Positive Approaches Journal, Volume 12, Issue 1

Volume 12 ► Issue 1 ► May 2023

Mental Health Stigma Across Ethnic Minority Identities

Koebe S. Diaz

Abstract

Mental health stigma impacts our view on mental health and mental health care. These stigmas can be different according to our ethnic and racial identity. It is important to acknowledge the differences that may exist because of our identities and use this to drive our research and practice so that we can ensure that all individuals are receiving quality and culturally relevant health care.

Mental health stigma emerges when there is a societal misunderstanding of mental health diagnoses and how they may affect a person.¹ The effects of mental health stigma can be felt in various ways, including discrimination in the workplace, misconceptions of capabilities, and influence on self-perception. These same stigmas that people use to judge others also influence how they view mental health for themselves, which can be referred to as “self-stigma.”¹ A mental health diagnosis is often viewed as if the individual is at fault for their diagnosis, unlike a person who has a physical ailment such as the flu or cancer. Mental health stigma impacts how people are viewed and treated when they receive a mental health diagnosis. This can impact a person’s eagerness to acknowledge their need for mental health services.

Racial and ethnic minority groups have historically been marginalized in the United States. This discrimination is embedded within large institutions and systems. Over time, the result of this discrimination has caused a lack of trust between marginalized groups and these institutions, one of them being the health care system. Within the health care system, race and ethnicity have an impact on the quality of care a person can receive. This may be due to socioeconomic disadvantages, geographical restrictions, discrimination at the hands of health care providers, and a lack of cultural competency.² The disparities that exist within the health care system can discourage individuals from accessing services and reaching out for assistance when needed. It is reported that 51.8% of white Americans will receive treatment related to a mental health condition each year. This rate is significantly higher than other racial and ethnic groups; 35.1% for the Hispanic population, 37.1% for Black Americans, and 20.8% for Asian Americans.³

Black Americans are, when compared to white Americans, less likely to be included in research, and “less likely to be offered evidence-based medication therapy or psychotherapy.”⁴ Hispanic children are, at times, at a greater risk for psychological disorders than white American children.⁵ Additionally, racial and ethnic minority groups face a variety of barriers to accessing mental health care. There are structural barriers that exclude racial and ethnic minority groups from accessing quality mental health services, which only strengthens mental health stigma among these communities. Some examples of these barriers include, language,⁶ legal restrictions,⁶ and a history of discrimination, misdiagnosis, and mistreatment by the healthcare institution.⁷ It is important that we challenge these ideas and offer perspectives that encompass the multiple racial, ethnic, and cultural identities that exist within the United States.

There are many factors that contribute to the different experiences of mental health stigma that ethnic and racial minority groups face including language barriers, access to care, access to culturally competent care, and cultural or personal beliefs and attitudes.^4,7,8,9 Two large factors that exist across racial and ethnic minorities that contribute to mental health stigma are strong religious affiliations and a desire not to appear “weak”. The strong religious affiliations that exist within these communities act as support and familiarity in the face of discrimination and adversity. Strong religious ties are often barriers to accepting mental health concerns  that are disregarded and believed to be treatable through their participation in religious services.^9,10 The desire to not appear “weak” or “crazy” is a common sentiment throughout many racial and ethnic minority groups and is a common factor of mental health stigma within these communities.^8,9,10

Additionally, within specific ethnic and racial minority groups, there are culturally specific factors that impact mental health stigma for each cultural group. For example, Asian Americans are the least likely group in the United States to seek care for a mental health related issue.¹¹ The “model minority” myth is a harmful stereotype which suggests that all Asian Americans possess the same characteristics which allow them to succeed more than other racial and ethnic groups, resulting in added pressure to reach these expectations.¹² The existence of stereotypes, such as the model minority myth, strengthens mental health stigma within the Asian community, as it enforces the need to not be seen as “weak” or “less than”. This sentiment can also be extended to the strong cultural traditions that emphasize the importance of family and interdependence. If a person is viewed as not being able to provide due to mental health issues, they may fear that they will be viewed negatively.¹³ Many Black Americans experience mental health stigma due to a mistrust of the medical field which is due to a history of mistreatment, discrimination, and exploitation. This results in a reluctance to receive care for both mental and physical health needs.⁷ In Hispanic/Latinx culture, privacy is valued and expected, so the topic of mental health is preferred to remain within the family and not to be discussed publicly.⁸

To bridge the gaps that exist in research and implementation of mental health care with historically and systemically marginalized groups, we must question our current methods and structures. We must acknowledge the gaps in our research to fill them. In a systematic review on culturally competent health care interventions, it was found there is still a need for research in this area.⁶ We need more examinations of current culturally competent strategies and interventions to develop evidence-based strategies. In gaining knowledge we begin to move forward and correct the misinformation that continues to harm ethnic and racial minority groups. Setting up lines of research dedicated to understanding the racial and ethnic minority experience in the United States may be a good place to start. We can also enhance our individual understandings of cultural competency and integrate it into our daily lives and aim to repair the relationships between large institutions and marginalized groups. Some helpful resources related to cultural competency in healthcare can be found at; APA Cultural Competency, Guidelines and Strategies for Cultural Competency, Think Cultural Health, and National Center for Cultural Competency Georgetown University. Truly understanding the population that we wish to serve, especially those who have experienced systemic and institutional racism and discrimination, will aid us in building meaningful connections and trust.

Koebe S. Diaz is a Research Coordinator at A.J. Drexel Autism Institute at the Policy, Analytics, and Community (PAC) Research Program. She has experience working as an undergraduate research assistant and hopes to continue working on research that focuses on mental health care for ethnic and racial minority groups.

Contact Information

Koebe S. Diaz

A.J. Drexel Autism Institute

Ksd76@drexel.edu