental health care. Also, people of color have higher rates of suicide than white people. Mental health conditions among people of color tend to be more persistent and the severity of the conditions increase over time. In order to address the higher rates of mental health problems with people of color, the issues of discrimination, lack of access, and the numerous other barriers people of color face in mental health care must be resolved.

4. COVID-19 Has Exacerbated RacialDisparities in Mental Health Treatment

COVID-19 disproportionately affects people of color. The “essential” workforce is mainly comprised of people of color, and people of color are more likely to become unemployed as a result of the pandemic. As a result, many people of color either lack the time or the income to seek mental health treatment. Despite the heightened levels of anxiety and stress in individuals in the U.S. due to the pandemic, people of color continue to experience racialdisparities in mental health care. Not only is their physical health in danger, due to the higher rates of being exposed, but their mental health is at risk as well.

B. Indiana's Lack of Legislation and How the State Compares to Others

In 2020, Indiana enacted legislation that requires the Behavioral Health Commission to release a report each year that evaluates access to mental health treatment, funding, mental health providers, and makes a comparison to other state and national programs. Since this is new legislation, a report has yet to be released. Indiana offers no other legislation on racialdisparities in mental health care, especially legislation that actively works on diminishing racialdisparities in mental health treatment. The purpose of the Behavioral Health Commission is to evaluate access to treatment, but it is not specified whether they will offer strategies or solutions to access barriers. Due to the statute's enaction being so recent, it is likely that it will take several years for it to be effective, if it proves to be effective at all.

In comparison, many other states have drafted, proposed, and passed legislation relating to mental health care. Most of these bills recognized the existence of racialdisparities and emphasized the rampant provider discrimination present in the mental health care system. The federal government has also attempted to enact legislation to improve mental health and limit the disparities in treatment that people of color experience. Despite these attempts, few were enacted into law. Those that were codified often did not produce the results intended. In order for states, including Indiana, to improve the quality and access to mental health treatment, the federal government needs to take the necessary measures to address it.

C. The Coronavirus Pandemic and Its Role in the Shift Toward Telemedicine

COVID-19 has had a significant effect on access to mental health care. Providers are shifting to the use of telemedicine to ensure that individuals still have access to healthcare. “Telemedicine involves the use of electronic communications and software to provide clinical services to patients without an in-person visit.” However, many providers use telemedicine for patients to use for appointments related to their physical health. Fewer telemedicine appointments are available for mental health treatment.

People of color are at a significant disadvantage in accessing quality mental health care through the means of telehealth. People of color disproportionately live in poverty and low-income areas, and often lack technology for telehealth to even be an option. Providers within these communities or healthcare network also did not offer virtual mental health appointments. Since many mental health care providers did not offer telemedicine as a means of receiving treatment, people of color were left to cope with their mental health conditions on their own. The coronavirus pandemic has limited access to mental health services for people of color even though those services were severely limited prior to the pandemic.

[. . .]

Mental health care has grown exponentially in recent decades. More people are seeking treatment and society is recognizing mental health conditions and the importance of accessible mental health care. More insurance providers are providing coverage for mental health services, and government officials are actively working toward making mental health services accessible for all. However, there are many racialdisparities in mental health treatment, which have been aggravated by the coronavirus pandemic. Mental health services are not as accessible due to stay-at-home orders and business closures, and more people are suffering from mental health conditions due to stressors brought on by COVID-19. Mental health care providers continue to discriminate against people of color when administering treatment, greatly affecting the outcomes.

The United States has failed to eliminate the racial mental health disparities and has offered very little legislation to work toward doing so. Indiana, like many other states, has failed as well. Indiana offers one piece of legislation about racial mental health disparities, with no requirements to improve or develop policies to eradicate the disparities. Legislation, pressure from the public, and educating people of color on the resources currently available are imperative in solving the issue of racialdisparities in mental health treatment. It will be a long process to resolve the decades of systematic racism that has been instilled in the U.S., but there are many solutions that have been recommended that need to be implemented to begin the process.

J.D. Candidate, 2022, Indiana University Robert H. McKinney School of Law; B.S. 2015, Indiana University.

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