Mental Healthcare Inequality

Watch Dr. McFadden discuss “Mental Healthcare Inequality” on YouTube:

In this video, I review a chapter from “Mind Matters: A Resource Guide to Psychiatry for Black Communities." The book is brilliant, but I selected a chapter for review that is especially pertinent today: Dr. Malaika Berkeley’s chapter on Racism and Inequalities in Mental Health.

Dr. Berkeley educates the reader on healthcare inequalities by definition and by example. Healthcare inequalities are, simply put, differences in health and healthcare. Minorities (including African Americans, Hispanic Americans, American Indians, Asian Americans, and Native Hawaiians) have a greater incidence of diabetes, cancer, heart disease, substance abuse, and infant deaths. They die at an earlier age from these ailments. They have less access to quality health care, and less access to ANY health care. And even when factors such as age, social standing, wealth, location, language, gender, sexual identity and orientation are controlled, these inequalities persist.

Dr. Berkeley gives specifics about disparities in African American vs. white patients. For instance, black patients are twice as likely to be diagnosed with diabetes than white patients. She goes on to talk specifically about inequalities in mental health care, including how African American patients are more likely to leave treatment after the first visit. This is a particularly devastating statistic to me. In my training as a psychiatrist, a central tenant was taught by every single supervisor I had.
“The goal of the initial session is to ensure a second session occurs.” The lack of follow up after session one goes against this basic truism of clinical psychiatry.

Another disturbing fact shared by Dr. Berkeley is regarding inferior treatment of depression. Only 27% of African Americans were prescribed antidepressants when first diagnosed with depression compared to 44% of Caucasians. In my practice, and in discussions with other health care providers, it is EDUCATION that boosts the percentage of patients receiving optimal care and follow up. While it not stated by Dr. Berkeley, TO ME this fact suggests inadequate time and education with the African American patients.

Dr. Berkeley addresses the helplessness people experience when faced with these facts. She acknowledges that by reading the chapter (or even this review!) you are doing something about it. Find out where you or your loved ones can go for help. Use the resources that are available and help a loved one take the first step to seek treatment.