Members of ethnic minority groups are faced with several barriers that prevent them from adequately participating in treatment for mental illness. Mental illnesses are commonly overlooked and untreated due to the negative connotations that surround them. Minorities with lower socioeconomic status frequently have poor physical health, which creates vulnerability to mental illness pooled with a lack of affordable treatment and accessible resources. Stigma along with various beliefs and attitudes generates discrimination and social distancing behaviors towards persons with mental illness, as a result of the direct affects of ignorance, negative attitudes, and common beliefs. This often results in discrepancy and underutilization of service amongst minority populations.
Mental Illness is a disorder of the brain that affects a person’s mood, thinking and behavior (Cohen 2002, NIMH). Mental disorders are all around us, however, in many cases some are overlooked. According to the National Institute of Mental Health an estimated 26.2 percent of Americans, ages 18 and older, suffer from a diagnosable mental disorder each year; an estimated 45 percent of those with any diagnosable mental disorder meet criteria for 2 or more disorders (NIMH 2010). Serious mental illnesses interrupt a person’s ability to carry out essential aspects of daily life. There are several different types of mental illnesses some of which are more severe than others, however, the most common disorders are depression, anxiety disorders, panic attacks, bipolar disorders, phobias, eating disorders, substance abuse, dementia, and schizophrenia (Kobau 2008).
Causes of mental illness range from inherited traits and genetics to biological, environmental and social cultural factors to life experiences, such as excessive stress. When mental illnesses are left untreated, it can cause emotional, physical and behavioral health problems (Cohen, 2002; Whitley, 2010). However, due to stigmas and various negative connotations surrounding mental illness people often try to reject, ignore or self medicate the illness in a state of denial (Cohen, 2002). Moreover, poverty is an important moderator of the correlation between serious mental illness and social problems (Draine, 2002). African Americans as well as minorities are more prone to suffer from significant and persistent disparities within the mental health system (Whitley, 2010). This research paper will examine racial differences of both men and women suffering from common mental illness disorders and their usage of mental health services associated with stigmas. Minorities suffering from mental illness are often less likely to access service from a mental health professional, and will more often receive poor quality care or drop out upon admittance (Whitley, 2010).
Stigma and Discrimination
The term stigma originally derives from the ancient Greek practice where criminals were branded, leaving them with a mark referred to as a stigma that allowed them to be easily identified (Gibson 2008). Persons with a stigma were usually rejected from society, viewed as outcast, and devalued by society similar to persons suffering from mental illness. Due to the stigma attached to persons tormented by mental illness, it forms a lack of personal contact with persons suffering from these disorders; resulting in a lack of knowledge, which in turn leads to prejudices, negative attitudes and stereotypes towards them (Alegria 2002, Guimon 2010). Stigmatization of persons suffering with mental illness stems from socio-cultural, ethnic, religious, and economic factors (Guimon, 2010). Stereotype-based negative attitudes and prejudices towards mental illness develop early in life, originating from cultural, historical and media depictions (Sartorius & Schulze, 2005; Bauman, 2007; Guimon 2010).
Prejudices, discrimination and social distance are frequent consequences of the stigmatization that follows mental illness. The effect of stigma permeates through many aspects of the lives mentally ill patients, resulting in discrimination by means of denial of civil, political, economic, social, and cultural rights. For example, adequate housing, employment, education, health, freedom of opinion and expression can all be affected either directly or indirectly triggered by mental illness (Guimon, 2010). Due to expectations of stable norms and values that shape today’s society social distance becomes a direct effect of stigma related to mental illness (Baumann, 2007). When severe mental illness results in unusual or abnormal behavior the desire for separation and social distance becomes essential. Several social psychiatrists propose that society itself is sick and that stigmas and the diagnostic process are simply attempts to label individuals who try to free themselves from society’s general organization (Guimon, 2010).
Stigma associated with mental illness exists across the general population. However, they hold acute significance amongst minority populations. Studies have found racial and ethnic differences regarding stigmatizing attitudes surrounding people with mental illness, which often influences discrimination and negative attitudes toward seeking treatment for mental illnesses (Alegria 2002, Faye 2005, Bolden 2005, Anglin, 2006). Minorities endure double stigma as a result of discriminatory practices along with having to deal with the burden of living with a mental disorder (Faye 2005, Shim 2009). Double stigma is created by ethnic minority group membership, which confronts the individual with significant barriers (Faye 2005). Researchers have theorized that African Americans, Caribbean blacks and persons from other ethnic minority groups hold more negative attitudes than Caucasians (Anglin, 2006; Shim, 2009; Whitley 2010). Stigmatizing attitudes in most cases acts as a barrier and deters individuals from seeking care in order to avoid the label and shame of mental illness that result when people are associated with mental health care (Gary, 2005; Anglin, 2006).
Quality of Treatment & Care
Furthermore, stigmatizing views are not strictly limited to the general population or in the context of social relationships with friends, relatives or employers; stereotypes also occur in the contact with general health professionals (Guimon 2010, Ross & Goldner 2009). A vast number of general medical nurses’ share negative attitudes and commonly held stereotypical beliefs of mental illness. Studies have shown that mental health psychiatry patients’ needs are not viewed as a priority by general medical nurses (Ross & Goldner 2009). Thus they have more constructive things to handle such as looking after someone who is really sick, and more deserving while mentally ill patients are simply taking up space preventing a patient in need from a receiving a bed (Ross & Goldner 2009). General nurses often stigmatize and present negative attitudes towards mental health psychiatry patients due to a lack of knowledge in addition to media generated and historical misrepresentations of persons with mental illness as violent and bizarre (Gary 2005; Ross & Goldner, 2009; Guimon, 2010).
Affordable treatment and accessible resources is also a discrepancy when it comes to seeking psychiatric services. Minorities are at risk for not receiving adequate mental health care, given the lower socioeconomic status (Gary 2005). They often lack health insurance and are not capable to pay for services (Roberts 2008). This creates a circle of poverty is created when serious mental disorders go untreated resulting in individuals becoming unable to fully participate in education and work opportunities (Roberts 2008). Family resources are often depleted due to poverty, drastically effecting families struggling to provide care, and costly treatment for their loved ones (Gary 2005).
Minorities with mental illness are less likely to receive treatment for mental illness. However, when they do receive treatment the care is more likely to be of poor quality (Shim 2009). “Because African Americans and minorities seek treatment during a crisis the care they receive is normally crisis oriented, episodic and less likely to enhance long term recovery.(Bolden 2008)” Social position plays major role in both mental illness and service use (Alegria 2002, Roberts 2008, Whitley 2010). Living in poor socioeconomic conditions encourage suffering distress and a greater risk of becoming diagnosed with a mental illness, with a lower chance of obtaining proper treatment (Roberts 2008, Whitley 2010). Minorities are overrepresented in underserved communities often lacking insurance or the ability to pay for services (Alegria 2002, Roberts 2008, Whitley 2010). Therefore, due to African Americans as well as other minorities’ previous experience with lower quality mental healthcare due to racist experiences they are often discouraged from seeking care (Algeria 2002).
Treatment Views and Outcomes
In order to avoid anticipated discrimination and prejudice due to their condition, many people suffering with mental illness fail to seek treatment for early symptoms. One in four Americans will be affected by a mental health disorder in their lives. However, two out of three persons will seek help from a professional (Roberts, 2008). Minorities often seek late treatment during a crisis at the emergency room or from a primary care physician opposed to a psychiatrist or other specialty mental health professionals (Shim 2009, Bolden 2005). Studies have shown that specifically African Americans and minorities underutilize voluntary professional mental health services, driven by the uncertainty of the effectiveness of treatment (Anglin 2008, Jagedeo 2009), viewing the mental health clinic as a place to be fearfully avoided rather than a provider of service (Whitley 2010).
Several researchers have hypothesized that certain demographics are more likely to feel uncomfortable speaking with a mental health professionals. Research has shown that a possible explanation for the differences of minorities seeking and receiving treatment for mental illness is a consequence of mistrust among patients (Alegria 2002).
It has been argued that African American patients believe that their mental health experience of anguish is a religious or moral issue opposed to a psychiatric concern (Whitley 2010). African Americans prefer to receive informal counseling from church officials and ministers, which in turn prolongs delays in clinical treatment (Bolden 2005, Anglin 2008, Whitley 2010). Deidre M. Anglin’s research also suggests that African Americans are more likely to seek services from extended family networks. Anglin stresses the importance of family involvement and religion in African American Culture, which correlates to psychiatric rehabilitation related to stigma and family involvement, where families often discourage persons suffering with mental illness from seeking treatment (Whitley 2010).
In contrast to the stigma associated with mental illness researchers have found that African Americans are more likely to believe that metal health professionals or a spiritual leader can help individuals suffering from mental disorders, however, studies consistently show that African Americans under utilize voluntary mental health services(Anglin 2008). Research has found that African Americans along with other minorities often believe that mental illness conditions will improve on their own, or that the condition is not serious (Anglin 2008, Roberts 2008, Shim 2009). Research has suggested that minorities believe that mild symptoms of mental illness are normal experiences, due to socioeconomic problems and daily experiences within their community (Roberts 2008). African Americans are more likely to delay seeking help until they experience symptoms or during a crisis, and are severely ill during the time of utilization which determines the length of the stay (Bolden 2005, Anglin 2008).
Furthermore, when individuals decide to seek treatment, many of them neglect the prescribed course of therapy, while others terminate mental health services all together (Faye 2005). Research suggests that once contact with mental healthcare professionals is made positive pretreatment attitudes diminish (Angling 2008, Shim 2009). African Americans and minorities have cultural mistrust when it comes to the mental healthcare system, leading to increased dropout and decreased client satisfaction surrounding treatment (Anglin 2008). Negative attitudes and stigma also advocate a strong association between mental healthcare and treatment dropout (Jagedeo 2009).
Racial and ethnic minorities’ beliefs regarding the natural course and the seriousness of mental illnesses relate to the perceived treatment effectiveness and common beliefs. Stigmatization, negative attitudes and discrimination attached to mental illnesses often lead to the under treatment of mental disorders. Minorities frequently believe that mental illness can be treated and possibly improve. However, there is inconsistency between the beliefs of actual need for treatment and utilization. Together, these realities support the hypothesis that minorities with mental illness are often less likely to access service from a mental health professional. In sum, increased awareness regarding the benefits of treatment can increase efforts, as well as beliefs hat mental health treatment is necessary.