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Excerpted From: MaryAllison Mahacek, The Mrs. B. Dilemma: How Can We Get Elderly People of Color More Access and Encouragement to Use Mental Health Services?, 29 Elder Law Journal 509 (2022) (332 Footnotes) (Full Document)


MaryAllisonMahacekMrs. B, an eighty-one-year-old, African American widow, who lived in a senior apartment, was asked to describe her experience with depression and the lowest points of her life, among other questions about her mental and physical health. When asked about the worst time in her life, she answered that it was the present; she was feeling sad that she left behind her beautiful apartment and friends in Chicago to live near her son in Philadelphia, who seemed too busy to see her. She often wondered about her purpose in life and said that when she prays, she asks God: “Please tell me what you want me to do in this life.” When asked how she could be relieved of her feelings of sadness and depression, she answered:

I guess if I had somebody to talk to or share my problems with. Sometimes I feel ashamed because I feel like God is blessing me each day. So I ask God, 'What are you trying to tell me? What am I doing that's not right? What should I be doing?’

This testimonial, one of multiple given in a study done on elderly African American women, gives a harrowing look into the struggle that elderly people of color (“POC”) experience regarding their mental health and the difficulty they have in coping with these issues in their everyday lives.

Mental health issues and the usage of mental health services have come to the forefront of modern scholarship on health and wellness. In 2019, the National Institute of Mental Health reported that nearly one in five U.S. adults live with a mental illness. It should come as no surprise then that mental illness plagues the elderly population of this country. In fact, between 5-10 million Americans aged sixty-five years or older suffer from depression. Another five million suffer from more severe forms of depression. Additionally, around one in five older adults in the U.S. experience a mental illness, substance use disorder, or both. This issue has the potential to get much worse. Assuming that the one-in-five ratio still exists in 2030, it will equate to approximately fifteen million people, as the number of Americans aged sixty-five and older is projected to double by 2060.

While many elderly people experience mental illness and mental health issues, this is an even bigger problem for communities of color, as demonstrated in the testimonial above. These groups do not have enough access to and/or are not utilizing available services to assist them with their mental health struggles. The Agency for Healthcare Research and Quality reports that racial and ethnic minority groups in the U.S. are less likely to have access to mental health services, less likely to use community mental health services, while being more likely to use emergency departments and receive lower quality care. This is largely due to not only racial inequality that exists within healthcare systems, like biases and stereotypes that lead doctors and physicians to neglect or actively discriminate against patients, but also, to outside factors. For example, economic disparities between racial groups make it more costly to get insurance, which prevents people of color from receiving medical care. Thus, individuals who have lower forms of insurance--if any at all-- tend to receive a lesser quality of care. Latinos are three times as likely to be uninsured and African Americans are twice as likely to be uninsured in comparison to whites, so low quality of care or no care at all is clearly an issue in these populations. There is also an underrepresentation of people of color in mental health research and communities of color experience more disability burdens from mental illnesses than do whites. At the root of these issues is a great distrust of the healthcare system from communities of color regardless of age.

This Note will discuss the efforts that have been made by various lawmakers, legislators, and health professionals to give elderly people of color the resources they need. It also will demonstrate how more needs to be done to fix this issue, specifically through the avenues of housing laws, Medicare and Medicaid, and nursing home behavioral health care, among others. Part II will provide background information on the definition of mental health, how mental health issues affect elderly communities, and specifically, how they affect elderly communities of color. Part III will discuss various efforts that have been taken to eradicate this issue, primarily through the avenues of Medicare and Medicaid, nursing home care, Section 8 housing vouchers, and the need for an integrated care or collaborative care model to assist elderly minorities in their care issues. Part IV recommends reforms to Medicare, Medicaid, Section 8 housing vouchers, and a call for a national awareness campaign, as well as requests for more research to be done in the avenue of the collaborative care model and its effect on older people of color, as well as wider implementation of the model.

[. . .]

Mental health issues and a lack of access to mental health care are serious problems for elderly people of color in the United States. This problem only is going to worsen as the elderly population grows and people start living longer while modern medicine develops. Bringing awareness to and fixing this issue will require the banding together of many disciplines, like governmental/legislative groups, public housing authorities, lobbying and public policy groups, medical care staff, nursing home entities, and those in health care administration. Additionally, this Note only has explored certain facets of the racial disparity in usage and accessibility to mental health services. Ultimately, this problem is deeply rooted in a mistrust of the healthcare system by minority groups, especially, elderly minorities who may have had bad health care experiences in their lifetime and are not looking to give new treatments or providers a chance. We, as a society, need to continue looking into this problem, find workable solutions, and get elderly minorities, like Mrs. B, the mental health care they need and deserve.

MaryAllison Mahacek, Notes Editor 2021-2022, The Elder Law Journal; J.D. 2022, University of Illinois at Urbana-Champaign; B.A 2019, English, B.A. 2019, Communications, University of Illinois at Urbana-Champaign.

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