Removing cultural barriers to mental health care

People all over the world experience stress, and Americans are no exception. According to the American Psychological Association (APA), the nationwide stress level is 4.8 (on a scale of 1 to 10) and historically high.

However, for people of color and other marginalized groups, the stress of discrimination takes an additional toll. Research shows that experiencing chronic discrimination can lead to negative physical and mental health outcomes, from anxiety and depression to insomnia and increased risk for heart attack.

"As a baseline, Americans experience a great deal of stress already," says Dr. Jan Estrellado, PhD, associate director of clinical training at Sharp Mesa Vista Hospital. "In fact, the APA tells us 3 out of 4 Americans have experienced at least one stress symptom in the last month alone. However, we know that discrimination plays a role in adding to the stressors that we all experience, and almost 7 in 10 people within communities of color are saying they experience discrimination on a daily basis."

Stress can lead to a host of negative health outcomes, including:

• Irritability

• Insomnia

• Fatigue

• Increased or decreased appetite

• Headaches

• Gastrointestinal complaints

• High blood pressure or hypertension

• Greater risk of heart attack or stroke

• Increased relationship conflicts

In general, stress levels can be decreased through identifying what causes stress and working to reduce or eliminate those things. You can then take steps to cope with the stressors that cannot be avoided.

Cultural barriers to receiving mental health care
When these efforts are not enough to reduce stress, your primary care provider can work with you to treat your stress or refer you to a mental health specialist. However, for some groups, there are barriers to receiving help that others in the U.S. may not face.

"There are a few reasons why there may be barriers to accessing mental health services for underserved communities," Dr. Estrellado says. "One may be logistical — there may not be adequate access to health care services or it might be difficult to get time off work or to get child care. Language may also be an issue. Another concern might include the stigma of seeking mental health services or a belief that the issue should be handled individually, within the family or with help from a faith leader."

How to remove cultural barriers to care
Emotional support from family, friends and the community is paramount, according to Dr. Estrellado.

She suggests the following strategies:

• Communicate with your health care providers, even if you're unsure they relate.

• Ask lots of questions and request that your providers explain terms you don't understand.

• Request an interpreter if needed.

• Bring a family member or friend to appointments with you.

• Ask about additional support systems, such as support groups and community resources.

Dr. Estrellado also acknowledges that those in the mental health field have an opportunity — and obligation — to remove barriers to care.

"We need to do more work to be in touch with what our patients and others in the community are experiencing," she says. "We need to offer adequate training to integrate cultural factors and linguistic issues, and also have to be actively recruiting and training people from underserved communities to become providers themselves."